I wrote about my other female cousin who lost three pregnancies in the last year. She consulted with a reproductive immunologist who recommends doing a hysterosalpingogram and hysteroscopy to rule things out. If those two tests and her partner’s sperm test check out, she recommends my cousin to try naturally with Clom.id for baby number one and IVF to bank embryos for number 2. I shared her information with Dr. E, my own reproductive endocrinologist, to get an idea of what she thinks the most sensible next step should be. My cousin is now 41. Dr. E thinks that the most logical thing to do is IVF with PGS. She said that chance of a healthy pregnancy with IUI at 41 is 5%. Chance with IVF at this age will be around 15%. She said that if my cousin waits and does IVF when trying naturally doesn’t work, the window of having a healthy pregnancy may have closed. Dr. E tells every woman over 40 to realize that she may not have a healthy egg left and that’s normal and to be expected. She said that having a miscarriage (getting pregnant naturally like my cousins does) doesn’t mean you have a higher chance of a healthy pregnancy. I told my cousin all of this. She said she’d wait until the tests are done. My cousin got her HSG done. Her tubes were open. Her hysteroscopy showed some inflammation and spots that may or may not be endometriosis. Her uterus has a slight septum so the next step is to do a surgery to remove the septum. It may or may not prevent her from having a miscarriage but it is to make sure that the uterus would not be the reason for a miscarriage if she had one. I reiterated Dr. E’s recommendation to my cousin. Maybe IVF is a bit out of reach for her right now financially? She is going to try Clo.mid like she had planned. Since she got pregnant all three times she “tried” (and the first time she didn’t even try), she is quite confident that she will get pregnant again very soon. She feels like once her uterus is fixed, she should be able to get pregnant and hopes to remain pregnant. She will continue trying naturally until her next miscarriage. If she miscarries again, she will pursue IVF in Europe instead of here for the fraction of the cost. From talking to her, I can feel her innocence that comes from not having been on this journey for too long. She thinks that she will get pregnant quite easily. The only thing she needs to do is to keep the pregnancy. I don’t think she worries about the egg quality. It sounds like she thinks that she will make some good embryos for transfer if she has to do IVF. I know from experience that even if you make many follicles and eggs, at age 41, the chances of making good embryos (even PGS normal ones) that would stick are quite low. And I have seen so many people having embryos that don’t make it to day 5 or 6. I just marvel at how differently she and I look at the situation. That’s not surprising right? She’s pretty new to trying to conceive and I have already come out of the other side having supported many and knowing all the heartaches that could result from failed cycles and more miscarriages. She could be a poor responder to meds. She could make a bunch of embryos that don’t survive til day 5 or 6. She could get implantation but go through the beta roller coaster. Going to Europe for IVF may mean she’d have to go back repeatedly for more cycles. Many things could happen. I hope that she never has to learn the harsh reality of infertility. I wish that her innocence can live on, which means that she’d be able to bring home a baby relatively easily. I really hope so. I don’t wish my journey or her sister’s journey upon her.
My dad was scheduled to come visit us yesterday. He was waiting to attend my cousin’s wedding on February 10th in Hong Kong. My brother was scheduled to fly there from the US for the wedding as well. All these travel plans were thwarted by the coronavirus outbreak. My brother canceled his trip to Hong Kong. My cousin got married in front of family, relatives, and friends donning their masks. It is such an unusual time. After hearing stories about brides and grooms having to cancel their weddings or having only a small portion of the guests showing up, she was so touched and forever grateful that most invitees showed up to celebrate her and her husband. The few days prior to the wedding, I suggested to my dad that he should move up his departure date to right after the wedding. Instead of agreeing with me, he actually told me that he was considering postponing the trip. He would have to self quarantine in the US, but he didn’t want to bring any viruses to our household that has two small children. My brother also feels that it is best for my dad not to be contained in an airplane for a long time being exposed to germs given his history of pneumonia last year. My dad said he’d wait until after the wedding to make a decision. He eventually decided that it would be the safest for everyone if he postpones the trip until the outbreak eases up. Who knows when that will be, right? I totally understand his position and support it 100%, but I am still very disappointed that we won’t be able to spend time with him as planned. My dad comforted me by saying that fortunately we had just spent a lot of time here in the US in September and in Hong Kong in October/November. What he said is true. It is still such a bummer that the kids and I won’t be able to explore new places with him these next few weeks. Life is unpredictable and many things are unexpected and out of our control. What is important is how we choose to deal with it. Hopefully my dad can visit before Bob’s parents come in May. If not, then hopefully some time in the summer after my in-laws’ two-month visit that he can make his way here.
For a long period of time in my life, I was very particular with my coffee. French press with certain brand of coffee grounds and half and half was my go-to daily. Turning 40 changed everything. A full cup of regular coffee would make me jittery all day long. I had to cut down on that and switched to having a latte. If I had time in the morning, I would stop at a popular coffee place and buy a cup of latte before work. I loved my coffee. That stopped when the twins were born. Bob and I were so tired everyday that I just would grab whatever caffeine we could get at home. For quite a few months we even resorted to instant coffee. I didn’t love the taste but I wasn’t picky when it came to giving me some caffeine to help me get through the day. When the babies became toddlers, the three of us started going out every morning. I had developed into a habit of buying a cup of latte whenever I had a chance. This had become such a routine that even Bunny and Okra would say to me in Cantonese at the end of our outing, “Mommy go buy coffee.” And when you ask them what kind of coffee, they’d say “Latte”. About six months ago, one of my best friends had a birthday party at her house and let me try a cup of coffee she brewed from her fancy looking coffee machine. I have gotta say it was a very good cup of coffee. And it was so convenient. She just pressed button, put a coffee pod in, and within half a minute, a hot cup of coffee was ready. After that time, I kept thinking about that coffee machine and the coffee. I knew that the pods aren’t cheap, but it would be much cheaper than buying a cup of latte at a coffee shop several times a week. Finally I told Bob that I wanted the coffee machine for Christmas. At Christmas time, the coffee machine was more than half off. I couldn’t be happier when this beauty arrived at my doorstep:
Both Bob and I are so happy with our purchase. The machine reads the barcode on the coffee pod to know if it is brewing a cup of regular coffee, an espresso, a double espresso, or a gran lungo. Did I already tell you how easy it is to brew a cup of coffee? You press a button and it heats up the water in 20 seconds. You put the coffee pod in and press the button again, it brews it within seconds. There is no need to clean any coffee grounds like what I did with my previous espresso maker (which I have already given away). Since it is so easy to operate, I get to enjoy a cup of coffee during the morning chaos and a cup of latte when the kids are down for their naps. Somehow my 40-plus body is okay with the caffeine from a full cup of coffee again. Oh and Bob loves it too! He sometimes makes a cup of decaf in the evening. It has added such joy in our lives that I am so thankful we decided to treat ourselves. I haven’t set foot in a Sta.rbucks for quite a few weeks now. Love having simple pleasures in life.
After staying home with the kids the last two plus years, I have realized that working for someone else is not going to give me the flexibility on my schedule to spend quality time with the kids. With a lot of soul searching, prayers, and thoughts, I have made the decision to start my own private practice part-time when my kids turn three and start preschool in the fall. Now, my idea of a private practice is not the typical brick and mortar clinic because borrowing money will be out of the question. I would like to start small and build it from there. Most likely I will start with doing home visits with the birth to three population, which is my specialty. This way, I don’t have to have the overhead of a physical clinic but it does take some time and effort to drive to different clients’ homes. I had seen some private clients at my home office in the past but I have come to realize that I didn’t quite do it right. I didn’t know to get all the licenses and paperwork to make it all official. This time round, thanks to all the F.B. groups that I have joined for my profession, I learned that you have to get all the ducks in the row to protect yourself and your business before you start. I want to do it right this time round. Early last year I learned about this online course that teaches all the ins and outs of starting a speech and language therapy private practice. I didn’t take the plunge until the first of the year because I feel like 9 months is a good time to start exploring and setting everything up before I try to get real clients. Like anything else, learning something new is overwhelming. The course is quite clear with step-by-step instructions. However, the instructor who put this course together is in another state, so the laws are a bit different than the ones in California. She does not go into details about the laws in my state, so I have to look further. Fortunately, the F.B. groups that I am in have frequent discussion about the details of setting up a private practice in California. I have learned that you can set up your private practice with a few different business structures. You can be a sole proprietor, an LLC, or a professional corporation. Many people opt to go the LLC route because the business owner is not personally liable for the business debts or liability. Sole proprietorship is the simplest form of a business where the business owner is not separate from the business. The owner is personally responsible for any debt. A lot of private practice owners recommend an LLC over sole proprietorship. However, I have learned that in California, a speech language pathology clinic cannot be established as an LLC. It has to be either a sole proprietorship or a professional corporation. Are you still with me? I found my head spinning a little when I went into details about all of this. BUT, I am determined to not let this overwhelm me. Rather than figuring it all out myself by researching online, I asked for recommendations from the private practice group that I am in for our state and received several leads on attorneys and CPAs that are familiar with setting up a small business corporation for my profession. My goal is to call these places up in the upcoming week and get the free consultation scheduled so I can ask my questions and make an informed decision about what is best for my situation. Without establishing the business structure for my practice, I will not know what kind of liability insurance or business license I should get. My goal is to complete all the steps to protect my practice in the first quarter of the year. Sometimes it feels like there is no time or space to even make a phone call with my kids around, but I am determined to get this done. When there is a will, there is a way, right? I hope to keep my momentum going so by September I will have some clients ready to be seen by me when my children enjoy some social time at preschool. I cannot wait to exercise the part of my brain that has been untapped in the last 2.5 years.