You are currently browsing the monthly archive for May 2012.

I had a feeling AF was about to arrive. I held on to a glimmer of hope that maybe my cramping was because I was pregnant, and not because I wasn’t…but as the cramping worsened, I knew it was AF. I was right.

I also thought it was unlikely that we’d get a response from the insurance company approving my infertility treatment in time for this cycle, and it appears I was right about that, too.

I’m not all that disappointed, since it’s what I was expecting, but it’s hard to be on the cusp of turning 38 and feel a little bit antsy to get things going.

I think the tentative plan – assuming I’ve gotten a response from my insurance company by mid-late-June – is to start an IVF cycle then. I have big concerns, though, about a work trip I have scheduled for mid-July. I just don’t know if it’s going to interfere, and I absolutely can’t get out of it. Traveling with all that medication makes me a little nervous, and I worry, too, about being on all that medication and working such long hours. When I travel for work, I am usually working 10-12 hour days. My biggest concern, though, is that the timing of that trip will conflict with an important point in the IVF cycle. When AF arrives in June, I’ll talk to my RE/her nurse about it and see what they think. If it’s too risky, we’re going to ask to do an IUI instead. Since that cycle wouldn’t require 2-3 weeks of bcp’s before starting any other medications, the timing would be ok. Unfortunately, we are traveling (for fun – not work) in August, and I have another work trip scheduled for September. I really, really hope we don’t have to delay IVF until October. I also really, really hope my insurance approval comes through sooner, rather than later. I am assuming 30 days, and I think my RE’s office sent the documentation on the 14th or 15th. AF arrived today, and should be back again around June 19. My short cycles are not making this any easier, but I’m hoping we have the approval by mid-June.

Everything feels like it’s just moving so slowly.

While I’m waiting for insurance approval (fingers crossed!) to start treatment and trying to just make the best of things, there are lots of hopes and fears that keep trying to get in the way.

Hopes:
– I have had a tiny bit of hope (which rationally, I know is completely unrealistic) that I’d get pregnant naturally this cycle – now that my endometrioma and other bits of endometriosis are gone. I’d be one of those stories – those mythical people who are waiting to start treatment and get pregnant. Wouldn’t that be crazy??? Well, the answer is yes – that WOULD be crazy, because I am getting crampy and spotting a little and feel like AF is in its way, which I’m sure it is. It looks like it might be early, too. Maybe it’s a 38th birthday present from my body.

– I hope that IVF will work.

– I hope we are making the right decision.

Fears:
– I’m nervous about scheduling an IVF cycle. If I am, as it seems, getting my period early, then that means my cycle in June will start a little earlier than I had hoped. I have to travel for work in July and absolutely cannot get out of it. I hope that doesn’t create a problem. I’ll need to be gone for 2 or 3 days/nights.

– I’m afraid that I am going to get left behind by my friends. Most of my friends have children already, but the last of my childless friends are pregnant. I feel like it’s already affecting our relationships, and it makes me sad – especially with the person who’s been pretty much my best friend since high school. I don’t hear from her as often as I used to, and I think that her extreme fertility has made it even harder for her to understand my dealing with infertility. You would think it would be the opposite – that it would make her more compassionate – but it hasn’t. If I don’t have a child, I feel like the gap between us will continue to grow.

– I’m afraid that the first IVF won’t work, and that M and I won’t agree on how to proceed. Or, that it won’t work, and my RE won’t let us proceed with my own eggs.

– I’m afraid that M is going to get tired of dealing with all this.

– I’m afraid that my dad’s cancer will come back, and on top of how horrible that will be, that I won’t be able to focus on infertility treatment.

I wish I could just know how it’s all going to unfold, so I could stop worrying and just deal with it.

I kept meaning to post last week, but work was crazy, and home was crazy, and it just didn’t happen. So, here’s what’s happened since then:

– I am feeling almost 100% normal after the lap. I am back to running and yoga, and even though I can feel the effects of not doing them and am suffering for it, I feel pretty good. Every now and then, I still have some pain in my belly button, but it’s pretty minor. I am surprised I can still feel anything at all, but it’s almost more noticeable than actually painful. It’s almost like a bruise or a sore muscle.

– I had a great appointment with my gynecologist last week! She said my cervix looks good, so hopefully my test results will show the same thing. I am keeping my fingers crossed!!! She isn’t concerned at all about my ability to carry a child (after having an extensive LEEP procedure in July), which was super good to hear, and we talked about my RE and the practice I’m going to for treatment. She had a lot of good things to say about them, and she even told me that she did IVF 15 years ago to conceive her daughter! I thought it was really nice that she told me, and it was just good to hear her thoughts on the whole thing.

– I’m pretty much in limbo as far as treatment goes. AF hasn’t arrived yet, but I also haven’t gotten insurance approval to move forward with treatment yet. I am not counting on getting the approval anytime soon, so I am assuming that this cycle will just be like all the other ones before it. It would be great if I got the approval in time to do an IVF cycle at the end of June, but I’m not sure yet if that will happen. There are also some logistical travel issues that could pose a problem at the end of June, so it’s entirely possible that we won’t do an IVF cycle until the end of July. I wish that weren’t the case, but I can’t spend too much time thinking about it, since it’s totally out of my control.

– Despite the frustrating insurance issue, I feel pretty good mentally/emotionally. I’m trying to use the time to get into better shape and just have fun (unfortunally, I find those two goals in opposition a lot of the time!). I still don’t know what the future holds for us, but I’m determined to make the best of it, either way.

– My birthday and anniversary are this week! Yay!

I had a good appointment with my RE. Even though I have/had stage 3 endo, it wasn’t as bad as she feared, and even the endometrioma came off relatively easily. She thought my ovaries looked good, and was happy with the way everything went.

Since things weren’t quite as bad as she feared they’d be, she said that we could try IUIs if we wanted to, but that IVF would still obviously give us the greatest chance of success. After trying for four years, going with our best shot sounds pretty good to me, so that was the tentative plan. I told her, though, that it was also dependent on getting my insurance to approve it, since I have infertility coverage.

I read through my benefit materials and emailed the billing/insurance person at my RE’s office to make sure IVF would be covered, and I was also concerned about a section that said that predetermination of benefits is required.

The staff at my RE’s office is fantastic (seriously, they are amazing!), and the insurance/billing person got right on it and contacted my insurance company for me. It turns out that my concerns were valid…that predetermination IS required, but since my RE’s office wasn’t aware of it, they haven’t submitted the paperwork yet. The ins/billing person told me that she had to specifically ask about the predetermination requirement – that even though she was asking about my coverage, the ins. company didn’t offer up that information. So aggravating!

Now, I know I am SO lucky to have this coverage, but it’s frustrating to have everything on hold while we wait to see what they’ll approve. It’s extra aggravating because my period is due in about a week and a half, and the insurance company requires that the documentation be sent by mail! I will be stunned if the approval comes through in time for this cycle, which is extra lame because the timing would have been PERFECT for an IVF cycle. I wondered if maybe we could do an IUI instead, but apparently, all treatment must be preapproved, which I didn’t realize. So, there’s really nothing we can do but wait.

I know it’s not the end of the world, but it feels like it’s so hard to gain any momentum in this. I know the staff at my RE’s office will get things moving on their end as fast as they can, but realistically, I think we will probably be looking at an approval in mid-June. It’s going to get tricky with some work travel I have planned, but I am hoping it will all work out. I would love to do an IVF cycle at the end of May, but it looks like it will be June, or even July. I just need to remember that even though it doesn’t feel like progress, it is, and it will happen…eventually.

I mentioned a while ago that a good friend of mine is pregnant. We’ve been friends since 2nd or 3rd grade, and we were college roommates. We’ve had some hard times, but generally, we are close. Up until she got pregnant, she and her husband were also among a handful of couples we enjoyed spending time with who didin’t have children. We don’t live near them, but until we moved further away a year ago, we went on a yearly vacation together.

Finding out she was pregnant was hard…partially because it was so incredibly easy for them, but also because I knew that an aspect of our friendship would be lost. It feels (and it’s possible that I am imagining things) like it’s become even harder for her to comprehend my dealing with infertility, when she got pregnant so easily. She’s totally preoccupied by being pregnant, and I don’t blame her, but I’m just not mentally in a place to share that with her. I email her occasionally to see how she’s doing, but to be honest, I am relieved I don’t have to see her face to face. I’m extra relieved that I don’t have to see her, along with a mutual friend who is expecting her second child, face to face on a regular basis. It’s just too much.

Usually, though, I can deal with it from a distance reasonably well. At least, I thought I could. When she sent an email letting our college friends know she was pregnant, it made me realize that maybe I’m not dealing with it as well as I thought. I truly am happy for her, and I wouldn’t want her to deal with infertility, but at the same time, it’s hard to see all the congratulatory emails going her way. It’s hard to see that all our college friends are surprised she’s pregnant, since she never wanted children, but there she is – pregnant after hardly even trying. I wish I didn’t sound bitter when I was talking about it to a mutual friend, but I’m afraid I did. Luckily, that friend is super nice and not judgmental.

Maybe it’s just bad timing. I am surrounded by pregnancies and pregnancy announcements, mothers day is looming, and I’m recovering from surgery and possibly gearing up for IVF. It’s bad enough dealing with the fact that I don’t have children because I’m infertile, but feeling like the odd man out just makes it that much harder to deal with.

My post-op appointment is later this week, but I am feeling pretty good. I’m not quite ready for yoga or running, but I can move around pretty much like I never had surgery, for the most part. I should remove the steri-strips on my belly button, but I keep putting it off…maybe tomorrow. My other two incisions look good, and since the steri-strips they used for those incisions fell off after surgery (I guess they fell off – I was sort of groggy when the nurse talked to me about it), they have only been covered by band-aids for the last week. I changed the band-aid once, and I finally removed them for good yesterday. Unfortunately, between the shaving and the adhesive from the bandage – combined with my sensitive skin – I have some kind of rash/razor burn/skin irritation that is itchy and driving me crazy. The incisions themselves look good, so I’m not too concerned…it’s more just annoying than anything else. 

I’m really looking forward to my appointment. I hope we can just move right on to IVF asap, but we’ll see what the doctor says and how cooperative my insurance is going to be. I’ll do some IUIs if I have to, and I know it’s possible that an IUI cycle could work, but the chances are just so slim. I feel ready to just give it my best shot. We’ve been trying to have a baby for almost four years, and I’m just done with waiting. 

I mentioned in a previous post that we weren’t interested in using donor eggs. I know that DE would really be my best shot at having a baby – and that the success rates are so much higher – but we just don’t feel that it’s for us. I think it’s a fantastic option for people who feel it’s a good fit, but both people have to be 100% happy with that option. M doesn’t like the DE option for us because he doesn’t want to have a genetic link without me having the same thing. He wants a genetic link to both of us, or no genetic link at all. I have mixed feeling about it, I know I’m not mentally in a place where I’m ready for DE. I guess that could change, but with M feeling the way he does, I think it’s probably just not a good option for us – at least right now. 

Now I just have to hope that my RE has good (or at least not bad) news at my appointment!

Now that I am well on my way to a full recovery after surgery, I’m thinking about the future….considering the multiple ways this whole trying to have a baby thing can play out. A lot depends on my post-op appointment with my doctor next week, but I am assuming that will be fine. Because of the endometrioma, she assumed I had at least stage 3 endo going into the surgery, which is exactly what I had. I’m guessing she’ll suggest we move ahead with IVF, unless she found something shocking during the lap – and I would hope she would have mentioned it to my husband after surgery, if that were the case. So, I’m going to just assume we’re still on the IVF-track.

One other area of concern is my insurance. I have infertility coverage (which I am so incredibly thankful for), but they’ll have to approve IVF before we can move forward. With my diagnosis of endo, high FSH, and low AMH, I’m hoping it won’t be a problem, but you never know. Luckily, my RE’s practice has a great billing and insurance person who will hopefully get that all worked out. I know I need to be prepared, though, for a possible delay.

So, let’s say I get the insurance approval and my doctor also gives us the go-ahead – then it’s IVF time.

Of course, I’d be thrilled if it worked the first time. But if it doesn’t, I feel like we need to have some idea of what we’ll do next. What we’re thinking is that we’ll try it once, and a second try would depend on a few things – whether the RE will even let us try again with my own eggs; how we dealt with the first cycle; and whether it seems like it’s worth trying it again. M was initially saying he wanted to only try it once, but I don’t want that pressure going into an IVF cycle. Plus, if I feel up to it, then why not?

We agreed that we’ll know when we’ve had enough. We don’t want to try donor eggs (more on that later), so there is a finite number of times we can try IVF with my own eggs. I think the insurance limit might be four, but I don’t know if the RE’s practice would even let me try it that may times if my eggs aren’t cooperating. We just won’t know until we try.

If IVF doesn’t work, then we aren’t entirely sure what we’ll do. I assumed that would be the end of things, but M brought up adoption again, which surprised me. I’m not opposed to it, but the financial aspect still concerns me. If we do look into adoption again, we agreed that this time (after our initial round of research), we would look into domestic. International felt like a good fit initially, but it’s gotten pretty complicated.

So, that’s our loose plan for how we’ll move forward. It feels good to have a plan and to (hopefully) be making some kind of progress, but it’s still hard to balance hope, optimism, reality, and the need to protect my heart.

Before my surgery, I found it really helpful to read about other people’s experiences with laparoscopic surgery to treat endometriosis, so I thought I would share my experience, too! This is a really long post, and it probably won’t be too interesting to anyone who isn’t thinking about or getting ready for surgery.  

Background: I had laparoscopic surgery to remove an endometrioma on my left ovary, to diagnose the level of endometriosis, and to treat any other areas of endometriosis. My RE performed the surgery, and is treating me for infertility. She recommended surgery because of the size of the cyst, regardless of whether we proceed with IVF or continue to try to get pregnant naturally. 

 

Before the surgery:

  • I had to take birth control pills for about 10 days, starting on CD3. I’m not sure if this was because the endometrioma was on my ovary, because of the timing of the surgery, or a combination of both. I took my last pill the night before the surgery.
  • My doctor chose not to do the bowel prep (with magnesium citrate). She said some recent research showed that it wasn’t necessary or beneficial, but her standard practice was usually to do it. I was really glad I didn’t have to do the bowel prep, but it also made me nervous, so I was careful with what I ate the night before. I had a salad for lunch and chicken noodle soup and toast for dinner. I drank water until about 10:45 pm. I was told to not have any food or beverages (including water) after midnight.
  • My surgery was scheduled at 1:00 p.m., and I had to arrive at 11:30. In the morning, I showered, but was told to not use any lotions (I made an exception and put a tiny bit on my face – my skin is dry!) or makeup. The nurse said I could wear a tiny bit of deodorant.
  • I wore loose pants with an elastic waistband, a loose shirt, and flats.

At the surgery center:

  • We arrived at 11:30, dealt with some paperwork, answered a bunch of questions, and went back to get ready. I got changed into the hospital gown, and the nurse got the IV started. This was all done by noon or so. I talked to a few nurses and the anesthesiologist, and my husband and I just sort of hung out, chatted, and waited. I felt pretty calm, considering I was about to have surgery. My RE also stopped by at one point to review things and to see if we had questions.
  • A little before 1, the anesthesiologist came and gave me three shots of something (through the IV). I said bye to my husband, and they wheeled me into the operating room. I felt relaxed and woozy. I slid onto the operating table, and the last thing I remember is the anesthesiologist putting a mask on my face (not strapped on or anything – just placed lightly) and saying ‘this is just some oxygen.’

Recovery:

  • I woke up feeling pretty ok. My husband said I was in surgery for about two hours – maybe a little more. He had talked to the doctor and said things went well. He said she removed the cyst, as well as some other areas of endometriosis. She determined it was stage 3 endo. The nurse told me that there was ice on my stomach because of the swelling, and that my RE had come by and done an ultrasound to make sure everything was ok. I guess the swelling wasn’t distributed evenly – I can’t think of how else to explain it. Basically, there were big lumps in my abdomen – big enough that the nurse was concerned – but it was just swelling, air, and fluid (which I’ll explain in a minute). They put me on this wedge shaped foamy thing, so that I was tilted a little to the other side, to try to get things to distribute a little more evenly. And then I had the ice pack, too.
  • I drank some ginger ale and had some graham crackers. I decided I was ready to try to get up, and then got a little sore, so the nurse gave me a percoset. I got into the wheelchair and started to feel queasy, so she gave me an anti-nausea pill. I really wanted to pee so I could go home, and I may have started moving around prematurely. Anyway, I peed, and then almost threw up, and had to sit down. I was really vomity for a little while, but the nice nurse rubbed my back and told me to take deep breaths, and it eventually passed. I got dressed (with my husband’s help) and realized that while my pants were stretchy, they were not quite big enough. Surprisingly, even the band of my bra was tight. I got everything on, though, and the nurse gave me a ginger ale for the road.
  • Luckily, I didn’t feel queasy again for the rest of the day. I ate some crackers and jello, and took vicodin. My throat was sore, and it was hard to move (or roll over), but I was able to sleep.  I was SO swollen. I read that swelling is to be expected, but I was not prepared for the level of swelling that I experienced. My stomach stuck out by about three inches, and was sort of spread out all the way to my hips. My husband told me that the dr. had put a liter of liquid (I later found out that it’s called adept) in my abdomen after the cyst was removed, to help with healing. So, I can only assume now that I had the air, plus a liter of liquid, plus swelling from the surgery itself. Now wonder I was so puffy!
  • Around 8:00 p.m., I went to the bathroom, and liquid started seeping out of the incision in my belly button. My husband assured me that the dr. said this was normal – that it was from the litre of liquid the dr. put in my abdomen after the surgery – but it was a crazy sight. It was funny, even, until I continued to get my clothes, sheets, and all our towels wet. I had read about having a heating pad nearby, but I didn’t read anything about stockpiling towels to deal with a leaky belly button! It became a bit of an issue, too, because I had so few items of clothing and underwear that would actually fit me. Luckily, the liquid stopped seeping out of my incision around midnight, and I was dry for the rest of my recovery.
  • I was still sore on Friday (the next day), but I think Saturday (two days later) may have been the worst. I was expecting to feel better, but I was still sore, and I got a terrible back ache – I think from the air. I wasn’t as tired, but I also couldn’t get comfortable. I think I may have also had air trapped under my rib cage, because it was hard to take deep breaths, and the whole area around my ribs and down to my belly button was achey, hard and sort of swollen. Another complication was that I hadn’t had a bm since Thursday morning. I didn’t eat a lot on Thursday, but I ate relatively normally on Friday and Saturday. I took stool softeners starting on Friday morning, but nothing seemed to help.  It was hard to eat, sleep – anything – and I felt like I would never be comfortable again.
  • I’m happy to report that while I was still uncomfortable on Sunday, I could at least walk around the house and even went into the backyard. I switched from taking vicodin to Tylenol (at least for most of the day), and I went in the car (which was pretty uncomfortable) to the drugstore, because I had started my period (which was to be expected from stopping the pill) and didn’t have enough supplies. The paperwork said I could use tampons, but seriously?!? – everything ‘down there’ was swollen, and I couldn’t imagine putting anything in there. I found a pair of loose pants I could wear, but not button. I also has a bm (I know – tmi – but it’s good to know!)
  • On Monday, I felt SO much better. I think the trapped air was giving me more issues that I realized at the time, and I think my expectations were also a little distorted from having the surgery so late in the day – I didn’t get much recovery time on Thursday. Anyway, on Tuesday, I felt even better, and today (Wednesday), I can almost move around without even thinking much about it. There are movements that make me sore, and I get worn out easily, but I don’t feel “bad.” I’m still wearing those same pants, but I can button them, unless I am sitting down. I also can’t sit totally upright for too long, or I get sore, and I can’t bend over, because it hurts my incision. I feel like my digestion is still a little off – heavy foods haven’t been sitting well, and it seems like I’m getting more stomach cramps than usual. I know that sounds like I don’t feel all that great, but those things are so minor in the scheme of things. I’m still swollen, but it’s isolated to the area around my belly button. 

Overall, it was a difficult few days, but bearable. I was never in excruciating pain, but the inability to get comfortable gets old fast. I wasn’t expecting to feel so lousy, but once those few days passed, it was amazing how much better I felt. I ended up taking three days off work, plus the weekend. I work from home, though, and I would probably have to take a few more days if I had to go to an office, and definitely more if I had a more physical job. I’ve read that people say two weeks after the surgery, you wouldn’t even know you had it. Over the weekend, that seemed impossible, but now, I believe it. The biggest things that surprised me from the surgery were the swelling and the leaking, so maybe someone else will benefit from reading about my experience!

My surgery on Thursday afternoon was (as far as I know) a success. My dr. removed the cyst from my left ovary and also removed some other spots of endometriosis. I have photos that show what she did, but I have no idea what I’m looking at, so I can’t really say much more about the location of the endo or how bad it was. She said that even though it’s stage 3 endo, everything was removed fairly easily, and at least based on the photos, it doesn’t look too bad to me.

My doctor’s report was conveyed to me through my husband, and I have no idea whether I talked to the dr. or not. I don’t think I did, but the nurse told me I did have an ultrasound while in recovery because she was concerned about some of the swelling in my abdomen. I guess the swelling was kind of lopsided, but the ultrasound showed that things were fine, so they propped me up on this wedge thing so that everything would migrate a little bit to the other side of my abdomen (I should add that I didn’t realize I was laying on any kind of support until it was time to try to get out of bed), They also put some ice on my stomach to help with the swelling.

I’m glad I did it, and that I’m starting to feel better. I’m anxious to hear what the dr. has to say when I see her next week, but until then, I’m just focusing on taking care of myself and getting back to normal.

History

2014
May: BFP for baby #2, due January 2015

2013
July: Our daughter is born!

2012
November: Still pregnant. Fingers crossed! EDD 7/5/13
October: retrieval 10/12; 5dt 10/17; BFP!!! 10/25-hcg=70; 10/29-hcg=391
September-October: IVF, microdose lupron flare protocol
June-July-August: approved! dealing with scheduling issues and most likely starting IVF in September
May: waiting for insurance approval to start treatment
April: laparoscopic surgery to remove endometrioma on left ovary; diagnosed with stage 3 endo
March: RE finds cyst - suspects endometrioma; also high FSH, low AMH
February: consult with RE; bloodwork, hsg

2011
January-February: Acupuncture once per week, vitex and natural progesterone after ovulation; back to charting bbt
March-April: end of ttc
May:diagnosed with severe cervical dysplasia (CIN III)
July-August: L.E.E.P. procedure and recovery

2010
December: Start acupuncture
May-November: Not actively trying/on a break/enjoying life
April: Not actively trying, still waiting for insurance coverage for injectables
January-March: still waiting to start injectables

2009
December 09-March 10: On a break while waiting to start injectables
November 2009: 50 mg Clomid CD 5-9; BFN
October 2009: All tests normal; Take 50 mg Clomid CD 5-9; BFN
July 2009: Ob/gyn asks for bbt chart, S/A, CD3 b/w; plan tbd.
April/May 2009: Switch from OPKs to the Clearblue Fertility Monitor
March/April 2009: Start using OPKs and bbt

2007-2008
Sept/Oct 2008: Stop preventing; 'if it happens, it happens'
Summer 2008: Stop BCPs; using bbt chart to prevent pregnancy
May 2007: Married again! husband #2; no plans for children

Previous Life
Fall 2005: Divorced
Summer 2005: See RE; more b/w, clomid challenge test, sonohysterogram; 2 Clomid IUI cycles - BFN; male factor discovered (he now has a child with wife #2)
Spring 2003: See ob/gyn for IF, get b/w and HSG; All results normal; Husband #1 gets S/A, which he says is normal; results never sent to ob/gyn
Spring 2002: Stop BCPs, begin ttc and charting bbt
Oct 2000: Married to husband #1