Flotsam

I feel bleary-eyed and disoriented, having emerged from the least-relaxing weekend ever. It began with a 24-hour migraine, the worst I have had in several years, the sort where you are in too much pain to sleep, and even the darkest room is too bright to be borne. The cats were delighted, as I spent the entire evening in bed with ice on my forehead and my hands over my eyes, allowing them to amuse themselves by crawling over me, attacking my feet when they poked out of the covers, and licking my icepack. I managed a feeble “No!” once in a while, but I was too weak to swat them away and they knew it. I don’t start Lupron for three days, and yet I worry that Friday’s migraine was a harbinger of things to come, sort of as if Lupron had engraved a bullet with my name and left it in my mailbox.

My drugs arrived on Friday as well—fittingly, as it was the first day of Blogher and I paid for them by canceling my trip to the conference—and they were, as expected, in a box the size of Kentucky. What I had not been expecting was a second Kentucky-sized box, this one filled with nothing but bags and bags of needles and syringes. When I opened it, Scott started laughing. YES, IT’S ALL VERY FUNNY WHEN YOU AREN’T THE ONE BEING POKED. He shouldn’t have laughed. He’ll regret it someday, when he wakes up to find I’ve glued his lips together. Try laughing now, hotshot.

Obviously I knew there would be many needles involved, but the volume was alarming. On the opposite end of the spectrum were the drugs themselves. Each vial is about an inch tall and the width of my pinkie. I was expecting the vials to be larger, especially as they cost $60 apiece. Couldn’t they be encrusted with precious jewels, or wrapped in mink pelts, at least? I managed to fit $1200 worth of stimulation drugs in my refrigerator’s butter compartment, which hardly seems right. The syringes, on the other hand, displaced my hand mixer and food processor to get their own large drawer. Which reminds me: Do used syringes have to go in the (tiny) sharps container, or is that just the needles? (I’m assuming that disposing of the container, when full, will be a simple affair of driving to the city dump under cover of darkness and burying it under the sign of the cross, am I right?)

Scott has begun referring to to our yet-to-be-conceived child as “Science Baby.” As in, “We should get this book for Science Baby,” or “I hope Science Baby likes the cats.” I cannot help but notice that he expects this cycle to work, and it makes me nervous. Everyone seems to expect this cycle to work, except me. Both his family and mine are acting as if it is a foregone conclusion, despite my increasingly desperate reminders that there is a greater chance of failure than of success. My mother asked me the other day whether I have a pregnancy exercise plan. Eventually I was able to recover sufficiently to remind her that I do not have even a regular exercise plan. Though if pressed, I would say my pregnancy exercise plan involves lifting various items to my mouth, and carrying the occasional heavy bowl of pasta.

I have gained three pounds since the wedding, and have been eating like…something that eats a lot. It is stress, mostly, and I am having a hard time getting back to my healthy eating habits without the spectre of fitting into a wedding dress to motivate me. I have a lot of days that I get through only by thinking of whatever delicious and comforting thing I will have for dinner, and to take that away from me would be cruel, don’t you think?
I know people do continue to work stressful jobs during IVF, I just don’t know how—I haven’t even begun and I am already tearfully fantasizing about a mysterious benefactor who would enable me to work part time, or at the very least stop spending Sundays at the office. I want desperately to take the next few weeks off to spend time with my mother before she leaves on the 13th and, you know, attend both to my ovaries and the dozens of unpacked boxes littering the hallway, but I have no legitimate medical reason to do so, unless my supreme annoyance at having to drive 30 minutes to the clinic and then 45 minutes to work every other morning (returning home at the end of the day just in time for my evening injections) counts as some sort of disability.

Before I end this already over-long epistle, let me ask: do you have any advice for the upcoming emo-ovarian carnival that is IVF? You were all so helpful when it came to planning my wedding, and perhaps you have an injection tip, or a book-to-read-during-the-long-wait recommendation, or some small tidbit of IVF lore you would like to share with the class?

Here is mine: Don’t count the syringes. Trust me on this.

Now, I am new to this, but from what I can tell, the first part of an IVF cycle is entirely spent making phone calls and being placed on hold. Who knew? If you had told me before this process began that in order to have a baby I would have to listen to smooth jazz several times every day for twenty minute intervals, I do not know whether I would have had the courage to proceed. Two weeks ago most of my hold time was spent with my primary insurance company. Last week it was split between my clinic and my prescription plan insurance vendor. This week, if this morning is any indication, will be spent on hold at the specialty pharmacy handling my medications, with occasional sojourns to the University Department of Hemotology and my clinic.

Being on hold is never pleasant, but it is made less so when in order to make the call you hiked a grueling ten minutes from your desk to a private phone room. I could use the phone at my desk if I didn’t mind my entire team being privy to my reproductive plans, but the last thing I need if this cycle fails is a gaggle of coworkers asking whether I am pregnant, which would likely result in bloodshed and possible criminal charges.

So let me walk you through the process of making a call:
1. Schlep up two flights and across vast building to private phone room
2. Dial number
3. Sit on hold for 15-20 minutes while doodling on scrap of paper (doodles grow progressively violent)
4. Reach live, human representative
5. Ascertain that live, human representative is unable to answer your question
6. Live Human Representative offers to call you back after conferring with mysterious Supervisor
7. Trek back to desk, wishing for kindly corporate Sherpa to carry your Fresca
8. Wait for call
9. Wait for call with crossed legs, afraid to leave desk
10. Dash desperately to bathroom
11. Return to find red message light blinking—Live Human Representative left phone number, but no information
12. Repeat steps 1-11

Alternate ending:
10. Do NOT dash for the bathroom, instead remaining at desk all day while bladder becomes painfully distended
11. LHR never calls
12. Repeat steps 1-11 the next morning, seething at entire previous day spent fruitlessly waiting for response

Things are complicated somewhat today by the fact that I just noticed that I have a spot on my pants—right on my ass. Its provenance is uncertain, but the most likely explanation is that I sat on something delectable in my haste to consume it. This spot makes the walk to the private phone room seem even longer, as I slink along certain I will come to be known as The Girl Who Soiled Herself.

Now, I realize that for many people, it is the 50+ injections involved in an IVF cycle that make them resent the ease with which fertile people reproduce, but I envy more the lack of time spent on the phone alternately listening to a saxophone play Careless Whispers and arguing with the bored, possibly illiterate staff of insurance companies. In fact, I have heard a rumor that fertile women may procreate without receiving insurance authorization at all! Probably an urban legend, I know.

I was going to write this entry yesterday, but it is probably just as well that I didn’t, as it would have consisted primarily of the word COCKSUCKER repeated with escalating font size and number of exclamation points. Today I have cooled down enough to instead provide you with a dispassionate recitation of the facts:

Fact #1: My medical insurance (Blue Cross) has always covered fertility medications. This year, however, my employer farmed out our prescription coverage to a separate vendor, with much assurance that nothing much was changing—our copays are exactly the same, as is the amount we pay for our medical plan. However, as I found out yesterday when I called the company administering our prescription benefits (sounds like Haetna), our new prescription policy does not cover fertility medications. At all.
You will all be relieved to know that while the company will not cover so much as a tab of Clomid, we do have a yearly allowance for “Male Performance Enhancement” medication.
I am filing a formal letter of complaint with my employer, though I will have to revise the one I wrote yesterday, as the page is gooey from all the dripping sarcasm. Though at least it is an improvement over my first draft, which read: “I HOPE YOU’RE HAPPY YOU SOULLESS CORPORATE ASS-PIGS! SCREW YOU AND YOUR HATEFUL, EMPLOYEE-FUCKING BOTTOM LINE!!!”
Ahem.
So, what I said Monday about not going into debt for this cycle? Not going to happen, with $3000 worth of meds to buy within the next week or so. And this pretty much guarantees that by the time we can afford a second cycle we will be using the complimentary retirement home shuttle service to make it to our RE appointments. So, no pressure!

Fact #2: I cancelled my trip to BlogHer. For reasons, see Fact #1. Also, I expect to start Lupron that weekend and adding the stress of travel to an already overloaded month is probably a bad idea. I’m mostly fine with this fact, under the circumstances, but I reserve the right to be pissed off that the circumstances exist.

Fact #3: Dr. Doctor, the only Reproductive Endocrinologist I have ever loved, is leaving the clinic. Her last day is this Friday. As in the day after tomorrow. I found out yesterday from another clinic patient, and confirmed it with a nurse this morning. Apparently a letter was sent out, but has not yet been forwarded to my new address. My care will be transferred to one of the other two REs, neither of whom I have worked with before, either of whom may fail to find me enchanting and instead pooh-pooh my research and wave aside my concerns. I am trying not to panic about losing the doctor I have seen for the past two years, but guess what? It’s not working. I still haven’t received my “official” retrieval date and prescriptions, which I was supposed to have by this morning. She promised me a late-mid August retrieval, but now that she is leaving I don’t even know if she is the still the one writing my protocol. I also don’t know whether she made it clear that I am to be referred to a hematologist, and I fear that my new doctor will look at the borderline but technically “normal” results of my recurrent miscarriage bloodwork and decide it isn’t necessary. Though I pity the fool who tries this, at least before removing all sharp objects from his office.

Mostly, though, I will miss the good times Dr. Doctor and I shared together—the thoughtful way she says “Now you’re going to feel some pressure,” her careful interpretation of clinical studies, her warm, sterile embrace. I even wrote a little poem:

I think that I shall never see
a more lovely, temperate RE
An RE whose hands are never cold
With research current—never old
An RE who surfs PubMed all day
Explains each test and each X-ray
Who found my cervix (with some poking)
And laughs at my pathetic joking
An RE who’s gentle with her wand
An RE of whom I’ve grown so fond

Many doctors there may be
but none as fair as my RE

When I get my meds, rest assured I will pour out a little Gonal-F in her honor.

Wednesday Scott and I had our “Comprehensive Appointment,” which included an ultrasound and sonohistogram for me, consent signings, and a meeting with the clinic’s financial coordinator. Scott has never been present for my ultrasounds before, so I was looking forward to showing him the wand that sees more action than he does and giving him a stirrups-eye view of the process. Because this was my official pre-IVF ultrasound, Dr. Doctor did it herself. The right side went well—eleventy thousand follicles or so, all ready and waiting to drink up the urine of menopausal nuns. My left ovary, however, was nowhere to be found.
Now, this particular ovary has always been a troublemaker, difficult to find and terribly lazy about producing follicles, but this was the first time that it had disappeared entirely.
“It has to be there somewhere,” I said nervously, “I would have noticed if it fell out.”
Dr. Doctor helpfully inquired as to whether I had woken up recently with any new scars, perhaps after being the victim of an organ thief. I glared at her.
“Oh well,” she said finally, giving my tender insides one final, fruitless poke, “We’ll have to find it when you start stims, but we won’t worry about that yet.”
Guess who is already worrying about that.

Next was the sonohistogram. The first stumbling block was, again, the inability to find a crucial piece of my anatomy—namely, my cervix. My cervix has been described by various providers as “tipped” “tilted” “backwards” “waaay in there” and “down and to the left,” so again, this wasn’t exactly unexpected. Expected or not, it was unpleasant. Specula are not really meant to be used to dig ferociously at the back of a girl’s vagina, wrenching painfully from side to side like a periscope. Scott began to look pale. I began to wonder whether my cervix had run off somewhere with my left ovary—a booze-fueled night in Tijuana? The dog races?
“There it is!” Dr. Doctor said finally, “Down there!”

The sonohistogram itself was of two parts. First, Dr. Doctor threaded a catheter into my uterus to measure it. This was fine until she presumably hit the uterine wall and I hit the ceiling.
“Eight centimeters,” she informed the nurse while I tried to stop panting. I began to worry about the embryo transfer, during which a catheter will similarly be introduced to my uterus, this time carrying $10,000 worth of embryos. They like to avoid having the uterus contract during that procedure, and I was fairly certain that had any embryos been in the catheter during this little measuring exercise they would have been expelled with enough force to puncture the far wall of the exam room. I was assured that the catheter used for embryo transfer is smaller, and ultrasound guided, and that there will be Valium coursing through my veins to lull my smooth muscle into an accommodating stupor.
The second part of the sonohistogram involved injecting saline solution through the aforementioned catheter in order to expand my uterus and get a look at its lining. This part was crampy, but the cramping was largely alleviated by the novelty of seeing my wee uterus expand on the ultrasound screen. I don’t mean to be immodest, but my uterus is adorable. Dr. Doctor printed out some ultrasound pictures, and I had to stop myself from asking for a copy.

After she was finished, Dr. Doctor left the room and I hopped off the table and got dressed, donning the completely useless panty-liner they provide to catch the saline. It was then that I noticed Scott looking a little afraid.
“You’re really good with pain,” he said, in a small voice, “I don’t think I would have liked that at all.” I assured him that it wasn’t something I’d like to make a habit of, either, but he remained impressed. I highly recommend bringing a squeamish husband with you to your next procedure. I am pretty sure that his awe will prove useful at some point in the future.

Dr. Doctor returned. I whipped out my list of questions.
“Your wife scares me,” she said to Scott.
“She scares me too,” he replied. I cleared my throat and launched into my first query, about a recent paper on activated protein C resistance.

To Be Continued…

I do not care for fireworks—nay, they terrify me. Partly this is due to an episode of Lassie I saw as an impressionable youth in which Timmy befriended a little boy who had been blinded by fireworks, and partly this is merely due, in my opinion, to common sense. One cannot control whether one is blown to smithereens by a bomb, land-mine, or similar, but surely refraining from detonating explosives and/or willingly being present when others detonate explosives for sport is a small, sensible measure we can all take to prolong our time on earth.

Yesterday, a colleague of mine regaled me with stories of girlhood summers spent setting off bottle rockets and otherwise inviting bodily harm in honor of Independence Day. She seemed surprised to hear that I had never played with fireworks. And actually, that is not entirely true—I once held a sparkler for a moment, until the sparkling really got under way and I handed it to someone else to avoid pesky burns.

Scott is always taunting me about having been a “bizarre child,” merely because my seven-year-old self didn’t enjoy fireworks, parades, amusement parks, diving, handsprings, baseball, Pop Rocks, or other dangerous endeavors.

“I had fun as a kid,” I insist huffily during one such conversation, “We used to have a marvelous time, my brother and I!” Scott asks what we used to do that was so diverting, and I say “Oh, lots of things! We pulled taffy, and picked apples, and once we went to a sort of quarry where you could look for amethyst!
Pulling taffy, picking apples, and working in an amethyst mine do not impress him as the hallmarks of a carefree childhood—or at least that is what I deduce from the tears of laughter sliding down his cheeks as he hoots unattractively and clutches his sides. I am glad I didn’t tell him about my favorite pastime of all, which was building my rock collection by chipping rocks out of the blacktop with a crochet hook.

I was in day care all day every summer until I was twelve, and found myself on a number of field trips to fairs and theme parks, where I endured the derisive cajoling of my contemporaries until they gave up on convincing me to try the Plunge of Death, Vomit Peak, etc., leaving me to enjoy the one ride I really loved: the carousel.

Roller coasters are against the code I live by: Don’t Borrow Trouble. Surely there is enough that can go wrong in a person’s life without the addition of needless thrill-seeking. Why not just read a nice book? Unlike roller coasters, books do not require a protective harness, and you will avoid having to say “Well, of course I’m disappointed by my newfound paraplegia, but those seven minutes of exhilaration and mild nausea sure were worth it!”

Life is full of routine risks and gambles—air travel, for instance, or infertility treatment, or love—and the compulsion to add more is one I have never understood. Maybe I am missing the gene that would cause me to enjoy bungee jumping or the Tilt-A-Whirl, but I don’t mind. Have you ever pulled taffy? It’s a good time, I promise.