Hopeful Again – The Mighty Hands of My OB/GYN Surgeon

It’s such a good feeling to get good news.

Finally, after all the previous saga with a failed attempt at our operative hysteroscopy at my own clinic, today was hysteroscopy take two with Dr. Gentle.  I guess because of our vacation, I hadn’t been thinking too much about it.  Plus, I somehow had more confidence about it this time because of Dr. Gentle.

One thing I notice is that UC.SF and Kai.ser handle things in very different ways.  In the pre-op instructions at UC.SF, I was told to 1) not to take any Excedr.in or other similar meds a week prior to the procedure, and 2) fast four hours before the procedure.  Kaiser instructed me to 1) insert two Misoprostol vaginally the night before the procedure to help soften and open up the cervix, 2) start taking antibiotics the night before the procedure and continue until I run out of it, 3) take Ibuprofen and Tylenol with codeine the morning of, and 4) take a Val.ium an hour prior to the procedure.  I was allowed to have a light meal before the procedure.

When we arrived, I was quickly checked in and called back.  Somehow I knew I was a little anxious, so my blood pressure would reflect it.  I told the nurse who was going to take my blood pressure.  She told me to sit for a few moments first. When she operated the machine, she told me to imagine a vacation spot and good times.  I closed my eyes and visualized Hawaii.  The machine beeped.  My reading was 120/90.  Although the systolic number was fine, the diastolic part was a bit high.  I sat for a bit before she redid it.  Phew so much better.  This time it was 126/86.  If it remained to be 90 or over, I’d have to go to internal medicine to be monitored or something like that.  I also hate being weighed right after my vacation.  *Sigh*.  It was inevitable.

A urine sample was required to confirm the lack of pregnancy, although that was kind of silly and unnecessary as I have been on birth control pills for two months now.  I was situated in a temporary exam room.  A nurse came in to give me two shots on my behind.  I was told to face the exam table, place my palms on it for support, and pull my pants down a little for the injections.  I think one was to relax my muscles and the other one was for pain relief.  One on the left and one on the right.  I almost burst out laughing because it was just a very vulnerable and compromising position for one to be in.  I have high pain tolerance so the shots only stung a little.  However, when the muscles absorbed the medication, it actually burned quite a lot.  The nurse praised me as a great patient and went her merry way.  I felt drugged up from head to toe and was feeling a little drunk without having any alcohol.  I waited for a few more moments and was taken to the “Minor Procedure Room”.

This is another difference from UC.SF.  At my previous hysteroscopy, I was put in a gown and was connected to an IV catheter.  This time, I was told that at the clinic procedure doesn’t require that.  Only in the hospital operation room you are allowed to have an IV.  So here at Kai.ser, I was told to remove my clothes from waist down and drape myself.  I didn’t even have to change into a gown.  Dr. Gentle came in and was as pleasant as ever.  She said, “Let’s hope we have better luck today than the last time.”  I had on my Wonder Woman socks, and the nurses and doctor were ooing and ahhing over them.  I had my legs up on the stirrups while Dr. Gentle did her thing.  She was explaining to me everything she was doing, which I appreciated.  The nurse gave me a heat pad for my stomach area.  Nothing really hurt throughout the whole process except for the injection she did for numbing the area.  Boy that totally burned for at least 15 to 20 seconds.  I went “ouch ouch” a couple of times.

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After that killer injection, the rest of the procedure was pretty straight forward.  I felt tugging and pulling, then the doctor pumped saline solution into my uterus.  There was a beautiful sight of my uterus, unlike whatever I saw at my last hysteroscopy at UC.SF.  Dr. Gentle first checked the opening to the left tube.  She said it looked healthy and wide open.  Then she went onto the right side.  There was no scar tissue anywhere whatsoever, but there was something that looked initially like a polyp, then later on she said it looked like a fibroid.  It was this white substance that blocked the right tube.

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She checked again.  There was no scar tissue.  So I guess whatever Dr. Director saw during the saline sonogram was that fibroid-like thing.  Here comes the very very cool part.  Dr. Gentle inserted the Myosure probe and my fibroid was removed right in front of my eyes.  The device sucked the tissue away.  Later on the tissue would be retrieved and sent for biopsy.   The nurse took quite a few photos of each part of the procedure.

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During the procedure, because of the position of my legs on the stirrups, the bottom half of my body started shaking slightly.  I kept on taking deep breaths to stop my legs from shaking.  It helped a little.  However, towards the end of the procedure, my whole bottom half was shaking like a leaf.  I really didn’t want to interfere with the procedure but I couldn’t keep myself still.  I knew that it wasn’t because of me being nervous, because I wasn’t.  It was the weirdest feeling.

Once the doctor was done and removed all probes, I asked if I could remove my legs from the stirrups.  Wow so much better when I could put my legs together.  No more shaking.  I sat up.  Dr. Gentle showed me two pictures.  Here they are:

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On the top is the view of the fibroid on the left side of the image blocking the right tube.  The bottom picture shows the uterus free of any scar tissue, fibroid, or polyp.  The little reddish areas on the left and the right sides show the opening of my fallopian tubes.  The top whitish triangular-shaped thing was the Myosure device.  Dr. Gentle commented on how great my cavity looked and how great my lining looked.  She said that she was glad my UC.SF doctors thought that there was scar tissue.  If we didn’t remove the fibroid, any embryos implanted in that area would have been miscarried.  She said that there is no reason why I can’t get pregnant with such a nice looking uterus and lining.  Wow, isn’t that nice to hear?  A normal looking uterus that can get pregnant.  This is the best news I could get today.

I couldn’t help but compare my experience here vs. at UC.SF.  It was so stressful there at UC.SF because Dr. No Nonsense was frustrated and it was not successful.  Here, Dr. Gentle made everything looked easy and effortless.  I am sure it wasn’t, but she really did know her stuff.  I feel so fortunate that she was the one who removed the fibroid.

I went on to ask how I could show the results to my UC.SF RE.  Dr. Gentle is the nicest doctor ever.  She gave me those two pictures to show Dr. No Nonsense.  Then she told me to wait in the procedure room so she could quickly go and write the report.  When I got up from the table, blood was gushing out.  It took quite some time to clean myself up.  I was told that bleeding is normal.  I only waited for a few minutes before Dr. Gentle came in and handed me the report.  She said that I should wait a week before intercourse, but if I am going to ovulate soon, go ahead and do it.  Well, I have been on birth control pills, so there is no way I will be ovulating any time soon.  Dr. Gentle shook my hand, wished me luck with my upcoming cycle, and walked me out of the clinic.  The surgeon herself walked me out of the clinic.  What do you think about that?

We parked our car at my work, so we walked a few blocks back to get it.  I was walking so slowly.  With all the drugs in my system, I could just move at a very slow pace.  When I got home, I already got an email from Dr. Gentle.  This is what she wrote me:

It was a pleasure seeing you again during your visit to ob/gyn clinic today. I’m glad you were able to visualize your procedure and that all went so smoothly. As a reminder, I do recommend that you take your pain medications around the clock today, then as needed tomorrow and afterwards. Today, I recommend you take one each of your Ibuprofen and your Tylenol with codeine tablets at 2 PM and again at 8 PM. If you have significant pain between these times, you may also take another of the Tylenol with codeine tablets. Make sure also that you complete your antibiotic course as prescribed. Please refer to your patient handout for expected post-procedure symptoms, and feel free to email me if you have any questions or concerns.
Good luck with your upcoming transfer!”

I just love her.

I scanned the report and the photos of my uterus and emailed them to my nurse.  She responded saying that 1) I should continue with my birth control pills and 2) she will show Dr. NN my report and hopefully get clearance from him before we say Yes to a donor.

So this is it!  I am so grateful for good news.  It’s a fresh breath of air after having repeated bad news.  Most important of all, I am becoming hopeful again that this dream of having our own baby can really be accomplished now that my uterus seems to be good to go.  We just need to make some good embryos.  Praise the Lord that this procedure went so well.

Now we are all good to go with our next steps!!!  Wow!  This is such a great feeling!

More Uplifting News: Refund for the Hysteroscopy

It shows you that it really never hurts to ask about anything.

I emailed the surgical coordinator at my clinic about a refund or a partial refund for the botched hysteroscopy that we had paid for out of pocket.  It was a total of almost $2600.  She was on vacation until this past Monday.  I hadn’t heard back from her so I  emailed her yesterday.  Bless her heart.  She called and left a voicemail for me, saying that she would try her best to get us some refund but there is no guarantee as it is usually difficult to get money back from UCSF.  She had to file a lot of paperwork but she would let me know as soon as possible.  I emailed her and thanked her for her willingness to try.

I didn’t expect to hear anything back from her for a while.

And then this morning.  Her message came at 7:40am:

“We are going to refund the facility and pro-fee for this procedure. You are responsible for $185.00 for the medications.  It will take about 3 to 4 weeks to get your money back.”

Wow!  I was blown away.  I was expecting maybe a little bit of the refund for the professional fee but none of the facility fee.  This is the best possible outcome for this non-surgery.  The refund is going to go back to my health savings account credit card, so I can apply the fees for other medical expenses.  It is so nice to know that our own clinic does take care of us.

I can’t tell you how thankful I am for this.  What a wonderful way to start the weekend.

Praise the Lord!!!

Finally Some Relief – Hysteroscopy Surgical Consult

I can’t tell you how relieved I am right now.

Today was my consultation with a gynecological surgical doctor at Kai.ser.  I had had some anxiety and fears about the cost of the surgery, thinking that it could be a fertility-related procedure hence not covered by my insurance.  I was also fearful that my constant bleeding in the last month and the tugging and pulling feeling in my abdominal area were more serious than just hormonal changes in my body.  I know those were irrational thoughts, but I just couldn’t help myself.  My fear was manifested in my dream one day: I was rushed to the emergency room because of the discovery of a lump in my pelvic area.  You can imagine how I felt when I woke up from that dream.

I arrived at 10:45am for my 11am appointment.  To my surprise, I was called to the back immediately for my blood pressure and weight.  I knew I was anxious, and my blood pressure reflected it.  The nurse asked if I was a little nervous.  She said that I didn’t have to worry because I was in good hands with the doctor that I would see.  She said she would remeasure my blood pressure at the end of the visit.  I was already situated in the exam room at 10:55am.   The surgical doctor entered at 11:02am.  I’ll call her Dr. Gentle.  She was really really nice.  I’d say she is one of the nicest doctors I have ever met.  I had to tell her a brief history about my infertility journey as well as my surgical history since none of it was done at Kai.ser so she had no records of any sort.  I explained to her that my abdominal myomectomy was done to remove about 50+ tiny submucosal and intramural fibroids.  I told her that I did not understand how scar tissue could be formed inside the cavity, since a saline sonogram two years after the surgery did not show any scar tissue.  Dr. Gentle said that scar tissue is usually formed following a uterine surgery that might have penetrated through the uterine cavity.  There should not be any scar tissue if there was none two years after the surgery.  She suggested that I may not have any scar tissue after all.  Of course during the procedure she’d take a look and determine if anything has to be cut.

I explained to her what happened at the saline sonogram and the attempt at the hysteroscopy at UC.SF.  After hearing that my cervix was too wide, Dr. Gentle asked if Dr. No Nonsense tried to clip the cervix close.  Uh… I don’t think so.  She said that the cervix is supposed to be wide to allow the equipment to go in.  At Kai.ser, medication is given to the patients to soften and widen the cervix.  In that moment, I started to think that Dr. Gentle might be the better professional to remove whatever I have inside me than Dr. NN.  She really seemed more knowledgeable about these procedures than Dr. NN.  I said that Dr. NN suggested doing an operation under general anesthesia.  Dr. Gentle said that it is not necessary.  She suggested doing a clinical procedure rather than one at the hospital in the operating room.  Basically similar to what Dr. NN did.  Maybe even simpler.  She explained to me that a procedure done in the OR under general anesthesia is basically the same as one done in the clinic.  So there is no need to subject me to anything more than a localized sedation.  She is going to use a technology called MyoSure, which is a technology that removes tissue in the uterus without cutting into the uterine lining.  She gave me a brochure and told me to watch a video online about the surgery.  Because I am a fertility patient, she feels strongly that this is the best way to preserve my lining.  This procedure can be done within 10 minutes.  I can go back to work the next day.  And we can try to get pregnant again the following menstrual cycle.

I was feeling more and more relieved as she explained things to me.  I asked her how soon I could be scheduled with a procedure.  She immediately got on the computer system to look for a time.  Initially she gave me July 28th.  I told her that we would like to pursue an egg donor who could start a cycle in August.  It would really help us if I could be seen sooner.  She is such a nice and compassionate doctor.  She looked in the system again, looked at the calendar, and mumbled things to herself for about five minutes.  Then she happily announced that July 15th would work.  The timing can’t be more perfect.  We will return from our train trip to Chicago on July 11th.  July 15th is the earliest, best possible time for this procedure.

Dr. No Nonsense requested to email whoever is going to do my surgery.  Dr. Gentle said that she could schedule a time to discuss the case with him on the phone.  However, since Dr. NN is traveling outside of the country for a conference now, it’s tough for him to have a phone call.  Dr. Gentle said that the best way to communicate is for me to obtain my saline sonogram notes and my surgical notes, scan them, and email them to her.  I will get that done in the next week or so.

Dr. Gentle told me that my bleeding (three to four weeks worth before I started the birth control pill) is most likely caused by the hormones that I was taking before.  Scar tissue does not cause extra bleeding.  I was relieved to hear that.

Because of the cervix problem at my last hysteroscopy, Dr. Gentle performed a manual exam on me.  She said that my cervix looked and felt normal.  Then she put her fingers in to feel my uterus.  She commented on how well my previous OB/GYN performed the abdominal myomectomy.  She said that my uterus felt very normal after the removals of so many fibroids.  “Normal” is such a nice word to hear when all I usually get during doctor visits is bad news.  She told me that she does almost all of Kai.ser’s abdominal myomectomy in San Francisco.  I asked her if a full abdominal myomectomy is what she would do in my case, vs. a laparoscopic surgery.  She said that with 50+ fibroids, it was probably going to be really hard to do a lap surgery.  The trade-off is that a full abdominal myomectomy weakens the uterine wall so a Caesarean-section is needed.  This is going to be true in my case when I get pregnant in the future.

Dr. Gentle ordered all the medications that are required for the surgery for me.  She explained everything to me and gave me a printout.  I asked her about the codes of the procedure because I was still afraid that it would count as a fertility treatment rather than a medical necessity.  She wrote down that it was going to be clinic visit procedure and most likely a co-payment like the one that I paid today.  My diagnosis is Intrauterine Synechiae, which has nothing to do with infertility codes.  To find out the cost, I was told by her to go down to Members Services to find out, since the phone call that I placed to Kai.ser last Friday had not be returned yet.  After that, I could go down to the pharmacy to pick up the meds that she had just ordered. (Later on, member services told me that I would have to call the business office to find out the cost.)

Dr. Gentle saw me for a total of 40 minutes.  She could not be more thorough.  She put me at so much ease that I literally felt the weight lifted off my shoulder.  The nurse was right.  I feel that I am in very good hands as she is someone who does surgeries every single day.  Although I just met her, I feel confident in her ability to fix my problems.  The way she talked about it, it seems to be a very simple procedure.  Since I was so relieved, my post visit blood pressure went back down to close to normal.  Interestingly, I looked up Dr. Gentle online after my visit with her and found all these 5-star reviews on Ye.lp.  A surgeon.  Doesn’t it feel like looking up a restaurant???  But it is a great relief to know that she is so well liked and is such a great surgeon.

God is answering my prayers in a way that is unexpected.  Given the information and the timing when we scheduled the hysteroscopy with my own RE, I felt that it was the best choice at that moment.  Little did I know that God has other plans for us.  Maybe Dr. Gentle is supposed to be the doctor who should do the procedure.  I don’t know how God works.  But I know that I have been praying and asking God to steer us to the right path, and to give me peace and strength along the way.  I asked him to take away my worries and fear.  Today, I finally feel the relief that I haven’t felt in a long time.  It feels like there is an end to my wait in the pit.  I am slowly climbing out.  I am very thankful for that.

So here we are.  Finally some positive news.  Phew!

 

 

More Roadblocks – Unsuccessful Hysteroscopy

There has been so many roadblocks in our quest to pursue egg donation.  It has almost become comical.

Yesterday was actually a sunny day.  Since I had to fast four hours prior to surgery time, Bob took me out to breakfast early so I could be full before the time limit.  Usually there are plenty of metered parking spots in front of the clinic’s building.  However, on a baseball game day (since the new clinic is very close to AT&T Park), these metered parking spaces are easily all taken.  We fortunately pulled into the last available spot before a bunch of drivers drove by asking if we were leaving.  Once we arrived at the clinic, we paid up and I was taken to the back for a physical exam.  The nurse took my blood pressure, which was slightly high.  And she also checked my weight in a convoluted way: after seating me on the exam table, the nurse raised the table and pointed a hand-held device at me.  The weight was registered on the device.  That was a weird experience.  Why they couldn’t just have the old-fashioned scale is beyond me.  Anyhow, a doctor came in and explained the procedure to me.  Since I was still bleeding even after being on the birth control pill for two weeks, I was worried that the blood would obstruct the view of the uterus.  The doctor thought that a little bit of bleeding would be okay.  As she explained it, I knew that it was going to be a simple procedure with minimal invasion.  Basically, Dr. No Nonsense was going to put a scope in my uterus, check on the scar tissue, and use scissors to remove it.  Okay.  I got that.

After the physical exam, Bob and I were taken to the other wing of the clinic.  This new clinic is like a maze.  The procedure side of the clinic had this open view of the bay with a few barges parked there in the water.  That was Bob’s work place for the next 1.5 hours.  I was led to a recovery room to get ready.  This is actually where the clinic currently does all the retrievals and transfers.  It looks really nice, clean, and modern.  All the recovery rooms are separated and all with a view of the bay.  I changed into my gown.  Both nurses were super nice.  They administered two pills of Ativan and one Norco to me.  The petite nurse told me that she only works here one day a week.  While she was doing that, she commented on my nice juicy veins.  Well, I think because she was not used to the IV catheter provided by this clinic, she kept on maneuvering the catheter needle and could not get it to go through my vein.  I usually tolerate pain really well.  Her maneuver was making it very uncomfortable for me.  She apologized, took out the needle from my wrist area, and tried my arm.  Same thing.  No luck.  She mumbled something like it rarely happens to her.  I reassured her that it was okay.  The tall nurse, a regular nurse at this clinic, came to the rescue.  She tried my right wrist and got it in on the first try.  Thank goodness.  I think the Ativan and the Norco were really calming me down because I was just sitting there smiling.  The tall nurse suggested to bring Bob back to say good bye before I went in.  He came in smiling, saying that he bumped into Dr. NN in the waiting room and showed him the electronic medical device that he was working on for work.  Dr. NN was super interested in it because his wife is a physician with a discipline related to the body part for which the device is intended.  Bob and I chatted for a little and kissed before I was wheeled into the operating room.

In the OR, I was positioned on the table before Dr. NN showed up later.  As usual, I asked for extra blankets.  The nurses were so nice.  They kept telling me that the most important thing was my comfort level.  They would give me the minimum amount of Fentanyl to keep me comfortable.  I could ask for it any time my pain level would go higher than five.  They really took very good care of me.  When Dr. NN came in, the first thing he said was how enamored he was of Bob’s new toy out there.  So I said, Yes, Bob said that since Dr. NN was going to cut up his wife, it was only fair for Dr. NN’s wife to purchase a device from Bob.  Too funny.  🙂  For the next 20 minutes, Dr. NN was trying to get the computer to log off from someone else’s account so he could log onto his own account.  I lay there with my legs wide open waiting for him to do so.  Sometimes technology is very frustrating.

Finally, Dr. NN was ready to get started.  He exclaimed and said, You are not just spotting, you are really bleeding.  When he started to put in the speculum, I felt the pulling and the tugging.  The nurse was right next to me explaining what Dr. NN was doing.  She was gentle and reassuring.  I was lying there watching the screen while he was doing his thing.  I was watching and watching, and my heart sank a little.  I had seen a hysteroscopy done before at my OB/GYN’s office.  I knew what it should look like. Although no one was telling me what was going on, I could tell that things weren’t going well.  I saw on the screen what looked like the inside of me.  But I didn’t know what part of my body it was.  Was it still in the cervical area?  Was it already in my uterus?  It was hard to tell.  I could see narrow passages and some blood attached to the wall of some sort.  I could see what looked like torn cotton balls blown by wind.  After struggling for a while, Dr. NN mumbled something under his breath and took the scope out.  He told me that my cervix’s opening was too wide, so the water that was pumped inside me that was intended to be used to expand the uterus kept on leaking out from the cervix.  He had a plastic bag underneath the table that was filled with the water that was supposed to remain inside me.  Because the uterus could not be expanded, he could not get a good look at the cavity in order to find the scar tissue.  He said he wished that he could do this in the real operating room when I am put under, so that he could use a bigger scope and maneuver things around inside me without making it painful for me.

With me lying on the table with my legs wide open, I listened to him and was thinking, This can’t be happening.   I told him that I cannot get the other surgery done with general anesthesia at UCSF because of the cost ($18,000 out of pocket, which I can’t afford).  I paid for this current procedure out of pocket hoping that the scar tissue would be cleared.  In order to get the other surgery done, I would have to go back to Kaiser, using my own insurance.  Kaiser insurance does not cover for a procedure done at UCSF.  Dr. NN told me that he wanted to write an email and refer me to another reproductive endocrinologist at Kaiser.  I mentioned that I actually did have an appointment scheduled with the surgical team doctor at Kaiser for June 9th.  I intended to cancel the appointment but was too lazy to do so.  So I currently still have the appointment scheduled for next Tuesday.  He said that whoever is going to do my surgery at Kaiser could contact him via email so they could touch base and talk about what to do next.  Dr. NN looked at my face, and said, you are disappointed.  I said, of course I am.  I just want to get it done and be done with it.  So he said, Okay, let’s try to do this one more time.

Dr. NN pushed the scope through one more time.  Same scene on the screen.  Some blood spots, fleshy looking walls, and some torn cotton ball like material being blown by the wind.  And liquid that kept on leaking back out of my body.  He couldn’t expand the uterus.  He pulled everything out, and showed me the big plastic pouch full of bloody water that came out of my body.  I lay there, looking at him.  I was speechless.  What can I say?  We tried.  So I asked a few things.  I asked about the fees that we had already paid for.  Dr. NN said he would see what he could do about it.  Also, I was wondering what code would be used for the procedure at Kaiser.  If a fertility code rather than a medical code is used, then the procedure will not be covered.  He really didn’t know the answer to that.  It is left for me to figure it out with Kaiser.  Dr. NN finished up with me, then exited the OR to go talk to my husband.  Before he left, he said, “I know the procedure in the future will be simple so we will get you ready to have your babies.”  The nurses remained inside the OR with me and explained the whole thing all over again to me about what happened just now.  I really appreciate their kindness and thoroughness with me.  When I was ready, I got up and was wheeled back to the recovery room.

Bob came in with a big smile on his face.  I really appreciate him being calm.  Dr. NN had explained to him what happened.  Bob looked at me and asked if I was worried about the money.  He told me that it was just money, so don’t worry about it.  The good thing is, we can get it done, and we will.  It is just a minor setback.  Because of his calmness, I was calm as well.  I sat there sipping my ginger ale and eating my crackers.  After the nurses made sure that I was fine, they removed the IV catheter from my wrist so I could change and go home.

It was still sunny when we walked out of the clinic.  Sitting in the car, I started feeling a little nauseous.  It could have been from the meds that were given to me.  When we arrived home, I had to lie down because the discomfort in my stomach was becoming a bit too much to tolerate.  I fell asleep.  My mom, who came home later, applied herbal ointment on my chest to make me feel better.  She and my dad also bought us dinner so we didn’t have to worry about food.  It is very nice to be taken care of while my physical being was recovering from the experience during the day.

How about my emotional wellbeing?  Like I said, it has been one roadblock after another.  I never anticipated a problem with the saline sonogram.  And I never expected a failed hysteroscopy because it is really actually a very simple procedure.  I shouldn’t be surprised that things are not going the way we want because… really, things haven’t gone the way we want for quite a few years now.  There is always a surprise when we turn a corner.  What is important is our attitude towards these roadblocks.  Frankly, it still bugs me a little at this moment that the simple procedure could not be done successfully.  But I can’t help but think that there is a reason why this road is so bumpy.  We are doing everything we can.  But we are not in control.  I think we have really learned that nothing is in our control, or our doctors’ control.  I prayed and cried out to God to just take me down the path He wants and help me to have the strength and peace to go through with it.  And I feel fortunate that my laziness paid off as I still have an appointment with Kaiser really soon.

Some days are harder than others.  When times are tough, I am learning to be extra nice to myself.  Today I still took a day off as planned although the procedure was canceled.  I felt that some down time is good for my wellbeing.  I got up early and spent some cuddle time with Bob.  I went for a walk with my father.  Breathing in the fresh air in the park, bathing myself in the sunshine, and chatting about whatever with my own father, those two hours were well spent and good for my soul.  I need to learn to embrace the good moments, and this morning’s moments with my father were the perfect example of something simple and extraordinary.

Friends, I am trying.  I feel that I am going to stay in the pit for a little longer.  But it’s okay.  I am figuring out a way, with God’s help, to climb out of it.  Hopefully I will find the way out very soon.

This Blog is Two Years Old

I was lying in bed this morning trying to wake up.  It suddenly dawned on me that it is June 2nd.  Two years ago on a Sunday, I gathered up enough courage to register on WordPress.com and started a blog.

And of course, when I got up, WordPress.com congratulated me on my achievement of being with them the last two years.  It is a nice milestone.  I went back and read what I wrote about my first anniversary last year.  Looking at my words, there are some of the fundamental things that I still believe in.  I still believe that God is in control.  God comes through every single time.  Last year I was in a better place with not being bitter.  I was still full of hope.  And this was the end of my blog post:

“And I hope that by then our little binky moongee will be growing inside me (of course without the binky yet) and will soon debut to the world.  I am holding onto that hope.  Maybe then the blog should be renamed “In Quest of Another Binky Moongee”.”

These words moved me to tears.  Another year has gone by and I am no closer to that baby in my body.  I have held onto the hope and the dream that have not been fulfilled.  In fact, tomorrow is the day I am going to deal with this unanticipated problem in my uterus: removing scar tissue hopefully to get the green light to move onto an egg donation cycle.  I am having a really tough time to deal with this emotionally.  I wasn’t having as tough of a time before when I was banking embryo because 1) I knew and had accepted that my ovaries are crappy and 2) I knew that my fibroids on the uterine wall had already grown back but were not a big problem.  My uterine lining was never a problem, so I held onto that belief that as long as I can find some good eggs, we can make normal embryos that can implant and become a baby.  The discovery of this problem has made infertility so much tougher to deal with.  I usually could deal with this kind of unexpected issue.  However, recently, things at home have been very tense.  The tension is related to pride, family living arrangement, self-image, work, finances, and of course, infertility.  With the stress and tension at home, I am having a really difficult time coping with it all.  Nothing stresses me out more than having tension at home.  My shoulders are always up to my ears.  I feel that I can’t even find a safe haven in my own home because I don’t know when things will explode.  Focusing at work has become a challenge.  Unfortunately, work has also been very busy.  I need to force myself to take a deep breath and focus.  In this infertility journey, I have experienced my share of ups and downs.  However, I really don’t remember a time I am having such a difficult time.  More often than not, I have these strong desires to go somewhere and hide from everything: from my husband, my work, my family, receiving more bad news, the surgery, and having to choose a donor and going through with a DE cycle.

Last year this time, I didn’t anticipate that life would be so tough.  But it’s okay.  I don’t know what the future holds.  But I know that when you drop to the bottom of the pit, there is no where else to go.  So I hope I don’t stay there for too long before climbing back up again.

Hopefully when I climb out of there, the view will be the best that I will ever see.

A Stressful Week has Ended, Yay!!!

I am so glad the weekend is here.  Even better that it is a long one.

Last two weeks were some of the toughest weeks I have experienced.  Somehow I don’t quite recall how trying for a baby month after month, starting IVF the first round, and banking embryos for the second round felt.  Maybe because I got used to it and felt familiar with the process.  Now that we’re moving on to egg donation, I was expecting my uterus to behave like usual so we could just move on with the process.  The fact that a therapeutic hysteroscopy is required in order to move forward is making my psychological wellbeing suffer a little.  My cycle going a little crazy again also depressed me a little.  Let me explain.

Menses started on March 18th after our failed transfer.  I bled for days and did not ovulate at all.  Breakthrough bleeding started on April 30th (my wedding anniversary no less).  I expected it to last for a few days like my usual cycles.  No luck.  I was bleeding for whole 19 days straight.  Last Sunday it was getting heavier and I was even passing blood clots, which scared and worried me because blood clotting is not good for implantation and staying pregnant.  Blood clots are also something new to me.  I wrote my OB/GYN about the blood clots, and she still thinks that the IVF drugs threw off my hormonal balance.  However, if I continue to be worried, she recommends a visit with her.  I just had an uneasy feeling that bleeding for so many days with an increased flow and blood clots is not normal.  I emailed my own nurse at my fertility clinic.  She said that if Dr. No Nonsense detects a blood clotting problem, he would prescribe both baby aspirin and Love.nox.

Another thing is, the surgical coordinator told me to contact her on cycle day two so that I could start birth control pills in preparation for the hysteroscopy if we decide to go with my current clinic.  Bob and I gave it some serious thoughts and do want to pay out of pocket to get my RE to perform the procedure.  However, given my continuous heavy bleeding and my recent wonky cycles, who knows when cycle day two would be?  Another thing is, Dr. No Nonsense is going to be overseas for a conference for two weeks in June.  He wants to be the one performing the procedure.  If we don’t catch him early enough, then we would have to wait until he comes back late June.  My email to the surgical coordinator on Sunday inquired about the bleeding situation and the timing of the surgery.  We connected on Monday morning.  She informed me that Dr. No Nonsense wanted me to start birth control pills right away because I was still bleeding.  I would be on the pill until the day of the surgery.  However, if my bleeding stops before I can start the pill, then I really will have to wait until cycle day two to start it.  That will further delay the procedure.  I don’t quite understand the reasoning behind starting the pills on cycle day two.  But I respect the process.  I was surprised to see that after passing lots of blood clots on Sunday, my bleeding had reduced to spotting on Monday.  If I didn’t start birth control pills on that day, then I would really have to wait until my body decides to ovulate or to have breakthrough bleeding.  Then it might take us all the way to June or even July before we could begin to schedule for the hysteroscopy.

You see the urgency for me to take advantage of my bleeding situation so I could start the pill?

So that morning at work, I had to rush to have the surgical coordinator order birth control pills for me.  Since my insurance does not cover for prescription ordered by my fertility clinic, I could wait for my OB/GYN to write me a prescription.  However, if I waited for my GYN, I had a feeling that my bleeding would stop the next day, which means I could not start the pills right away.  Instead of waiting for my GYN, I found an online discount coupon for the birth control pills and just paid out of pocket at the pharmacy down the street from work.  I swallowed my first birth control pill in my life at 1pm last Monday.  My first birth control pill at age 40.  That must be some kind of record.  I must have had a good hunch about things, because bleeding did stop later that day.  Timing is everything, right?  However, I was still worried that I started the birth control pills at the wrong time (because the bleeding had stopped shortly after I took the pill) and that would jeopardize the uterine lining and thus the surgery.  I wrote the surgical coordinator for reassurance, which she gave me as she told me to just continue the pills until the day of the surgery.

As if this is not complicated enough (or that I have made it complicated enough), Bob and I got into a robust discussion that morning about funding the procedure.  We do have the money for it.  And since it is a medical expense, I can use my Health Savings Account money.  However, my HSA does not currently have enough funds so I would have to fund it with my next paycheck.  My next paycheck is on May 31st.  I notice that depending on when our work payroll person deposits the HSA checks, sometimes the fund doesn’t show up until 5 or 6 days after pay day.  So Bob would like me to schedule the procedure some time after June 6th so that the HSA money is enough to cover for the procedure.  That kind of stressed me out because Dr. NN is going overseas on June 5th.  If we don’t schedule something before then, then we’d have to wait until later.  But Bob was also going a little crazy about having to pay for one other thing.  I think psychologically he just felt that our fertility problems have gone out of control.  Just one thing after another.  Everything has been unexpected, of course.  And even when we were so prepared for having to do a egg donation cycle, we still didn’t expect my uterus to have problems.  So his frustration is not because of the cost of the procedure per se, but because of his sense of lack of control.  He even went as crazy as to say that we should just cancel our Chicago trip and some other things.  I found that when he feels the lack of control, he becomes illogical like that.  So this whole conversation took place online while I was juggling work, correspondence with the surgical coordinator, and emailing my GYN.  Finally, I stopped engaging in that online conversation with him and just stepped away.

And not to mention that I had a huge presentation scheduled on Wednesday so I was trying madly to finish up the final touches.  My dad was going to come to town on Tuesday from Hong Kong after not coming back for 2.5 years.  Given some sensitive family issues between my husband and my side of the family, it was stressful for me emotionally to deal with everything all at once.

I know that all of this may not sound like a lot to all of you.  But it was a lot for me to take.  I really didn’t need Bob to go crazy on me about finances.  Fortunately, my husband always thinks about our robust discussions afterwards.  One of the good things about him is that he comes around very quickly.  He became sane again and apologized later on.  When the surgical coordinator came back with June 3rd as my surgery date, I told Bob that we might have to use funds other than the ones in my HSA for part of the procedure.  He returned my message thanking me for trying to use my HSA and told me that it would be fine to use other funds.  I was so glad to get my logical husband back.

Normally I don’t get stressed out by any one of these things.  Somehow I had a really difficult time handling all of them at the same time.  I told Bob not to fight me on Tuesday and Wednesday because I needed to put my game face on for my presentation.  My body could feel my stress though.  My shoulder hurt.  My wrist hurt.  I was emotionally on survival mode.

Then this happened on Wednesday, the afternoon before my huge presentation:

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My husband sent these flowers to work for me to wish me luck at my presentation and told me that I would do an awesome job.  Aren’t they gorgeous?  He saw how stressed out I was in the past few days and wanted to cheer me up.

This has made up for everything.  The good news is, the presentation went really well, my dad arrived safely, and both Bob and I have been having a fantastic time with my parents.

Like I said, I am so glad the week is over.  Next week will definitely be better.

Hysteroscopy Needed

One more hurdle to overcome.

I totally thought that once we decided on egg donation, all we had to do was to choose an egg donor.  Other things would fall into places.  This is so not the case.

Dr. No Nonsense didn’t call me until Thursday.  The saline sonogram was on Monday.  So it took a whole three days for that phone call.  The “no-news-is-good-news” theory didn’t really work here.  Fortunately I actually was available to answer his phone call on the day when I had back-to-back clients.  As usual, he put me on speaker phone, which I really dislike because I feel like I can never have a decent conversation with him.  He asked if the saline sonogram was painful.  Actually it wasn’t.  I have pretty high pain tolerance for these things.  My previous saline sonogram or diagnostic hysteroscopy all did not hurt at all.  Even the hysterosalpingogram (HSG) didn’t hurt either.  Anyways, Dr. NN said that it looked like there is scar tissue.  No one knows how much there is.  So he said that he would need to go in and clean out any scar tissue that I may have.  He would prefer to do it when I am awake vs. me being totally sedated so that I can look at the procedure being done.   He hoped that we could clear all of it out using this procedure.

I just remember my heart racing fast and my mind going wild.  I just don’t want any sort of surgery if I don’t need it.  I was really hoping that we didn’t have to go down this route.  I just wanted Dr. Director to be wrong and for Dr. NN to say that the images from the saline sonogram were fine.  I always pride myself for having a good lining because it has never been a problem.  The fact that there is scar tissue that needs to be cleaned out is enough to make me want to puke.  But I held myself together and started asking questions about logistics.  I have Kai.ser insurance, which means that whatever procedure I do at UC.SF will not be covered by my insurance.  I reminded Dr. NN that fact.  I could hear him go Ugh.  He didn’t know the cost of the surgery.  So I asked him, “Is it a hysteroscopy that you wanted?” since he never told me what the procedure was called.  He said Yes.  And he said that I could get it done at Kai.ser, but that means that it will most likely be done under general anesthesia in the operating room.  If that’s the route I want to take, he would want to talk to my doctor at Kai.ser.  He told me to give my nurse’s email to my Kai.ser doctor to contact him.  And if I prefer to have the procedure done at UC.SF, the financial coordinator can contact me.

We hung up.  I really was not feeling good that a procedure has become a reality for me.  I could have felt sad, or mad.  However, I didn’t have time to analyze my feelings because my problem solving mode was turned on.  In the short 10 minutes that I had left before I saw my next client, I emailed my Kai.ser doctor, updated Bob about the situation, and emailed my own nurse to get some questions answered, including my bleeding problem that I was too flustered to remember to ask Dr. NN.  Bob was sad and frustrated.  He was mainly mad at himself for quitting his big corporation job and losing the fantastic health insurance that came with it.  He was mad that this could all have been covered at UC.SF had I continued to use his big corporation insurance rather than having to sign up with Kai.ser through my own work.  Nobody could have predicted what might happen in the future.   So it’s really not helpful to blame oneself.  I told him that we can’t worry about what has been done already.  We have to look ahead.  He said that he wanted to scream out of frustration, but he would try to persevere, like I was doing at that point.  He felt so sorry that it has been so tough on me.

I went on to see my next three kids.  It was really tough to get myself together.  But I did it anyways.  I really had no choice.  I tried as best as I could be to focus on the kids, but at times, my mind drifted back to the reality of having to do a hysteroscopy and possibly delaying our egg donation process.  My mind again went to a dark place: the fear of not being able to carry a child to term because of whatever problem I have in my uterus.  Again, I know this is not logical.  But that’s what fear is.  Not logical.  My mind went far.  The possibility of losing the egg donor. The possibility of scar tissue that is too serious and needing a gestational carrier.  It was scary to let my mind go so far.

One great thing about Kai.ser doctors is the accessibility to the doctors themselves.  My OB/GYN, whom I have never met in person before, returned my email right away.  She said that this kind of procedure is usually done in the operating room by the Kai.ser surgical team. She could make a referral for me if I would like.  I wrote her back asking for a referral. I also wrote again, gave her my background of my IVF cycle, and asked her if my 15 days of bleeding was a concern.  She said that it is most likely the extra hormones in my system that cause the vaginal bleeding, because scar tissue doesn’t usually cause that.  She also said that the surgical team will call me in a week to schedule an appointment, and at that time my questions regarding diagnostic code and procedure code will be answered.

The whole night on Thursday, while I was still waiting for the quote from UC.SF on the procedure, I became more and more calm about this new development.  Like I said, I have turned to problem solving mode.  Things may get delayed for a little.  But I would rather get this done first than to risk having implantation problems because of scar tissue.  At the same time, I feel like one day I may just explode.  There just has been one twist after another in our quest of a baby.  It has been really tough.

God really spoke to me that night.  The several daily reading plans that I read all helped me refocus my eye gaze back on Jesus.  One says, “But there is one thing that will never change, even through the ups and the downs of infertility.  Jesus Christ is the same yesterday and today and forever.” (from Infertility Encouragement from Sarah’s Laughter)

Another passage says, “When it comes to hardships in life, it is common to feel as though you are stuck…… When bad things happen, it’s understandable to feel continually defeated in your heart and spirit.  We can be tempted to think that we will always stay stuck….. One of the best gifts God has given to use is free will……. We have free of choice… we can CHOOSE joy.  We can CHOOSE to run to God. We can CHOOSE to do something about life from this day forward.  We can CHOOSE to pick up the pieces and create the best life possible with God’s direction.” (from Grief Bites: Finding Treasure in Hardships)

With these reminders to put my focus back on God, I fell asleep.  I woke up feeling mostly at peace.

My nurse returned my email saying that 1) the financial coordinator will contact me, 2) the bleeding could be a sign of perimenopause and I could be put on birth control pills to stop the bleeding.  I was taken aback a little by the word “perimenopause”.  But I guess, we have already chosen this route of egg donation.  So whether on perimenopause or not, I should be okay.

About an hour later, a surgical coordinator from UC.SF contacted me informing of the cost of a hysteroscopy in the office with sedation.  The total of facility fees and professional fees for scar tissue removal is about $2600.  If Dr. NN finds more than just scar tissue to remove, the professional fee may increase with the maximum of $500.  I was to contact her when I would like to proceed.  Dr. NN would most likely start me on birth control pills or Aygestin on cycle day two and schedule the procedure 15 days or more after I have been on the medications.  I asked if I could chat with the doctor one more time to learn about why I should get it done at UC.SF instead of Kai.ser.  The coordinator said that since Dr. NN has been following me, he knows how much to remove.  I asked about the cost of the procedure done at an operation room with general anesthesia because that will most likely be the procedure done at Kai.ser.  I was shocked to learn that it would cost $18,000 at UC.SF.  Uh no thank you.

So currently this is what we are facing.  A choice between paying out of pocket at my own clinic with my own reproductive endocrinologist or possible insurance coverage for the procedure at Kai.ser.  I haven’t called Kai.ser to learn about the cost.  I have a high deductive insurance plan so I will need to pay out of pocket up to a certain amount before insurance starts to cover for health-related cost.  The cost of the hysteroscopy at UC.SF is actually well within my expectation.  I will contact Kai.ser this weekend or on Monday to get a quote.  Another thing is that, I don’t know what code will be used at Kai.ser.  If an infertility diagnostic code is used, then the procedure will definitely not be covered.  So that’s something I have to look into.  Plus if it’s not covered, the cost of doing the procedure with general anesthesia in an operating room at Kai.ser is going to be really high.  I may as well just get it done at a clinic with which I am familiar.  Then I’ll just have to put on my big girl panties and do it with sedation in an office.  Hopefully it won’t hurt too badly.

Yes.  One more hurdle.  But I think we are in good hands: both God’s and the doctor’s.  I just pray that Bob and I will continue to remain calm and get over this hurdle with the peace and strength that only come from God.