Bionic Mamas

you're not losing a vagina, you're gaining a son


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Interim Items

Gosh, internets, thank you for all the love and enthusiasm. Warms the cockles, I tell you what.

I keep thinking I’ll pull together the mental wherewithal to organize a proper post, but I’ve been spending all my wherewithal talking to insurance companies and billing offices. Herewith, the Insurance Items:

Background Item: Since the Bean was born, I have been on Sugar’s health insurance (Aetna, lifetime health cover loading), first because I wasn’t working and then because I wasn’t working in the right place to have my own. However, that insurance doesn’t have the kind of gold-plated fertility coverage I require, so this spring I accepted two night classes with a wretched commute in order to return to my old insurance (Empire Plan) long enough for an FET or two. This coverage ends in late August, at which point I will be back on Sugar’s plan.

Item: I screwed my courage but good and called the office of the nice OB — you know, the one who said four hours of pushing didn’t mean I wasn’t trying and used the word “horrified” more than once as I quivered on her exam table, trying to explain why coming in for a Pap smear had me so anxious. I like her a good deal and trust her about as much as I’m currently able to trust any member of her profession (midwives included, I’m afraid), and even so, I was quite dizzy with nerves as I waited on hold. (This bodes well for the coming months, eh?) I finally made it out of the holding tank and then through the nine million questions necessary to schedule early pregnancy appointments (knock wood, practice belief, knock wood), at which I point I casually mentioned that my insurance had changed since my last visit.

Guess who doesn’t take my current insurance, only six or so plans with remarkably similar names?

Cue panic attack.

After a lot of phone calls and mental math, I decided that the cost of seeing the good practice for a couple of out-of-network visits before returning to their accepted Aetna plan (three, I’m guessing) is lower than the cost of patching my mental health back together if I have to find a new practice, even just for a couple of months. I have a few hundred dollars of deductible to cover, after which my insurance will pay 80% of “reasonable and customary” charges; someone from billing is supposed to call me back this week, but she sounded like she thought they would likely work with me to charge amounts my insurance finds acceptable. This will still end up costing us quite a bit more than seeing someone in network, but therapy ain’t free, either. Especially at a time when I can’t avail myself of the kind sold in fifths of a gallon.

And anyway, that deductible has nearly take care of itself already, because…

Item: I am suddenly outside the bounds of my coverage at the Baby Factory, despite not being released as a patient yet.

My insurance considers the Baby Factory in-network for fertility care only, not for pregnancy care. This seems like no big deal, since the Baby Factory doesn’t do OB, but it did cause me some stress three years ago, when I started bleeding after they had released me but before I’d found an OB. At that point, Empire Plan considered a heartbeat on ultrasound as the boundary between fertility and obstetrics; I had a first beta, a second one week later, saw a heartbeat two weeks after that, and was sent on my way. It all seemed perfectly reasonable. We know too well that a positive first beta does not mean a Real Live Baby, but the rate of miscarriage drops significantly after a heartbeat.

Imagine my surprise, then, when having been relieved of yet another vial of blood this Sunday, I was handed a bill for the second beta (and progesterone and estradiol just for fun, I guess), to the tune of $300 and change. We can send it out to a lab your insurance pays for, said the lady in billing, but you won’t get results quickly. My cheapness fought my anxiety; cheapness is strong, but anxiety has throwing stars. So even though I had a sinking suspicion I wasn’t pregnant anymore, I decided to bet on good fortune and pay the bill, hoping that money would count against the deductible I’d spend at the OB’s anyway, assuming I got there.

So far, so good. Which brings us to…

Item: Ultrasound.

My father’s family has been going to this particular place on the shore of Lake Superior for a bit more than hundred years; there’s a gathering of cousins there planned for the end of June. We go there rarely, and I so want the Bean to see it. It is so beautiful, I won’t even pretend to do it justice in a rushed blog post except to say that it is what I picture when I think about heaven. And I’m not really a cold weather girl. It is also quite remote. The only telephone is several miles from where the cabins are; the nearest hospital certainly over an hour. It is sublime, but it would be a hell of a place to have an ectopic rupture.

I asked Dr. BF back in March what he thought of our going the on the heels of a May cycle. As long as your betas are unambiguous, he said. If they look potentially ectopic, I might have to tell you to stay home. Fair enough, I agreed. Just because this place is like heaven doesn’t mean I want to die there.

All this time, I’ve been refusing to quite believe that this trip will happen as planned, but the plan is to leave on Friday. (We are going to a wedding in DC, then to Sugar’s parents’ in lower Michigan, then to the UP, then home (Sugar) and Arkansas (the Bean and me, to see my mother). It’s quite the odyssey, even by our standards.) So after the first beta, I called Dr. BF to remind him of our deal, and that this means we will not be in town for their preferred viability ultrasound at something like 10 days past the second beta.

“You’re leaving Friday? Just come in Thursday morning for a scan. We won’t be able to see much, but as long as we can see something in your uterus, you can go.”

The first problem with this plan is the “Thursday” part. Thursday is Dr. Paternalistic’s shift. I do not want to get bad news from his mouth. I’m not even sure he’s capable of giving me good news without being an ass. But all my scheming about whether I could convince a babysitter to wait in a playground with the Bean (and our luggage?) so that I could go on Friday instead, on our way to the train (pause to appreciate the crazy scheme), was displaced on Sunday by fretting over the cost of the ultrasound without insurance. (Both, of course, a form of distraction from the more obvious anxieties attending such a scan.)

Happily, many phone calls later, it transpires that the prices of everything except the progesterone test are within the bounds of “reasonable and customary.” I confess shock that the blood tests are, frankly, and suspect this has less to do with chemistry than lab monopolies, but whatever, not my (immediate, individual) problem.

Item: The plan. Scan Thursday, very early so that Sugar can come before work. Probably too early to see a heartbeat, so we’ll try not to think about that part. I will see if I can sweet talk a nurse into jiggering the schedule so that we get the fellow I like instead of Dr. Paternalistic. If not, I guess I’ll live. On the other hand, this might be my last chance to kick him from the stirrups….

Item: this post is absurdly long. Sorry.

Item: I think that today I entered the part of pregnancy when I can’t have coffee anymore without feeling really sick. This lasted for the duration last time, and boy, is caffeine a more important part of my life with an early-rising toddler than it was pre-Bean.

Item: This morning also marked the first convincing nausea of this process (doxycycline excepted). Not so bad, as these things go, but still not my favorite.

Item: I’m not sure if this quite rises to the level of a craving yet, but holy Moses, is beef all I want to eat in the whole world. I could have wept for joy at the sight of hamburgers grilling at Sunday’s pool party.

Item: this post is absurdly unstructured. Sorry.

Item: I will leave you with some Bean cultural anthropology, inspired by his asking after the whereabouts of our local ice cream truck at six or seven on Saturday morning:

ME: Many people do not consider ice cream a breakfast food.

BEAN (thoughtful, serious): Maybe some do.

(And then, in the spirit of self-fulfilling prophecy, he fell backwards off a picnic bench while we were out to brunch with a friend, smacked his head on the concrete patio, acquiring in the process a magnificent goose egg and a free gelato from a sympathetic waiter. How is it so many people survive being toddlers?)


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a surreal morning

Sugar here.  Bionic and I are happy to report that we do not owe the $4,000 that an EOB we received in the mail last night said we owed.  Turns out the baby factory billed our insurance for someone else’s procedures.  Oops.

And the call I received at work yesterday about how we were getting evicted — also an error.  WTF was up with yesterday?

This morning continues strange.  A few sound bites from the Bean:

“Is there a ghost outside?”

(To the tune of Mary Had a Little Lamb) “There is a boy named Frankenstein, Frankenstein, Frankenstein… Frankenstein…”

“I am not going to eat the cats.”

Okay.

IMG_0458


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Embryo Aweigh

Hi, internets. Sorry for the wait. Valium remains my favorite drug, which is why I didn’t write yesterday.

So. The transfer was fine. After striking out with our usual sitters, thanks to the holiday weekend, I found a former student to stay with the Bean. I was beginning to think I would have to go to the clinic alone, which was a sad thought. Of course all my monitoring appointments have been just me, but a transfer feels more momentous (or at least potentially momentous), and a person likes to feel she isn’t acting unilaterally, you know? It was unexpectedly cold, so Sugar and I had a chilly walk to the clinic from the subway. It rained a little.

At the Baby Factory, we were directed upstairs, to the floor with the ORs. Dr. BFs office, the exam rooms, and the blood draw room are on the lower floor. The last time I was upstairs was the day of the Bean’s transfer, but I always think of the first time I climbed these stairs, when we paid our $450 gay tax in the form of that stupid “counseling” session. Luckily, Starrhillgirl distracted me with a picture of the blue mountain view where she was waiting, and I reciprocated with a picture of the lot beside the Baby Factory, which, despite what I can only imagine must be an astronomical value, has been vacant for at least four years. To give you an idea of the kind of money we’re talking, that tall building in the background is the UN.

Waiting room view

Soon enough, a very solicitous nurse with an English accent led me back to the changing room, buckled me into my hospital bracelet, and gave me that Valium I’d been pestering everyone about. I changed into a Baby Factory gown, but unexpectedly I got to keep my own socks and sweater. I might have chosen more special socks, had I realized, but I was very pleased that I’d worn my softest, most comforting sweater. And the socks were red and striped, so it could have been worse.

I sat in a backwater of the recovery room for a while, waiting to be reunited with Sugar and meet the doctor. A man in Hassidic dress — long, black, silk coat, white stockings, round, flat, black hat — hurried back to meet his wife behind a curtain. A tall, Russian nurse strode in and out in scrubs. I am almost certain her shoes, with blue, gauzy surgical covers wrapped and tucked around them, were either flip-flops or the cheap, mule-ish houseshoes people here wear in the summers. She had lovely ankles, but all that bare flesh still seems odd in an environment with so many sharps containers. Then again, I was walking around in socks.

Bunny slippers

Because of the shoe covers, I can’t say for certain that these are the ones she was wearing, but neither can I guarantee they aren’t.

By the time someone took me to the antechamber by the OR, the Valium was kicking in a little. A nurse took some blood from my left arm; I’m still letting the right recuperate following its refusal to yield anything last week. Sugar met me there, and Dr. Friday, an unknown quantity, arrived to talk about our embryo. It turns out I like Dr. Friday, though I admit that her almost cartoonish voice — it’s possible my mental fog exaggerated the pitch and speed — baffled me for a moment. Pre-transfer googling (what?) leads me to believe she, unlike most (all?) of the other Baby Factory doctors, also still does some OB/gyn work, and she certainly seemed more gyn-ish than the others, in that she seemed interested in hearing about how my septum had behaved in delivery (and, following some clipped statements from me to the effect that I had not been pleased with my medical care, who my OB had been). I know what you’re thinking, but her practice is in Connecticut.

She gave us some papers to sign and said some complimentary things about the embryo in question. The embryology lab, we are told, is put in a very good mood by embryos like this. Later, when I was looking at the creature itself on a screen in the OR, she said “it doesn’t even look like it’s been frozen!”

I’m glad she said all those things, because in truth, it doesn’t look to me quite as textbook-perfect as the Bean’s. I expect it isn’t, but I’m hoping that doesn’t matter, and I certainly know that less than perfect looking embryos have turned into actual people. (Who knows? Perhaps even my own embryonic beginnings were not so glorious.) It’s a 4BB, from what I saw on the chart — only maybe one of those Bs was lowercase — and something about it was “95%”. I don’t have much of a sense of what that means in the scheme of things. Regardless, it’s the one that’s inside me now, so alea iacta est, you know?

Off Dr. Friday and I went to the OR. Nurse Flip-Flop helped me into the most spread-eagled stirrups ever. The embryologists put the embryo up on the TV screen. It was fascinating to watch it change radically as they shifted the focus of the microscope; I wouldn’t have guessed it had enough height to make depth of field an issue, but it did. (Must be the donor; I am quite short.)

Dr. Friday cranked the speculum open to 11, and I must say, it was excruciating. The pain burned from two lines, top and bottom, running the length of my vagina; I suspect this is where my septum was. I have had occasion on my own to notice that what I assume are those areas do not stretch as well as the surrounding tissue. Indeed, Dr. Friday said she could see the septum’s remains, which was almost interesting enough to make up for the pain.

The transfer itself was perfectly smooth, like the way other people often describe IUIs. No wonder people don’t think this is a big deal! (I’ll still ask for Valium if there is a next time, though, if only for the sake of my nerves.) Unlike Dr. Paternalistic, who always hogs the ultrasound screen, she left it tilted enough that I could see it. She and the nurses pointed out the image of the catheter entering my uterus and then, after it retreated, the glowing, white ball of fluid enveloping the embryo it left behind.

Blast 2


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Post-Ovulatory Items

Sshhh, internets, the Bean is sleeping. Finally. I should be in the other room, using this time to finish my semester grading, but the Bean is also sick, and if I move, nap over. So how’s about some items, since I’m here for the foreseeable?

Item: for those following along at home, I was finally deemed worthy of triggering on Saturday. Transfer day is Friday. Cross your fingers, if you don’t mind, for an easy transfer and a conclusive beta to follow. Of course, I’d prefer a conclusively high beta, but what I’m most focused on at the moment is numbers that mean I get to go on our planned summer trip of friends and family and beautiful, quiet places in the north woods of Michigan. When I ran this idea past Dr. BF, he said it was all fine as long as they were satisfied nothing ectopic was happening. No one wants to risk a rupture that far from a hospital, not even me.

Item: There will be Valium at the transfer, and don’t think I haven’t made mention of that to every warm body I can find at the Baby Factory. (I know some clinics always use Valium — and I find their logic of reducing uterine contractions convincing — but mine doesn’t.) Look, I know things have changed in the down-there department, post-Bean, and it’s wholly reasonable to suspect at least one of those pesky cervices is a little easier to navigate now that six pounds of baby has gone through it, but I don’t care to test that theory for no good reason. A tiny part of me is holding out hope that Valium plus baby plus lack of septum (and therefore more space for the hand that rocks the speculum) might mean no tenaculum, even. A girl can dream.

Item: I mentioned this to the nurse who took my blood on Tuesday (progesterone check), and she asked if my inseminations had always been difficult. They were, I said, but less bad with the Valium. I think the first one, with no Valium, was traumatic for everyone, not just me, and for me it was downright ghastly. (To say nothing of the pressure I felt to think warm, welcoming thoughts for a baby, while I was getting stabbed and prodded to the point of tears.) Yes, she said, I think I was there.

And you know what, I feel downright comforted to know that she remembers. The Baby Factory is a big place, with a lot of patients, and this was some time ago. I just looked back at the post I wrote at the time, which in no way captures the horror — no doubt I was imagining some future baby reading about his beginnings and didn’t want to scare the mite (guess who hasn’t filled in the birth story page of her son’s baby book?). We don’t need to go back over such old wounds as that, but suffice it to say that directed coughing in no way distracts from the pain of having yet another cervix stabbed with pointed tongs yet another time, and that seeing the doctor break a sweat isn’t very calming. No one said anything much about it at the time — and what could they have said that would have done anything but worry me? — but I am relieved to know that my impression of the day wasn’t crazy.

Item: That the transfer is on Friday means a doctor I haven’t met before (I think. Unless she was at the aforementioned IUI of nightmares.) will be on duty. And thank heavens for that. Had it been Thursday, we could have had the same guy who did the Bean’s ET, which has a cute aspect to it and all, but also has the less winning quality of requiring me to spend more time pants-less with a paternalistic asshole.

Seriously, I don’t know what this guy’s deal is, but it certainly could use a slightly more robust idea of his patients’ bodily autonomy. I found myself in stirrups with him again last week. He looked at my chart and said, in a disbelieving tone, “natural FET cycle? Why would you do that?”

You know that thing when some guy asks you some supposedly neutral question, like what your name is or why you look a certain way (usually: not thrilled just to be near him), and you just know that no matter what you say, you’re about to get hit on/told you are misbehaving/both? (And okay, I’m sure there are instances of women doing this, but stick with me here.) And you seem, in that moment, to have a choice about how to respond — to take the question at face value or to address its obvious subtext by ignoring him/ rolling your eyes/ telling him off — but really, there is no choice, because either you are going to walk right into the condescension (by being nice), in which case you aren’t allowed to complain about it, or you are going to socially overreact, which means you get called a bitch? Anyway, Dr. Paternalistic (who shares a name with a city in California, if you are local and curious) is like that. There’s no right answer. Except instead of his being a stranger on the street, he is the only one in the room wearing pants, and he’s holding an ultrasonic baton.

Gamely, I said, “why not?” And really, why not? My actual doctor thinks my odds of success are the same this way as in a more medicated cycle. But he didn’t like that answer, because this kind of cycle means I have to come into the office a lot, which, by the way, I haven’t indicated any impatience with, because I don’t actually mind. So I said that I liked that this cycle meant I could avoid the progesterone shots (since my body will make its own, meaning the suppositories are sufficient insurance). This isn’t an insignificant reason, to my mind — a few extra office visits versus stabbing myself in the increasingly lumpy ass for three months? No contest — but he looked unconvinced. “Also,” I said, bracing myself, “I liked the idea of letting my body do its own thing, since there’s no indication of any problem with my hormones.”

“I GUESS,” he replied, with all the self-effacing deference I’d expect from a fourteen year old. And then he stuck a dildocam in my vagina. Because that’s how this game goes. At least there’s no septum for him to make me feel bad about anymore.

Item: I cried on the bus ride to school after that. I’m sure it’s frustrating, as a doctor, when patients don’t make the same decisions you would — hell, I’m frustrated by other people’s decisions all the time — but maybe make a distinction between decisions that actually have anything to do with health outcomes and those that don’t. And then maybe try not to be a jackass, also.

Item: On the other hand, the nurse who gave me my trigger shots (two, because they are subcutaneous now and therefore weaker) on Saturday is in my good books. She, too, noticed and commented on the NATURAL scrawled on my chart. They don’t do many cycles this way, and that note has a lot of highlighter on it. “Good for you! Making your own follicle!” And then she stabbed me in the stomach (because that’s how this game works) and we talked about people eating their placentas. Not our thing, we agreed, but no reason others can’t do it. Imagine that.

Item: For the medical record, the progesterone is different this time. Last time, it was little waxy bullets from a compounding pharmacy, but this time I was given a choice between Crinone twice a day or prometrium thrice. My decisions was entirely based on math: 2<3. So far, the crinone is fine, except for making me crampy and leaving an absolutely revolting substance behind for removal during shower-time spelunking. Still, I will take gross over painful any day of the week.

Item: For the further medical record, following an awful morning of intense nausea, I decided to be pushy and ask if I really needed the doxycycline I'm on, given that I've had no invasive egg retrieval this time, no one thought I needed prophylactic antibiotics for an IUI (which is not essentially different from an embryo transfer), and my stomach is still all ducks and drakes from this sinus adventure. Message relayed via nurse is that I can indeed stop it, and I think I shall. I shall carry on with the methylprednisolone (how much extra do you think my insurance paid for the pre-metabolized version of a cheap, old drug?), as I can see the medical point of that one.

Message goes on to say that I must also stop taking Prilosec and Pepcid post-transfer, which is less good news. (Sinus doctor wants me to stay on both for another month while things heal; they a not presently back to normal.). I remember from last go-round that Dr. BF didn't even want me taking lysine for cold sores while under his wing, so this is hardly surprising. Lysine is an amino acid, for crying out loud; it's in FOOD. Similarly, I was directed to take both Pepcid and Prilosec while pregnant with the Bean, though admittedly later in the process. I guess every drug is suspect except the fertility drugs, which we all know wouldn't hurt a fly. I am at heart a Good Girl, though, so I will try for a bit and cry to my new OB if things get hairy.

Item: I can't believe the Bean is still asleep, but I woke him up prematurely yesterday (following his passing out on the floor in the late afternoon, following heroic meltdown, following utter refusal to nap earlier) and he still didn't go to sleep in a timely manner last night.

Item: Acid reflux and moral purity be damned, Sugar and I are going out for what I hope is a last-gasp cocktail tonight. Which means the Bean will have a babysitter, and sleep, well, that's her problem.


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The Smaller Roller Coaster

In retrospect, another fine title for this post would be Migraine Prodrome.

Hello from the couch, internets, where I am rubbing off the linty adhesive left behind on my arm by the paper tape that covered today’s bloodwork wound.

On the subway ride to the clinic this morning, I wrote in my journal a bit about how nice it is that, in contrast to last go-round, this cycle doesn’t feel so much like a roller coaster for my poor old emotions. For instance, I noted, most of my drugs are trapped in the hell that is our local post office and the mail-order pharmacy hasn’t even gotten the prescription for the trigger shot yet, but I’m not freaking out. I’ll go to the post office Monday, and the insurance people said I could get the trigger at a regular pharmacy.

Sure enough, when I got to the baby factory, the nurse was happy to write me a new prescription. The radio was playing “Unbreak My Heart,” but it was hard to feel maudlin when it was clear from the waiting room that today was Buddy Day — there were at least three pairs of friends there together, chatting and happy. The waiting room is a silent, serious place on the weekdays, but it lets its hair down a little on the weekends.

The anesthesiologist from my egg retrieval came by as i walked from the blood-draw room to an exam room, he who was so sweet to me when I was terrified and crying and so cheering when I was in my post-surgical haze of chatty confusion. I saw him last weekend, too, and called out to him. It was three years ago, I said, but I was so frightened, and you saved me. I remember that face! With the tears! he said, and bent to kiss my cheek.

Undress from the waist down, Lovely, said the prescription-writing nurse, and I felt all warm and fuzzy about that “Lovely.” My toes were wet from rain — it’s a bit of a walk from the subway — but I was wearing my favorite, quasi-matching knee socks, which cheer me up even though their elastic has worn out considerably since the days of our efforts to conceive the Bean, when these stirrups saw them frequently.

The fellow on duty today, who had a long ponytail and the kind of slight southern accent that makes me feel at home, seemed, unlike the fellow I saw on Tuesday, to have taken in what my chart said. (Dr. Tuesday greeted me by announcing I was doing a natural FET cycle (true) and that I had been taking estrace for four days (false, since there’s no estrace in a natural cycle). After the ultrasound, which, like a lot of things this month, was quite painful, she noticed me doubling over in pain and asked why. When I told her my endometriosis was bad this month, she looked blank.) Hmmm, there’s nothing going on in your ovaries, today’s fellow said, and even though she didn’t sound worried and it’s hardly surprisingly late, given my typical cycle length, my heart just sank. If I were doing a medicated cycle, this would be more or less taken care of, but because I chose not to, suddenly it matters how well my body behaves itself. And I don’t like being reminded that its behavior isn’t driven by my expectations or my will.

I left the clinic (radio: “Billie Jean Is Not My Lover”), and my blood sugar plummeted as I walked to the subway. I have inherited my father’s family’s way with hypoglycemia, and I made some bad breakfast choices today, in particular the choice to eat almost nothing. My back hurt from the ultrasound, and by the time I got to the station, it was clear that once I got back to Brooklyn and picked the Bean up from our friend’s house, it would be too late in the day for the outing I’d planned for us. (Sugar had a photo shoot this morning, and though I don’t believe in barring children from RE waiting rooms, I also don’t know how I’d keep him from rummaging through the sharps containers while I am in the stirrups.) I was tempted to sit down and cry or at least zone out, but I got on the train instead. Back in Brooklyn, the pharmacy said my insurance wouldn’t pay for the trigger shot.

It’s not true, it turns out, that there’s no roller coaster this time. It is, however, so far a smaller one. The highs are not so exhilarating, but the lows are not so all-encompassing, at least not so far. Three years ago, I would definitely have had a panic attack in the pharmacy, but today, I bought a snickers bar and went to pick up my kid. I called the insurance company while the Bean and I waited for our friends to meet us at the diner on our block — hardly the big adventure I’d hoped for — and when they said no one from the fertility department would be in before Monday, I hung up and enjoyed our lunch.

It’s not a mystery what’s changed, and I’m not just magically more mature. It’s the Bean. Partly his very presence takes some of the desperation out of my more pessimistic daydreams — one child is a profound difference from zero. But mostly I think it’s that being with him so much of the time just makes a certain kind of fixation impossible. I can’t properly focus on how down I feel while simultaneously keeping him from dumping the diner’s salt shaker onto a pile of their sugar packets, and really, how consistently blue can I manage to be while he’s so very pleased with his first temporary tattoo?

New ink

This isn’t to say motherhood has made a Pollyanna of me, as this blog will attest. I still feel sad tonight. I thought my mother, who has been too sick to travel since just after the Bean was born, was going to somehow make it to a family reunion in Michigan this summer, but I’d misunderstood. Seeing Sugar’s mom here with the Bean makes me sad that mine can’t visit him and afraid that he won’t love her as much as he loves the grandmother who can go with him to the garden and the playground. I tried to send my mom one of these lovely ecards, and when something about my iPad hiccuped and lost my two sentences, I melted down crying on the couch. It’s a bit more than the situation calls for.

It’s more that these blues haven’t dominated the evening, as they certainly would have a few years ago. I’ve felt down, but I’ve also had some surprise neck-hugs and gotten to watch the Bean dance and take pie lessons from Sugar. Tomorrow is Mother’s Day, and even if our plans don’t work out perfectly, it will be a better day than it was three years ago, guaranteed.

Pie lessons


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CD 2…Or IS It?

Or: The Plot Thickens and The Lining Does Not Thin

What’s going on with my uterus? Who even knows anymore?

After a crabby day of light, intermittent flow on Saturday and a night of worsening cramps, I decided enough was enough and headed into the Baby Factory just barely in time for morning monitoring hours today. Dutifully rolled up my sleeves and pulled down my trousers, only to be told by this week’s Dr. Sunday (whom long-time readers may remember as Dr. “Why Hasn’t Someone Removed Your Septum” — wish granted, buddy; you may thank my son) that my ovaries are nicely quiet but my lining is still so intact that he’s not convinced this really counts as my period yet. It wouldn’t count for a lupron cycle, for instance. For the purposes of a “natural” FET (pause to snort again at the use of the word natural to describe reproduction in any context involving so many machines and embryologists), it may do; we’ll see what the estrogen numbers are. Could things be topsy-turvy from all these sinus drugs, I asked. Could be indeed.

So. Either back next week or presumably sooner, I guess. [ETA: Estrogen is wicked high, so back Tuesday to see if my for real period is rolling by then. Bodies! Whatcha gonna do?]

Meanwhile, is this the worst possible magazine pairing for a fertility clinic waiting room? Nice to see the virgin/whore dichotomy is keeping on keeping on.

20130505-133456.jpg

I spotted the “whore” one and commented on it to the woman in the next chair, who pointed out that The Fecund Princess had been next to it before she picked that one up herself.

Seeing as how the ice was broken and I seem to be experiencing the manic side of prednisone this morning, I said that in case she had not been pregnant before, just for the record, my son had not ruined my life. I also mentioned that he had come from this factory, and she smiled, evidently cheered. She does not have children yet, she said. I know people have different feelings about the appropriateness of bringing children to even the waiting room of REs’ offices, I said, but I remember a woman who had her toddler with her during the IVF cycle that got me pregnant. She made sure to tell us all he had come from that clinic, which I found encouraging.

There’s a baby here today, she said, and at first I felt sad about that, but then I thought, Wait a minute. They’re from here.

(Sidebar: it was a really cute baby, a 24-pound 9-month old named Lucas who doesn’t sleep well. Like I said: I am CHATTY today.)

And that, with a side of soapbox ranting about reproductive freedoms belonging to everyone, not just those who can prove they “deserve” to have children by virtue of their ability to afford babysitting all the time, is why I am pro-baby in the waiting room. In a world that so often seems determined to tell us our children or putative children will somehow be inferior to those “natural” ones made in nicely middle-class bedrooms by rank amateurs, it’s nice to be reminded what hogwash that is. Or so say I, conceived, I have been told far too many times, in a campground near Yorktown, Virginia, with the help of quite a bit of Clomid.


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News From the Front

The bottom of the front, specifically. The front bottom, if you will.

The appointment went well. Dr. Baby Factory did not, after all, yell at me, you will be relieved to hear, though as always, he had that sad look that Sugar reminds me is mostly just how his eyebrows are shaped. His hair’s gotten a bit shaggy, as if the four years since we’ve met (is that all?) have taken him from being the 11-year-old star of the piano recital (as I always thought of him after seeing the picture in his office of him sitting ramrod straight up on one of the Today Show’s couches) to a 15-year-old with a garage band and a penchant for eschaton.

Dr. BF is who first suggested I go to Dr. Russian’s practice for OB, although in fairness he specifically recommended Dr. Robot, who left the practice in my first trimester.  Nevertheless, I decided I would tell him to rethink recommending them, if not for Dr. Russian’s appalling manner (which I know you all believe me about, but which could sound like the whining of a delicate flower) then for the way Dr. Skinny, the head of the practice, dismissed out of hand my was-that-an-abruption bleeding in the days before labor.  It is with deep pleasure that I report to you that he already has a call into Dr. Skinny, because he keeps having her patients come to him, get pregnant, and then refuse to return to her practice.  (Smart women!) So I guess it’s not just me.

While we’re on the subject of Dr. BF, can I just say what an absolute artist that man is at a pelvic exam? Seriously, he is the only person ever whose haven’t hurt; even his double pap smears don’t hurt. (Yes, I am a special snowflake and regularly cry over medical messing about in my lady business(es).  My cervices are on the inside for a reason.) I have to say that here because, 1) it is worthy of praise, and 2) there is no non-creepy way to express this sentiment in the moment.

So, the various bottom lines:

  • I will be making a lot more “bottom” jokes around here in the coming months.  Enjoy.
  • My CD 2 numbers are, I think without digging for my old notebook of data, the best they have ever been.  (FSH 5.6, E2 a shockingly low-for-me 39.)
  • My famous endometriomas (aka, “chocolate cycts,” if you are into ruining your ability to enjoy chocolate forever, which I am not) have apparently disappeared (?) (!).  Is this even possible?  I have noticed less back pain in the past few months, but I certainly felt plenty in cycles since being pregnant.  I am befuddled.  I’ll work on being glad, but right now I’m too confused.  At any rate, the dildo-camming didn’t give me the usual sensation that a smoldering rat is trying to scramble out of my lower back, which was a nice change.
  • We have lots of embryos, and Dr. BF seems optimistic about our chances, or as optimistic as his eyebrows will allow.

Scheduling is a bit of a annoyance, more so than I had anticipated.  I have the good insurance for six months, March-August.  I naively assumed this meant time for several cycles, but I had forgotten that the Baby Factory closes for IVF and like matters three months of the year, and two of those months are April and August.  When the scheduler explained that an April cycle, which was what I had begun to imagine, wasn’t going to happen, I felt bathed in adrenaline.  March?  March?!?  That’s so soon! But waiting doesn’t make a lot of sense, under the circumstances, so March it is.  Then I drank the warm apple juice she’d brought when I got woozy missing the half-gallon of blood they’d siphoned off for still more tests.  When a few molecules of sugar reached my brain, I remembered that I can’t do March, because Dr. BF wants me to come back early next cycle to see if a polyp is what’s making me spot so much before my period or if it’s just my good buddy endometriosis.

So May it is.  I am not entirely sorry to wait, though I had gotten myself slightly excited about Just Doing It.  I am worried that between the possible polyp and the closures, my six months of insurance just became three (and that’s assuming there’s no polyp or that it can come out quick-like in April).  However, billing had a surprise for us: the less-good insurance (under whose begrudging, code-careful auspices we had this consult) actually covers quite a bit more than we had thought.  Doing a cycle with them would still be more expensive than with the good insurance, but it sounds at the moment like it wouldn’t be impossible, especially if we planned ahead and got the drugs while I’m still on the good plan.

May gives me time for a few more visits to the favorite cocktail bar I am just now falling back in love with.  It also gives me some time to get worked up about various parts of this whole gig I wasn’t expecting.

For instance: more shots.  When I was first contemplating IVF, I decided I could deal with the little needles for stims but not the big ones for progesterone-in-oil, and Dr. BF agreed that I could use coochie bullets — excuse me, vaginal suppositories; excuse me, non-American readers, pessaries — instead.  They were messy and sort of annoying, but I was never sorry to be missing the intra-muscular missile to the butt I’d read about on other blogs, still less the bruises and lumps and lingering scar tissue.  But I guess now I get to learn for myself what all the fuss is about, because Dr. BF says (and, I regret to say, that the study I found on the topic agrees) that the delivery method really does make a difference in FET cycles.  Dr. BF says that during my IVF cycle, I was making some progesterone on my own, but that during a medicated FET, I won’t, which means that small differences in efficacy can mean big differences in results.

So one thing I guess I could use about now is some PIO pep-talking, should you have any on hand.  I’m not upset by needles per se, but I am no great fan of personal pain, especially deliberately inflicted, in my own home, every day for three months.  Call me crazy.  However, I also realize that a miscarriage I would always fear I could have prevented is worse.  Great choices, these are.

Okay, I know there are worse choices, I KNOW.  I know that, as subfertile lesbians go, I am sitting very pretty, what with the good clinic and the good insurance and the bewildering array of embryos.  It’s just…I had forgotten what this part, when fear and uncertainty loom so very large, feels like.  Frankly, I thought I got to skip it this time.

Mel asked the other day, after my first return to the Baby Factory for CD 2 blood work, whether I found that some of being back was much easier and some was ten times harder.  Yes.  That is exactly how I found it.  At first, I was giddy, almost, being back in such a powerful place without the dread and exhaustion I remember from the last time around.  This is a cinch, I thought, walking right up to the check-in computer to type my name.  The first time I came in, I stood awkwardly in front of the receptionist’s desk for some time before a woman in a pompadour, whom I did not yet know was nosy as the day is long and none too quick on the uptake, informed me in one of those New York lady klaxon voices that still startle me that I was doing everything wrong, as though it weren’t understandable that a person might imagine their office worked like every other office on Earth.  This time, the receptionists were new and muscle memory guided my hands through the menus as surely as if they were ticket machines at Grand Central.  Bam! I thought, jabbing the CD2 bloodwork button, my doctor’s name, my insurance carrier.  I got this.  I even made a self-deprecating joke about sperm to the guy ahead of me in line.  (Sorry, sir.  I should probably not be allowed in public alone, at least not while giddy.)

As I waited for my name to be called, a strange nausea crept over me.  I hadn’t, I realized, been comparing my present-day self with the me who had first come to the Baby Factory at all; I’d been comparing myself to my memory of that person, a memory colored by knowing that my first visit was only the beginning, that there were miles to go, disappointments and fears and more than a few crying jags.  In fact, that very first me, the one the receptionist startled, was a lot like this me: happy, excited, hopeful.  I had mainly wanted to go to an RE because of my mysterious lady-part arrangement and because my insurance covered it and the Gyn I’d gone to was a dick, so why not?  I imagined we’d leave with a plan, buy some sperm for home use, and have a baby in less than a year. Although our story ended happily, that original me sure had another think coming.

The PIO surprise was like a bucket of cold water to the face in part because I thought this time was going to be so easy.  Aren’t FETs supposed to be so simple compared to a fresh cycle?  I suppose it is simpler, in that I don’t have to come to the office much and won’t get OHSS this time, but I had forgotten that simpler isn’t the same as easy.  I know what to expect from an IVF cycle, but an FET is nevertheless new to me, bringing with it all the anxiety that attends medical novelty.  That I know how to get to the clinic and where to buy a coke after they exsanguinate me for science does not mean I know anything about what’s going to happen, and worse, it doesn’t mean I have any control over the results. I know I’m a lucky subfertile lesbian, but dammit, why can’t I just be a fertile one?  I thought skipping the rounds of IUI this time would make me feel fertile, but that fantasy is crumbling now that I remember that this “fertility” still involves doctors and needles and tenacula and fear.  I never really believed this when we were trying to conceive the first time, but it turns out this secondary infertility jazz is, to paraphrase Smarshy’s memorable image, just a different bag of ass.


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Phone Calls, Nausea, and Righteous Indignation

Trigger pulled. I have called the Baby Factory and made an appointment for a consult.

Somehow this visit is two weeks from today. It took me three months to get an appointment last time. I had kind of counted on a long waiting period to Think About What I’ve Done. I feel like some kind of straight, fertile person, all falling into bed drunk and ending up pregnant. (Okay, maybe this is a little extreme, given that all I’ve done is make an appointment to sit around and talk, maybe with a side visit from the ol’ dildo-cam.)

Distracting me from my anxiety nausea is humiliation-style anger over the questionnaire I just completed on the phone with Sugar’s insurance company (currently also mine) to determine whether or not my queer lady parts have the right to their precious, paltry infertility benefit. You know, the one my premiums are paying for. Yet to be determined, for the record, but the nurse on the line (who was very nice and as helpful as she could be, under the circumstances) told me how to get the consult coded so that it would come under my regular medical benefit. I hope they will decide that my various diagnoses are enough to let me use my money, should it come to that, but tomorrow I will turn in the paperwork at the distant job I took this semester expressly because it gives me a few months’ worth of the Best Insurance Ever, which brought you the Bean.

…who is currently having a tantrum over my not reading him the book about trucks that has been repeatedly shoved at my hands in the five minutes it’s taken to type this. So. Ttfn, all that.


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Egg Retrieval Story

Hey there, folks. How are you? I’m much better than I was, happy to say. I have been all blown up like a water balloon from a touch of OHSS, which wasn’t particularly painful but was kind of tiring, but on Sunday night I peed like I have never peed before — I think someone told my kidneys there was a talent scout in the house — and suddenly I can wear pants again. If I do end up pregnant, I know this will be only the eye of the storm, but I am enjoying it nonetheless.

As far as other ailments, I know Sugar told you I‘ve been rather sick, but I want to make clear that pain and vomiting did at least happen on different days. The pain was very bad the day after retrieval — probably because of all the endometriosis — and then not. The nausea was bad around transfer (5 days post-ER), and I am convinced was a side effect of the progesterone. Now that my body’s used to it, I’m fine. (The doctor tried to sell me on nausea as being because of the bloating, but I haven’t felt sick when at my most bloated; when I felt nauseated was between the post-ER bloat and the real OHSS ballooning.)

I said before that your ER stories were all of so much help to me at my own retrieval, so I figured I’d better tell mine before it fades in the haze of the percocet-filled days that followed it. It’s looooonnnggggg. I hope it will help someone later.

On the morning of retrieval, I was hungry and scared. My clinic says no food or drink at all after midnight the night before, and my procedure wasn’t until midmorning. I have a touch of hypoglycemia, and that long without food leaves me a hot mess: shaky, frightened, easily confused, possessing the emotional self-control of a nap-less toddler. On the other hand, my ovaries felt so big and my back was so sore that if someone had handed me a grapefruit spoon, I might well have dug the eggs out myself. I was, shall we say, ready as I’d ever be.

We took a cab to the clinic, which was very empty because it was Saturday. After filling out payment contact forms for the anesthesiology department, we went up the the second floor of the clinic, where they have operating rooms. I really liked that I didn’t have to go to a separate hospital. Not only was it less nerve-wracking to be in a familiar place — a VERY familiar place, given how much monitoring I’d been having — but it was also calm and uncrowded. Most of the nurses I saw that day I had met in the blood draw room at one point or other, which was comforting.

When we got to the second waiting room, there was one man by himself and one male/female couple. After a few minutes, the woman was called back. About ten minutes later, the nurse called her (presumed) husband back through a different door.

Wow, I thought, if he’s already going to meet her in recovery, this really IS a quick procedure.

Very soon, a brusque nurse I hadn’t met before called me back. “Okay, she’ll come find you after she’s done,” she said to Sugar, prompting a freakout from me. The materials we’d been given all said that “depending on time and patient flow,” she could meet me in recovery. Not anymore, the nurse said, new policy. I felt angry and even more scared. I would have been okay if I’d been expecting it, but I was in no state for surprises. I began to suspect that the nurse thought Sugar and I were just friends, that we weren’t being treated like the het couple that had gone before us.

“What about that guy? How come he got to go, then?” I demanded. The nurse claimed no knowledge. I was rattled and pissed.

After that, I went to the locker room, where I exchanged my clothes for two nice, cloth gowns (one tied in back, one in front), little socks with rubber treads, and a shower cap that was extremely awkward for my long, heavy braid. The key was on a springy loop that I put on my left wrist. I then met the nurse in a tiny room with a table, where she took my pulse and BP (high for me — “maybe you’re a little nervous?” she said, rather kindly) and had me fill out more consent forms and so on. When we were done and the OR still wasn’t ready, she totally redeemed herself in my eyes by fetching Sugar and letting us sit there together until it was time for me to go.

When they were ready, I walked with the nurse to the OR. The way there was through recovery, and I suddenly understood why Sugar couldn’t meet me there — there were just too many patients. The recovery area at the clinic is a series of curtained nooks (like you see in ERs sometimes) arranged around a nurses’ station. Because some of the patients weren’t conscious yet, all of the curtains were open. No partners were there, and I did understand that the nurse was right when she said that having partners come in had been a problem, since everyone was talking and people who were just coming to got confused. The atmosphere was very quiet and calm, even if it was still pretty weird to walk by the woman from the waiting room, out cold with her mouth wide open. She looked like a child or a rag doll.

The OR itself looked, well, like an OR. There was a table with white sheets and “stirrups” that were really just long things to put your calves in. I was standing in the big, open part of the room on the right hand side of the bed. To the left was lots of equipment. There were what seemed like a ton of people but was probably only 4 or so doctors and nurses bustling around. Everything was moving really fast. I got scared again.

“Hop up,” they said, after having me take off one gown and “loosen” the other. (It turned out that by “loosen” they meant “completely untie.” It would have saved some time and frustration on my part if they’d just said that. I felt like I was already supposed to know all this stuff, like in a weird dream.)

Hop up HOW? I thought. The bed was too high for me to get onto easily. They pressed something and it lowered down, I got on it, and everything started happening really fast. A man in green scrubs grabbed my left hand and pulled it out to the side, where there was a little table at a right angle to the bed. He started telling me to make a fist and so on, so he could start the IV. At the same time, a nurse I knew from the blood draw room was telling me to scoot down the table farther, so that my butt was at the edge of a hole in the bed that I could see because it was covered with a pad. Then she told me to put my legs up, then scoot more. Also at the same time, the anesthesiologist was asking me lots of questions about my history with IV anesthesia, my drug allergies, and so on. Only the anesthesiologist, on whom I have developed a bit of a crush, introduced himself.

At this point, I came a bit untethered. The man in scrubs — who I recognized at some point as the surgeon, Dr. Saturday (and wouldn’t it have been nice if he’d introduced himself?) — put the IV in. It hurt like hell. In fact, it never stopped hurting for the rest of the day and I still have something of a bruise there, because it wasn’t in right. I wish I had known that it wasn’t supposed to be like that and that I should have asked him to do it again. (On the bright side, many people reported that the first stuff in the IV stings, and I barely felt that….) Everyone kept telling me to do things all at once. Someone put a BP cuff on my right arm, which inflated itself every minute or two. I started to cry, just a little.

“Oh, no! Don’t cry!” said the sweet anesthesiologist, an Italian man of roughly my father’s age. “Whenever I see a pretty lady cry, I start to cry too.” I pulled myself together and explained that I was worried about the IV sedation, because when I had that for my wisdom teeth, I woke up in the middle and threw up for several days afterwards. He listened to that and to my saying I was going to need real pain medicine after, because tylenol doesn’t do jack for me, and assured me that he would make sure everything was ok.

It was then that I really appreciated tbean’s story, which scared the hell out of me when I first read it, such that I required much buoying from friends who’d done IVF themselves. As upset as I was at the time, my experience wasn’t anything truly traumatic, but it helped during the worst part to remember what tbean had said about how this is surgery, no matter how much they act like it’s just a “procedure.” I looked up at the ceiling and told myself that everything that was happening was normal and how it was supposed to go, that these people were doing their jobs and that my job was to look at the ceiling, try not to think about how much my hand hurt, and trust that Dr. Italian would take care of me. The nurse tucked a white blanket around me so that my right hand was against my chest (nice touch), and the next thing I knew, I was in recovery.

My bed was facing the window, so I could see the green vacant lot next door and the bridge beyond. It was a sunny day, the view was pretty. I don’t remember feeling anything but awake — no groggy period or confusion. I knew where I was, why, and everything else. A nurse noticed I was awake and came over to check on me. She took care of me for the whole recovery period and was great in every way. She asked if I was in pain, and except for the &^$%ing IV, I mostly wasn’t.

After a few minutes, I started to be. My belly was sore in the gas/endometriosis kind of way it had been that morning, my back was a little bit achey, as it had been for a week or more. My vaginal pain was very slight and never got bad, ever. Less pain than I have after a pap smear. I told the nurse and she said she would have the anesthesiologist see me as soon as he was out of the OR. That took 10-15 minutes, by which point my belly had started to be more of a problem.

Dr. Italian came out and gave the nurse something to put in my IV, and I started to feel better right away. He later gave her a syringe of the same something to give as an IM injection, which would last for the ride home.

I was my typically chatty self under the influence of drugs. I asked Dr. Italian to repeat his name a few more times. I ended up remembering it almost right. I told him, somewhat in awe, “I didn’t wake up!”

“That’s my job,” he said.

The nurse brought me some apple juice and graham crackers, which were awesome. At some point, the nurse asked if anyone had told me how many eggs they got. She brought me a paper and pointed at the number 32. My eyes bugged out of my head.

I reminded her that I really needed a scrip for something that wasn’t tylenol, and she had the fellow write for what turned out to be very necessary percocet. “Tylenol doesn’t do anything,” I said, “I might as well take water; it tastes better.”

“That’s my kind of lady!” said Dr. Italian, passing by.

A while later, she said it was time for me to try going to the bathroom, and helped me very slowly get up, carried my IV bag to the hook in the bathroom, and left me sitting there, with firm instructions not to try to stand if I felt weird.

So I sat there.
For a long time.
Nothing.

I had had two bags of IV fluid by that point, but nothing was happening. The nurse called to me that I should come out if it wasn’t working. I was desperate not to stay longer than I had to, so I asked for an extra minute, turned on the sink, tried every mental trick I know, and peeds maybe 3 drops. When I wiped, I was shocked by how bloody the toilet paper was.

The nurse declared that even three drops counted, and I graduated to a recliner with the leg cushion out. Eventually I was allowed to sit up normally. Dr. Italian dropped by again and said “Good work, young lady,” which I loved. (Seeing a theme? Why can’t this man just be constantly passing through my life, praising me?) A while after that, she detached my IV from the cord (leaving it in my hand), and sent me to go put my real clothes back on. (I stopped to get a dreaded hospital pad from the bathroom, as I’d cleverly left the one I brought from home with Sugar.) Once in the locker room, I realized my fatal error: my key was attached to the wrist of my IV hand, which still hurt like hell. I had to gingerly stretch it over everything, which sucked. Nicole: put the dang thing on your right hand.

I returned to the chair, carrying my bra, because hell, no, it was not going back on. The nurse took out my IV, gave me my scrip, and sent me home with Sugar. As we left the 6th floor, I explained to Sugar my understanding why she couldn’t be in recovery, but said I was still confused about where that first husband had gone.

“Dude. He went to give a sperm sample.”

Oh. That’s probably why the nurse didn’t explain, huh? I hope the other waiting husband at least thought my outrage was funny.

We took a cab home, I retired to bed with my percocet, and everything was basically fine. I ate and drank normally. I peed. At some point, I stopped bleeding. The pain got bad the following day, probably as a combination of some OHSS and a lot of endo, but I don’t think that’s typical. In short (TOO LATE!), I was scared but nothing terrible happened. If I have to do this again, I don’t think I’ll be that upset.