Saturday, March 18, 2006

The Post I've Been Putting Off Writing

I don't know why it has taken me so long to write this post. Maybe because I'm overwhelmed. Maybe because I am unsure and a little scared. Maybe because I haven't really organized my thoughts or the experience as a whole in the matter. Maybe it's all the above.

The first thing I want to say is that as I go through this experience, there is a temptation to abbreviate all the medical jargon and words, but as I read other journals and blogs about infertility and the processes therein, I get lost. I admit it's like another whole language to me and it's a language I do not yet understand. So, in the process of learning this language myself, I want to teach it to others in the hopes of helping make it easier on them. The words or phrases in red are things I still don’t understand or haven’t learned what they mean yet.

I had my first appointment with the Reproductive Endocrinologist on Thursday. It was snowing as I drove to my appointment. I wasn’t sure what to expect and kind of felt…as though I were outside myself. I hope you know what I mean when I say that because I am not sure how else to explain it.

I arrived at my appointment right on time. When I walked in the clinic, I saw about a half dozen women and the all looked up as I opened the door. The waiting room was tastefully decorated and lit with a dim, homey sort of lighting. I went to the desk to check in. As I told the nurse I was there to see Dr. Breadbaker (not her real name, but if you want to put a bun in the oven, maybe a breadbaker is the person you want to see), a woman walked up and interrupted us. She asked if Dr. Breadbaker was still running late and then asked how many people were ahead of her. The nurse said yes, the doctor was running late due to a delivery she had to make and all the snow and there were 2 people ahead of her. This woman became incredibly snotty and said she wasn’t up to waiting much longer and she should get to go next or she would have to reschedule. I’m not sure how that was resolved because I was the newbie and not up for a conflict, so I just went to the magazine rack to find something to read.

Magazine racks at the Reproductive Endocrinologist’s office tend to focus mainly on parenting and babies. Not exactly the reading material I was looking for that day. I did manage to find a Glamour magazine that wasn’t too outdated and settled in to read all about Sarah Jessica Parker’s perfect life.

My name was called very soon after I started reading. A nice looking, motherly woman took me to a room and said she was there to go over my insurance benefits and what was covered and what wasn’t. She was very helpful and I was surprised at how good my insurance coverage for this is. I’m not even sure what it all means, but my insurance covers the following:

-Medical management of artificial insemination/intra-uterine insemination and infertility drugs
-6 cycles of inseminations with clomid, with or without artificial insemination, or Gonadtropin cycle.
- Lifetime maximum benefits = 2 million with no out of pocket max or deducible
-Prescriptions for orals or injectables such as Clomid or Gonal F.

After meeting with the nice business office lady, I was sent back to the waiting room to wait for Dr. Breadbaker. While reading about SJP again, I saw that bossy, impatient lady was playing cards with her husband. They played kind of loudly and sat in the middle of the room so as to be seen by everybody. I kind of wonder what their story is. While they played, a VERY pregnant woman came from the back with 2 adorable little girls. Bossy lady saw them and asked them loudly if they were twins. They shook their heads no in unison, but backed away from her, looking for their mom who was at the appointment desk. Before I could observe move, I was called back again in order to be weighed and have my blood pressure taken. Ever notice how, if your blood pressure is good the nurses praise you? My nurse praised me as though I had something to do with it. I know I somewhat do in that I try to eat right and exercise but it’s not as though I trained my blood pressure to remain in the healthy range. I did say thank you as though I had, though.

After that I was sent back to the waiting room because all the rooms in back were full. Bossy lady and her husband were gone so I assumed they were in one of the full rooms in back. I waited about 10 more minutes until they called my name. Unfortunately they meant to call back another woman who also had my name. Sheesh. Finally, my whole name was called and I went back. I walked past the requisite bulletin board full of baby pictures and was taken to a small room with a table. I only had to wait a little bit for Dr. Breadbaker. She was very nice and down to earth. She apologized for being late and said she usually didn’t deliver babies on Tuesdays and Thursdays but this had been an emergency.

Dr. Breadbaker gave me a folder full of info and then asked me why I was there. I told her I had been married 4 ½ years and we weren’t pregnant. She said at 38, it was good I was there when I was because we have this whole year to try. She asked me if I smoked. I said no. She asked if I was ovulating. I said yes. She asked if my husband and I had sex by the calendar and I said yes. She asked when I seemed to be ovulating and said about day 14. She asked how many days between periods and I said 28 give or take 1 or 2. She asked if I had ever been pregnant and I said no, not to my knowledge. She asked when my last PAP smear and breast exam were. I said in January. She asked if I had ever had an irregular PAP. I said no. Then she asked a bunch of questions about Bob. Did he drink a lot of beer every night? No. Did he smoke cigarettes? No. Did he do drugs? Other than the pain meds he’s on…no. Did he have any STDs? No. Then she said something along the lines of how it’s amazing to her that people ever have “surprise” babies because of all the things that have to be “just so” in order to get pregnant. Then she pulled out the illustration of the female uterus. She said that since I have such good insurance she would like to have some tests run before we decide on a course of action, but if all the tests come back looking good, she would like to do the full 6 cycles starting with 2 of Clomid. However, first she wants Bob to do a semen analysis to see how his swimmers are doing. Then I need to do a day three blood test. This test is done during the third day of my period. Day 3 FSH (follicle stimulating hormone) and estradiol (E2) tests measure a baseline FSH on day 3 of the cycle, and can sometimes indicate how close a woman is to menopause and if she has relatively less "ovarian reserve". Another way of saying this is that if the baseline FSH is elevated the egg quantity is reduced from what is expected. After that, she wants me to schedule a Hysterosalpingography which is just a fancy term for a uterine dye test. This is where they will inject dye into my uterus and fallopian tubes in order to see if there are any blockages or problems such as polyps or fibroids.

Once those test results have come back I am to schedule a meeting with Dr. Breadbaker to go over the results. If the results are all OK, she will prescribe some Clomid for me and insemination procedure for two cycles. I asked about the chances of multiples on Clomid and she said my chances while not on Clomid are 4%. My chances while on Clomid are 8%. I’m good with that. She said if I didn’t get pregnant after the two cycles of Clomid, then she would move to injectables and insemination. She said the chances of conceiving multiples while on injectables were 20%. Then we talked about what we would do if the tests came back anything other than OK. Her concern is endometriosis. We discussed the history of my periods and my mother’s hysterectomy. My mother had endometriosis and a hysterectomy as a result. (So did my grandma and aunt.) So if test results come back indicating the possibility of endometriosis, Dr. Breadbaker would like to perform a laparoscopy to look for adhesions, fibroids, and cysts.
Once we got all the chatter out of the way, she wanted to examine me. This, of course, meant the privates probe. For the first time in my adult life, a doctor used a regular sized speculum on me and it didn’t hurt! It wasn’t comfortable by any means, but it wasn’t horrible either. Dr. Breadmaker said my uterus looked great, so…I guess that’s good.

Once I was dressed I was given instructions for Bob’s semen analysis and I was free to go. So I went. On the way out I could hear a fetal heart monitor beating and it sounded so amazing. I had to pass by the baby bulletin boards again so I stopped to look at all the lives that Dr. Breadbaker and her colleagues have brought into this world. There were a lot. All of them beautiful. I couldn’t help wonder if a picture of our baby might be hanging there one day. There is that hope thing again…rearing its head.

After all of this, I am not sure what to think or how to feel. When it was just me and Bob trying to get pregnant, it was just us. Duh, I know. But when you bring all these other people in it just feels so clinical. When it was just us, it was hard enough to deal with getting my period and feeling like I let Bob and myself down. Now if I get my period there are so many more people involved. Plus it makes it all the more real. What if I do get pregnant? Yikes!
Bob and I already know if we don’t get pregnant after the 6 cycles, we are not going further. After the 6 cycles, we will head to Hennepin county social services and apply to be foster parents or for adoption. The only reason we aren’t doing that now is that we are still trying to get our credit in order…and because we want to see if there is a physical reason we haven’t been getting pregnant

So that’s it. That’s what has happened so far. I need to call and schedule an appointment for Bob to give his sample and as soon as my period shows up I need to schedule my day three blood test and uterine dye test. Not much else will be happening until after all of that has been completed. I guess I am glad for the time to continue to process all of this. Of course I will write about it all as we go along because that is what I do.


Dawn from PA said...

I'm keeping my fingers crossed for you guys. Hopefully something good will come from these visits. I have to tell you, I love the name you gave the doctor--lol!!

Heather said...

I know that all of the testing is frustrating but doesn't it at least feel good to be proactive about it? At least that's how it is for me. I don't like that we are dealing with all of this, but at least I feel like I'm taking an active roll instead of just sitting back and doing nothing.

Jen G. said... you know that I have always been a very blunt person. Having said what you need to do to have a baby. If it means scheduled sex, have scheduled sex. Romance will be around for a long time...just DO IT! LOL.

Seriously...God gave us medical knowledge to use to help us. Don't feel like you are manipulating anything or doing something that some might consider "unnatural". Sometimes couples need extra help to get that bun in the oven...and keep it there! Again...take the help that is available and run with it! You will be in my prayers. I love you! Aunt has a nice ring to it, doesn't it???


Lut C. said...

Are you sure you wrote those options down right?

I thought all insemination was 'artificial', natural insemination being sex.
So "6 cycles of inseminations with clomid, with or without artificial insemination" doesn't make much sense.
I guess you mean 6 cycles of Clomid, with or without insemination.

Now of course, sometimes "artificial insemination" is used as shorthand for cases where donor sperm is used. Since it was the insurance lady talking, and not your doctor, it makes some sense.

It is all very confusing, and the jargon doesn't help. But it sounds like you have a plan, and that's worth a lot.