MicroblogMondays: Getting Back To Normal

Microblog_Mondays

Ever since I returned from the Maui trip, I had felt like I had a hard time getting back on my routines.  We did have a mini “staycation” on Sunday when we did nothing.  Not even going to church.  I knew that it was a wise decision because I was still recovering from my cold so I just wanted to sleep in.  Plus Mother’s Day and baby dedication at church were going to be too much for me to handle.  Bob and I are usually greeters on the second Sunday of the month, which Mother’s day always falls on.  For the last few years I put on a brave face and did my duty.  It was usually okay.  But this year was different.  Ever since we were told that I may not ever get to carry my own baby, the idea of greeting on Mother’s Day at church became too much for me to handle.  One way to show yourself some grace is to know our own limits.  This time, I knew not to force myself.  So my wonderful husband arranged for us to take a day off from church duties.  We just chilled and rested at home.  However, that was still not enough.  My mid-night coughing from the postnasal drip and stuffy nose made it hard to sleep through the night.  I had such a hard time waking up in the morning at my usual time for a few days.  This fatigue carried on throughout the day.  When my body was not feeling well, my mind was not in the right place.  Life feels more grim when one does not feel well physically.  I felt like I had a cloud hanging over my head because I knew that we had to eventually make a decision about our next steps.  However, I didn’t have the mental capacity to think about the future.

My cold and cough had cleared up a great deal by Wednesday.  That was when I started to think about our future.  I was and am still feeling quite confused about this whole situation.  There are many possibilities and it is hard to see how it will play out.  What I didn’t write about a couple of weeks ago was that Dr. No Nonsense, my RE, contacted me by phone one night.  It was quite late at night but he couldn’t get a hold of me during the day.  Since I didn’t expect his phone call, I didn’t prepare myself with questions.  It was unfortunately a short phone call.  He said that there are no data to support that surgery makes a difference in pregnancy outcome.  To him, Lupron does not hurt, so we could try Lupron for three months and attempt a transfer.  When I asked about adenomyosis and the risks of pregnancy, he seemed to be annoyed that I had gone to Dr. E to get a second opinion.  I forgot exactly what he said but that was the impression that I got.  Then he told me that he had to go, but he promised to call me back the next day.  That was more than two weeks ago.  He never called me again.  I started to get sick on that day and I didn’t have enough time and energy to track him down.  So we haven’t talked since we left the conversation.  After speaking to him, I felt more confused.  So finally, Bob and I decided to try Lupron for three months and transfer, and at the same time look into surrogacy.

I wrote Dr. Gentle, my surgeon, about doing Lupron for three months and scheduling scans to check if the mass has shrunk in order to get ready for a transfer.  Her email back to me made it sound like she does not approve of our plans of just using Lupron.  This is her email:

I would discuss this plan with your fertility specialist first to make sure they agree with it. Your MRI shows that you have a large fibroid or adenomyoma that has a large endometrial component. Most of your uterus appears abnormal. Even if it shrinks, it is very likely to continue to have a significant endometrial component. This would make your uterus ineligible for embryo transfer as it would increase your miscarriage rate. The Lupron would still be helpful in shrinking the fibroid and treating any adenomyosis, and it can help to facilitate surgery, but it is unlikely to render your uterine cavity normal. You may still try to conceive if your cavity is not normal, but most clinics will not do embryo transfers into an abnormal cavity.”

So does it mean that we shouldn’t even pursue a transfer into me?  I am left even more confused than ever.  I wrote Dr. E this really long email asking for her opinion since she should have received the CD that contained my MRI images.  She wrote back quickly and said that she’d share her thought with me soon.

In the mean time, our donor is in the process of the cycle that is prior to ours.  So hopefully it will be our turn soon. Dr. E did share with me that our donor’s most recent complete cycle had excellent results.  All eight out of the eight blastcysts that were tested are all genetically normal.  At least that’s a piece of good news for us.

I also feel good enough to start to learn about the surrogacy process from wonderful ladies in this community who are caring enough to share their knowledge with me.  Lovely Dreaming Of Diapers spent so much time with me telling me about her experiences working with her sister as her gestational carrier.  Another friend of a friend who had a ruptured uterus and loss her baby at 32 weeks is now expecting her baby via surrogate to be born in the next two weeks.  She also spent a significant amount of time going over the steps, the process, and the cost with me.  I am forever grateful for them because the more we know about the process, the more the mystery is lifted, and it does not seem like a huge beast anymore.  My dear friend behind Dreaming of Diapers shared her wisdom with me, that if we go down this path, we will get tested, but it is totally worth it.  She tells me to put one foot in front of the other then we’ll get there.

I hope that this coming week my body can feel 100% well so that my mind can be cleared up even more for making these important decisions.  I have been praying for wisdom and a clear path to emerge.  My hope is that with Dr. E’s opinion and Dr. NN’s opinion (if I can ever get a hold of him), we can move forward with whatever that we need to do to bring our baby home.

A Week Into My Vacation

I have been thoroughly enjoying my vacation.  I sleep in until whenever I want to.  I met up with my friends, some of whom I hadn’t seen in ages.  I went shopping and attended a couple of Christmas services.  Bob has been home so we have enjoyed our time together as well as fought some.  And we’re getting ready for our trip to Pacific Grove for three days.

Thank you so much for your support when I last wrote about my friend.  We finally chatted on the phone for about thirty minutes.  My heart was beating fast before she called.  I just didn’t know how I would react to her during the phone call.  I was surprised that I remained quite calm throughout the conversation.  She’s currently 14 weeks pregnant.  I did my calculation.  When I saw her last, she probably found out about her pregnancy the following week.  So she did not know that she was pregnant when we met.  Somehow that made me feel a little better, and I don’t know why.  She did one blood test, of which I totally forgot the name.  It could have been Mate.rniT21.  The results were normal for that test, meaning it didn’t detect any chromosomal abnormalities in the baby.  However, the subsequent NT scan showed that there is a 1 in 46 chance that the baby could have Down’s Syndrome.  She described the shock when a genetic counselor came in to talk to them.  She and her husband did not expect this because the first blood test didn’t indicate as such.  My friend was told that the NT scan is not a diagnostic test and the mother’s age is weighed heavily when the results are calculated.  She’s not quite worried about it as the first blood test said that the baby is fine.  My friend decided to do amniocentesis to find out precisely if the baby has Down’s Syndrome.  She said CVS is out of the question according to her doctor.   We discussed about the risk of doing amnio.  She said that she would want to find out because she can’t really live in this state of unknown throughout her pregnancy.  Her amniocentesis is going to take place right after the holidays.  She didn’t specifically say what she would do if she finds out that her baby does have Down’s Syndrome.  But from the way she talked, my speculation is that she may consider termination.  I am not her so I don’t know what she’s going through.  And I am not one to judge what others should or should not do.  But it pains me that she is faced with this situation and she can’t really enjoy this pregnancy yet.  I really hope that everything is going to turn out fine because I will hate to see her face uncertainty as well as an extremely tough decision.  I was touched that she said she felt guilty and that life isn’t fair because she got pregnant so easily and I have had to struggle so much.  I appreciate her thoughts and feelings for me.

We all got together that night after the phone call with two other friends.  She didn’t look pregnant at all.  And everything came very naturally.  Nobody talked about anyone’s pregnancy or the lack thereof because there was plenty to talk about among four women.  They mostly complained about husbands and relatives.  Haha.  It was a great time to get together and I am so glad that my friend and I had a great talk ahead of time and got all the issues out of the way before we met.

I also met up with one of the donor coordinators at the brand new location of my clinic.  The new location is about 12 minutes away from my house, but about 25 minutes from work.  Plus it’s somewhere that is very difficult to get to via public transportation.  If Bob ever has to come to the appointments with me, we’ll have to make special arrangements for him to get to work.  I arrived and scored a non-metered street parking.  I arrived early and was told to wait in the Marina Room.  This waiting room has some fancy looking chairs that were extremely uncomfortable.  I sat in one and immediately started to have backaches.  The back of the chair was curved in a way that you can’t really easily lean back.  If you lean back, your feet can’t really touch the floor.  After sitting there for a while and was still not called back for my appointment, I switched to another smaller chair.  It was extremely  uncomfortable as well.  I finally sat at the sofa that was attached to the wall.  These sofa seats were extremely short.  I think half of Bob’s thighs would hang out if he had sat there given how tall he is.  It’s ridiculous that the clinic spent so much money to build a nice place but did such a horrible job with the chairs.  Why did I have so much time to examine the chairs and complain about them?  Because the donor coordinator was 25 minutes late in taking me in.  And I was the only person in the waiting room since this new location has not been exactly in use yet.

The donor coordinator and I talked for about 25 to 30 minutes.  Here is a summary of what we talked about:

1) You’re guaranteed at least 6 eggs for frozen egg cycles and two transferrable embryos.  If the patient doesn’t not get at least two transferrable, decent embryos, then the fees minus the cost of the medications will be applied towards a new frozen egg cycle or a fresh donor egg cycle.

2) Currently there is only one Asian donor with frozen eggs available.  Fortunately, she is one of the choices we have been considering.

3) Once the donor coordinator learned that I am 40 years old (relatively young to her) and that I want two children, she recommended that we pursue fresh donor cycles because of the potential of more embryos and more to be frozen for a second child.  She wants me to consider having a chance to have children who are fully genetically identical rather than just half.

4) Pure Chinese donors are very hard to come by.  In order to find one, we will have to contact donor agencies.  This is exactly what Bob doesn’t want to do because of the extra cost.

5) We cannot be placed on the wait list for any of the donors until we meet with the psychologist on staff.  Both Bob and I have to meet with her.  Initially the coordinator scheduled us with the psychologist the second week of January.  After knowing that we may have a retrieval and transfer that same week, she wanted to wait until our beta is done before we go to the appointment.  My beta will potentially be done by the end of January, so the appointment is scheduled for the first week of February.  We just cancel if we find ourselves pregnant.  The cost of the session will be counted as part of the cycle if we decide to go with the current clinic.

6) Since we’ve been cycling with this clinic since September, the donor coordinator is going to backdate my priority on the wait list.

7) Since we’ve been cycling with them, I most likely won’t have to redo all the pre-cycle testings.

8) The timeframe from being matched to retrieval/transfer will be within three months.

9) This clinic doesn’t provide any guarantee programs, so all the money that you spend in one cycle will be gone once you pay.  Patients can participate in ARC which is a program for financing.  And we don’t want to do financing.

10) We’ll stay with the same RE for donor cycles.  Dr. No Nonsense it is.

11) For any clinical/medical questions, I was told to talk to my nurse or doctor.

12) In contrary to the books that I have read, I was told by the donor coordinator that we don’t have to get an attorney to do any sort of contracts or consents for the donor because of the laws in California for the protection of intended parents.  Once signed the consent, the donor relinquishes all the rights to the eggs harvested.  She said that none of her patients have used an attorney.  So one less thing to pay for.

13) The donors at this clinic are screened with strict guidelines so that will be an advantage over donors found through an agency because the screenings for first time donors have to be done after the match.

I checked out the donor agencies recommended by the clinic online.  Some of them do have Asian donors, but I still haven’t seen any pure Chinese donors.  It sounds like a cultural thing to me, as egg donation may be attached with certain stigma.  There are a few half Chinese donors.  This may really be something that I’ll have to seriously consider.  Bob and I would like to start our donor egg cycle as soon as possibly if our own egg cycles fail.

So research goes on.  And it can get tiring very fast.  Sometimes I don’t want to think about it.  But at other times, I feel like I really need to learn more so that we can move on.

Another question we have to consider is, do we really want to have a second kid if we are fortunately enough to have our first baby.  Bob has been feeling very frustrated and tired of the process.  And if we’re fortunate enough to get pregnant and for me to give birth at age 41, it’ll take me a while to have a second baby.  Do I really want to try again at age 43?  These questions are coming from a man who had always wanted four children.  But this whole path of infertility has made the desire to have more than one child a dream and a goal that seem very difficult to reach.  I don’t blame him for being tired.  But we have to leave a chance for us to have the choice to have another child.

So in the 36th month of us trying to become pregnant, we’re faced with many choices.  Emotionally, I am surprisingly feeling better than a year ago.  I remember how sad I was on Christmas day because of one of my friends’ pregnancy announcement.  This year I wasn’t ambushed on Christmas day, although my Dear Colleague gave me a heads up that a coworker announced her 7-week pregnancy on one of the days when I was not at work.  I am not much affected by her, although I wonder why people announce their pregnancy so early on.  I am not immune from sadness, but I have learned to handle my emotions a lot better.  I am determined to enjoy my time with Bob.  We had a nice few quiet days to ourselves at home.  I am thankful for restful time, and we’re set out to do that in the next few days during our trip.  One way or the other, we’re moving on.  And I am happy that we decided to enjoy our lives and each other in the midst of this infertility storm.  I have been looking forward to this trip to recharge.  Hopefully the quiet time will help me recuperate and allow me to have the strength to make all the decisions we have to make.

Today is the 9th day after ovulation.  I confirmed with one of the nurses that I would start Est.race for estrogen priming starting on day 7 past ovulation.  I hope that my luteal phase will be regular (about 14 days) and that my period will come next Wednesday or Thursday so we don’t have to cut our vacation short for my baseline appointment.

IVF #8 will start in less than a week.  I am hoping for a very good beginning of 2015, whatever life may bring.

Maybe A Therapist Can Help

The ups and the downs in the world of diminished ovarian reserve.

I have been so excited for my blog friends who have gotten pregnant using their own eggs or donor eggs.  I was particularly excited for Maddie.  She went through a hell of a time banking her eggs for many cycles because of her husband’s sperm issues.  She eventually had to use donor sperm to fertilize all the eggs that she tirelessly saved up for a long time.  She got her first BFP ever in her life only to find not-so-good news at her first ultrasound.  It has not been confirmed yet but the situation doesn’t look good.  My heart breaks for her.  I was overjoyed when I learned that she was pregnant.  I hate it so much that this already difficult journey is not smooth sailing for her.  I know I project a lot of my hopes and dreams on her because of the similarity of our situation.  I really didn’t want her to experience the chemical pregnancy/early miscarriage that we all dread.  If you have a moment, could you please go give Maddie some love and hugs?

*****

I have so many questions in my head for the next steps.

I had two phone consultation last week with the clinic that suggested egg donation for me.    I did it just for the heck of it.  I want to see what a donor egg cycle entails with this particular clinic just to see how doable it is.  The first one was with the nurse coordinator.  During the hour-long phone call, I learned a dizzying amount of information regarding donor egg cycles.  I have been reading the Insider’s Guide to Egg Donation so I am not unfamiliar with the process.  However, it is still a lot to learn.  This particular doctor/clinic requires specialty blood tests to be done for anti-phospholipid antibodies, natural killer cell assay, and TH1/TH2 intracellular cytokines.  This costs $1322 for the lab in Chicago and $55 for this clinic to send the blood over.  The coordinator also explained the difference between frozen egg cycles vs. fresh egg cycles and what each entails.  It seems like each batch of frozen egg costs from $10,000 to $15,000 depending on the agency, and a fresh donor cycle will cost $5000 to $10,000 for the donor compensation and $15,000 for agency fees. That doesn’t include the fees for the clinic.

The second phone call was for a financial consultation with the same clinic.  They offer frozen egg cycles and fresh donor egg cycles.  I learned how much everything cost for this one particular clinic.  There is a choice of frozen egg cycle, which is the least expensive.  It follows by a single fresh egg cycle.  The most expensive option is the shared responsibility plan that refunds 90% of part of the fees if you don’t get pregnant after transferring all the embryos.  The kicker is that the full fee that you end up paying is $12000 more than the package price that is quoted.  These are fees for necessary procedures such as ICSI, assisted hatching, culture for embryos, etc.  You would’ve been fooled by the fee structure published on the website.

I was quite shocked at the sticker price for a whole IVF cycle with donor eggs.  I originally thought that it’d cost about $35000 for a fresh donor egg cycle.  Now I have to rethink the whole thing.  I know I can do frozen egg cycles.  We do want to have two kids though, so it seems like a fresh donor cycle that goes well has the most potential of giving us multiple embryos and a chance to freeze.  I have a problem with paying this clinic so much money as their success rate isn’t even the best.  UCSF’s donor egg cycle success rate is even better than theirs.

With this new information, I have become more reluctant with the thought of exhausting all of our IVF fund on mini-IVF cycles with my own eggs.  What if they don’t work?  Then we’ll have to spend many many months saving up again.  So I told Bob that maybe we should do at most three mini-IVF cycles in order to leave some money for egg donation if those fail.  He told me to take some time to think about it as he wants to do as many cycles as I desire.

I have been doing research on other clinics that have a good reputation with donor egg cycles.  S.DFC seems to be a good choice.  R.BA is a bit too far away for me.  I would love to talk to the ladies who are cycling at these places or have cycled and have found success.  Egg donation in the States is so pricey.  I joke with Bob about having a donor with blonde hair and blue eyes as we learned about Aramis’ wonderful news with her donor egg cycle in the Czech Republic.  We doubt that we can find a donor with black hair and brown eyes there, but the cycles are so much more affordable.

The interesting thing is how open my mother is to this idea.  I shared with her about my various online friends’ life and mentioned about Aramis’ success.  She said excitedly, “You should go try too!”  I asked her if she realized that it’d be most likely with a donor who is of European descent.  As first she was taken aback by it and said to find an Asian donor first.  I joked with her and asked, “What if we really decide to go for a cycle in the Czech Republic?”  Her answer surprises and warms my heart. She said, “As long as you and Bob think that this is the right choice.  We’ll be 100% supportive and will love the baby all the same.”  I had never expected or imagined my mother to be so open with her thoughts.  She is a Chinese parent after all.  To me, it shows how much she loves me and how much she wants the best for us.  She told me to let her know when we get pregnant.  I said, it’ll most likely be four months into the pregnancy.  She was again very much okay with it, as long as we tell her.  Bob said that his mother would’ve demanded to know right away (if I were an Indian daughter-in-law).  My mom has a beautiful soul.

Anyways, back to my decisions.  At this point, it’s not simply (which is not simple at all) about choosing donor eggs vs. own eggs and SoCal vs. UCSF.  It’s about how many mini-IVF cycles we do so that we leave some money for donor egg cycles knowing the cost.  Our preference is not to borrow money so saving up money is the only way.  I am very grateful that we’re in the financial position to save up.  It doesn’t come very easily and we have to make good choices financially along the way so we can achieve our goal faster.  Bob has the vision, intensity, and the passion to save up towards this goal.  I feel this very heavy financial burden while we get ready for our next cycle.

I think I am leaning towards UCSF.  However, I have irrational (or not so irrational) fear that I am not doing the best I can and taking the “easy” way out (again, it’s not at all easy) if I don’t bank embryos for 6 or 9 cycles in SoCal.  Am I not trying my best if I don’t go the difficult, stressful, but maybe more promising route?  Is SoCal actually a more promising route?  One lady who got pregnant after banking many cycles in SoCal actually transferred a day two embryo (that was immature to begin with) for her first transfer instead of the other blastocysts that she banked.  My point is, it wasn’t Life’s good culture for growing blastocysts that made it possible for her to be pregnant.  It was the normal egg and an element of luck plus her good lining.  So it could happen to me at UCSF as well if we bank and transfer day 2 or day 3 embryos.

Instead of going crazy with my questions, I searched and found a therapist who specializes in infertility and even third party reproduction.  I wrote her an email and was pleasantly surprised to find that 1) her clinic is a few blocks away from my work, 2) she has evening hours, and 3) her rate is reasonable.  Ever since Bob switched to small companies, we don’t get coverage for therapy anymore and we’ll have to pay out of pocket.  I am happy that he’s very open to it. (See, he’s reasonable when it comes to important things and to him, flowers are not important.)  Anyhow, the therapist and I had a phone intake.  It was a fresh breath of air to know that she didn’t need me to explain anything about IVF or egg donation.  I just told her my history and she knew exactly what I was talking about.  We made an appointment for our first session next Wednesday.  I would really like this time with a professional to sort out my thoughts and feelings regarding this whole thing.  I love talking to various friends but I think it’s about time to talk with a professional.  At the end of the phone call, she asked me what insurance we had. I told her that we had Ka.iser which does not cover for mental health outside of Ka.iser.   She gave me a $20 discount, stating that it’s unfair for Ka.iser patients that they don’t get reimbursement.  That was so nice!  It’s still a lot of money but I think it’ll be helpful for us.

*****

Wow that’s a load of information.  Ladies who have gone to S.DFC or R.BA, could I get some input from you?  Thanks in advance!

Tearful

I have been feeling tearful today.  The trigger?  My last phone consultation with an RE.

I had scheduled this phone consultation a month ago.  It was scheduled for July 8th at 1:45pm.  In anticipation of it, I called the 2pm client’s mom and scheduled them for 2:15pm.

Yesterday I scheduled an phone conversation with the precycle coordinator at UCSF to go over the checklist of things that I need to get done.  It was to take place  today at 10am.  I figured that I could do one phone call in the morning and one phone call in the afternoon.  No problem.

A little later in the afternoon, I stared at the appointment reminder email for the phone consultation and realized that the time of the phone call was supposed to be 1:45 pm, but EASTERN TIME.  The RE is in New York so of course the phone call is 1:45 pm his time, which translated to 10:45 am my time.  DUH.

Good thing I caught this mental mistake the day before the appointment.  I was confident that I could finish the UCSF phone call by the time I call the New York RE.

Fast forward to today.  The phone call with UCSF was 40 minutes.  My head was spinning writing down all the previous lab work and procedure that I have to check and all the new lab work that will be ordered.  When the phone call ended, I quickly went and got ready for my 11am client.  At 10:45 am, I called the clinic of the New York RE.

Very nice guy on the phone.  Very obviously did not read my history that I took a lot of time to fill out.  He asked me a few pertinent questions.  Then his conclusion:

1) There are usually three causes of high FSH: familial, autoimmune problems, and endometriosis.  It looks like mine could be endometriosis (a small patch of endometriosis was removed during my surgery to remove fibroids back in 2011).

2) He suggests doing an immune testing panel with him, which will cost $3000.

3) He suggests doing laparoscopy to remove all the endometriosis that exists inside me.  Usually he will have to accurately diagnose it.  But since endometriosis has already been discovered in my system, we can skip that part.  He predicts that since the surgery was three years ago, the endo may have worsened at this point.  He recommended going to a doctor that specializes in stripping away the endometriosis rather than just lasering it away.

4) I should go see him for a workup and he can talk about the next steps.  He can work with local doctors if we decide not to do IVF again.  If we do IVF, we have to do it there.  He thinks that for my age, I should continue to pursue IVF because I don’t have a lot of time to waste.

5) He thinks that my high FSH, poor responses to stimulation, and egg quality all have to do with endometriosis.  After treatment, my response should be better.

All this information was gathered in a 10-minute phone conversation.

I was feeling very overwhelmed.  This is a brand new suggestion.  I have asked Dr. E, my previous RE, and Dr. No Nonsense about the cause of my high FSH.  They both said that it is difficult to know the cause.  I asked Dr. E if it could be because of immune issues, and she said that it could well be, but there is no treatment for it.  Dr. Y from Southern California is the only doctor who has ever said that my endometriosis is a factor in my response to stimulation.  However, he never suggested a surgery to remove it.

My head felt overstuffed with ten thousand pieces of information.  Where do I go?  Do I do a surgery?  Do I just go with the local doctor and try a few more cycles?  Do I try to remove the endometriosis to see if my response is better?  Am I not trying my best if I don’t do what this doctor suggested?  Am I not giving it my all if I don’t go the difficult route of traveling out of town for treatment?

I am going to turn 40 in two days.  A year ago, we started our first IVF cycle and had the retrieval on my birthday.  I played in my mind many scenarios last year.  Will I be pregnant in a year?  Will we already have a baby by then?  What will the next year bring?  Will my 40th be a happy occasion, celebrating with a new baby or one growing inside me?  Or will it be the same as last year, only a little grimmer, a little less hopeful, a little more fear-filled?

I am usually pretty good at being hopeful.  But today, I allow this fear to set in.  In a year, will I be still in the same situation?  At a crossroad?  No baby?  No pregnancy?  No clue what to do?

I know it’s hard to predict what is going to happen around the corner.  But when we first embarked on this journey, I really didn’t anticipate myself in this situation: 40 years old.  No baby.  No pregnancy.  I never thought that I will still be childless at this point.

I have been holding back tears all afternoon long.  I had kids I had to work with.  I had coworkers around me and I couldn’t show this weakness on my face.  Deep down I feel like hiding under the cover and having a good cry.  But I had to put on a happy front for my clients.

This huge sense of unfairness came upon me today.  Why in the world do some of us have to make such difficult decisions all the time?  Why can’t we have a break?  Why do we have to wait so long and have to do so much just to have a baby?  Why do some people have it so easily?

Of course there will not be an answer to any of my questions.  They are rhetorical.  But I have to ask them anyways.

In order to make myself feel better, I made a detour on my way home and got this:

hot chocolate

 

It is making me feel a little better.  We’ll see how I do on my actual birthday.  I may just break down and cry like a baby.  Stay tuned.

Let’s Talk Money

On this fine day, my first day past ovulation, let’s talk money.

Money has been on our mind recently.  First there were all the phone calls I had to make to inquire about the cost for outside monitoring at local clinics.  Then Bob and I were talking for days about his job offers and money and decisions.

It’s been daunting, to say the least.

As I have said before, UCSF’s IVF clinic is just down the street from my work.  It would be the ideal place to do my outside monitoring if we decide to go with the Irvine clinic.  I also wanted to meet with one of the REs there.  A lady that I met on an online forum has been banking her day 3 embryos there using mini-IVF with this particular doctor.  I would like to consult with him about the cost and the protocol so we can make an informed final decision of our clinic choice.  

So this is the lowdown.  Seeing the doctor for one hour for consultation and an ultrasound scan will be $325 as someone without insurance.  It’s reasonable and I am okay paying that.  The in-person consultation is scheduled for mid-July.  I can also wait for that.

The staff member responsible for outside monitoring was not available at the time of the phone call so she had to return my call.  When I listened to the voicemail, I thought I heard it wrong because she was heavily accented.  I left her a message requesting for an email confirmation of the fee schedule.

An outside monitoring appointment will cost $385.

Three Hundred Eight Five.  For a ten-minute appointment.  How in the world can they think that they can ask for this much?

Sticker shock.

The cost of blood work ranged from about $48 to $77 each, with $16 for each blood draw.  So imagine… every single time you go there for a monitoring appointment, it will cost at least $545.  Average three appointments per cycle.  You’re looking into $1635 for each cycle.

It is so depressing to think about it.

I was determined to find a cheaper place.  The next day I called two other clinics.  Clinic XYZ that Jane Allen’s RE uses charges $325 per ultrasound, but the blood work for each type of test is $135.  Clinic number three in the city is even more ridiculous.  The grand total of an ultrasound comes to $450 each, with blood work for each test being $110.  So you’re look at $595 to $670.  Per monitoring appointment.  Three times of that will be $1785 and $2010.

I got even more depressed.  

So turns out, UCSF is the least expensive out of the three clinics if you take everything into account.  I can still go to a Quest or LabCorp for blood work.  That should be a lot cheaper.  But in terms of taking time away from work, it seems to be the best to stick with one place.  UCSF is the most convenient.  I can also go back to my own RE who is one hour away.  She is cheaper and I trust her.  But can you imagine that drive for three times each cycle and then traveling to SoCal for retrieval?  Just the thought of it makes me want to puke.

It’s almost a crime to ask for so much money for such a simple thing.  What do they have to do?  Measure the lining.  Measure the follicles.   Nothing else!  Is it because I am in the Bay Area?  It’s just so….. depressing to think about the cost.

*****

Bob had been struggling with making a decision with the job offers that he had.

Here is the list:

1) Big huge corporation – It’s a contracting job.  Hourly rate is wonderfully high.  No benefits.  The team likes him so much that they immediately said they could request to have Bob hired as a fixed term employee for one year.  That would mean a salary for one year plus the full benefits that the company offers.  I know that this company offers great fertility insurance.  So we were very hopeful for a weekend… before the word came back that the team had already reached its quota for full term employees so the request got denied.  How disappointing.  The contract is for nine months only.  After that there is a very low chance that he will be hired on as a regular employee without having to go through the vigorous interview process.  So… most likely he will be looking for a job again in nine months.  But the pay is going to be so so good…. Imagine saving up money for donor egg cycles…

2) Small but established company that is far away – Bob likes the type of things that he’d do at this job.  But it’s so so far away.  He went to the interview for giggles as well as to gain as much experience as possible.  They turn out loving him.  They offered him a job with a decent salary.  But the drive is just too far.  Bob had done that before with his previous jobs and hated it.  This drive is going to be even more brutal.  After thinking a whole lot for days, he decided to decline.  The CEO immediately called him back and offered to let him work from home one day a week.  He also agreed to raise the salary by a few percent.  It was very tempting and Bob was very exciting for only driving there four days a week, until the next morning.  He slept on it, opened his eyes, and found that the commute at 7am would take an hour.  It takes driving on five freeways to get to this job, and the last freeway is notorious for being crazy.  In fact on that Thursday morning we checked, the traffic didn’t clear up until after 10am.  So even with leaving later like at 9, it will still take him an hour to get to work.  After struggling for one day, he finally said he didn’t think he could do the commute four days a week.  It was a very tough decision… and he had to decline the job, again.

3) Start up company in the city – He is also very interested in this job.  But because of his past experience in his previous startup company, he’s a bit leery about this company.  It is more established than his previous company.  It has enough money for another six months and its founders are currently looking for investors.  Bob at first got what we considered a lowball offer.  After a bit of negotiation, the salary went back up to be comparable but still less than the desirable level.  The great thing about this job is that commute takes only a mere 37 minutes with walking, public transportation, and walking.  Totally comfortable and doable.  He has always wanted a job in the city.  So this IS an answer to our prayer.

4) Another small company across the bay – This is also an interesting job.  It’s accessible by public transportation, which would take about an hour.  However, these people are very laid back.  They are slow in taking their time to get back to him with an offer.  At the same time, Bob had been pressured by the other two companies to respond.

Given these choices, Bob had had a few very stressful days.  The pressure was creating some stomach problems for him.  We talked for numerous times on the phone about these offers, what to say in the emails to negotiate for better terms, about the commute and evaluate what was more important.  I prayed.  He prayed.  And we thought for more.  Finally, we decided to forego the bunch of money that the huge big corporation offered.  We declined the far away job because the commute is just too brutal.  The small company across the bay is still taking its sweet time.  The final winner is the job in the city.  Not the easiest decision.  But we both feel at peace about it.  We are blessed with choices, so we’re thankful for that.  But boy, it was a very very tough decision.  It proves that money is not everything.

So, after three months of being unemployed, Bob has a new job!  Hooray!

*****

Glad we made a decision about the job.  The decision about outside monitoring clinic is still pending.  I will have several phone and in-person consultations in the next few weeks so we’ll make a decision about my next cycle soon.

We were good with baby dancing this cycle.  I went for my pap smear yesterday and my doctor commented on how much cervical fluid I had.  I guess it was my fertile time.  We acted on it last night and I got a temperature shift this morning.  I told my doctor that I was not counting on it to give me a baby.  She said… things happen when you least expect it.  I usually would get annoyed with comments like that but I wasn’t bugged by it.  I hope she’s right this time.  Maybe after all, we don’t have to decide on how much money to spend on anything if this is the cycle we’ll find success.  I really really hope so.

Mini Vacation and Other Things

Uh… What do I need?  I need time!  I feel like I don’t have time to blog anymore ever since the Fall began.  Dear Colleague saw me today and asked if I had nothing to say since she checked my blog and saw no new blog posts.  I have a lot to say but I don’t have time to write my thoughts down.  Since she asked, here I am blogging.

The biggest news is that Bob’s last day at his Big Corporation job is tomorrow!  And tomorrow is our third anniversary of our engagement, which happened on 10/10/10.  Three years have passed already and we have experienced so much as an engaged couple and married couple.  I still love my engagement ring and the thoughts he had put in to purchasing the stone and the style.  Anyhow, on Monday, he will start his brand new job.  He has a choice of working from 9 to 5 or from 10 to 6.  He will initially choose to work from 10 to 6 so that he can avoid most of the morning commute.  I am very excited for him!  He has been feeling excited but at the same time nervous.  I think these feelings are totally understandable.  I hope that his talents and skills will be recognized and put to great use at his new job.

Why is tomorrow his last day instead of Friday?  Because we are going to attend my younger cousin’s wedding at the wine country on Friday!  My cousin is actually going to get married at one of my favorite wineries in St. Helena.  We were about to begin our fertility treatment when he announced his wedding date.  My mind immediately began calculating the possibility of my pregnancy by that date, whether or not I’d be showing a bump, if I would need to wear a dress that would hide said bump, or whether we would need to announce the pregnancy before the wedding.  Well, no worries right now.  I am free to wear whatever dress I wish.  It’s such a bummer.  Anyhow, I am still looking forward to having a few days off.  We will head to the wine country early on Friday and hang out.  I have booked a vacation rental about half an hour away from the wedding site and will be sharing with my older brother’s family.  This will be the first time Bro’s family and Bob spend time away.  I am very excited about this opportunity for Bro and Bob to become closer friends.  This job change has brought them closer together as Bro gave advice and listened to Bob’s concerns.  I am hopeful that they will even be better friends after this trip.  I have also booked onsite massages for Bob, SIL, and myself for Saturday.  I cannot wait to have some chill time.

One thing that I dread about the wedding is seeing my relatives and the possibility of being asked about babies.  How do I dodge the bullet?  Maybe avoid talking to anybody. HAHA.  Or maybe because they don’t see a baby or a baby bump two plus years after our wedding, they’d get the clue NOT to ask the question?  I don’t know.  I don’t know how well Chinese people behave when it comes to their own relatives’ fertility.  

My temperature finally rose about four days after the positive OPK.  However, the temperature has been hovering a bit over the cover line, for those who chart.  All in all, I think this is a weak ovulation because of the crappy temperature.  I have lost hope that we would miraculously get pregnant naturally this cycle.  And I don’t know if I should count those days before the temperature shift as part of the luteal phase.  I truly don’t know when my period will come this time.  I guess it doesn’t matter.  We still have not decided what our next step is.  I have been taking a break from therapy and treatment for fertility so I have not gone back to Dr. K, my acupuncturist.  We have been emailing each other for updates though.  Last week she emailed me and told me to call her.  She had completed a cycle with Dr. Y down in SoCal at the clinic at which I am considering doing mini IVF and natural IVF.  She wanted to give me her first-hand insight of Dr. Y and the clinic.  I have already heard of the clinic’s services going down hill for out of town patients.  My conversation with her totally confirmed that.  She said that the instructions for her cycle were given at various times by various nurses and they were chaotic.  She wasn’t asked if she knew how to do the injections.  She was given the order of injections.  Good thing she had done IVF before so she knew how to do them.  When she had a question, she would be put on Dr. Y’s call-list and he sometimes wouldn’t call until very late at night.  Due to poor response the first cycle, she had to do a stimms the second month.  The blastocysts from that cycle were frozen.  She then had to return for her frozen embryo transfers in two consecutive months which resulted in BFNs for both.  In those four months that she dealt with the clinic, she only spoke to Dr. Y four times.  When she arrived in SoCal for the egg retrieval, she was shocked to find that Dr. Y wasn’t even the one who performed the retrieval.  It was some random doctor that she had never talked to or met before.  The one thing that totally turned her off was that Dr. Y didn’t seem to care who she was. She was just a number.  One of the women seeking help from his clinic.  Dr. K and Dr. Y have mutual patients.  Dr. Y knew that.  If Dr. K had that impression that he couldn’t care less even with the knowledge that Dr. K is also a practitioner, how would he treat me?  Dr. K’s conclusion is that, if I can, stick with Dr. E because I’d never find a doctor who would give me the level of care I’ve been getting.

That was a long explanation of why we haven’t made up our mind as to what the next step is.  With our savings, we can see Dr. E for three more cycles that we would pay out of pocket.  After that, I don’t know what we will do.  With Dr. Y, we can do nine mini IVF cycles or natural cycles even with his recent price hike.  I am torn.  What if nothing results from the cycles with Dr. E?  Then I begin to pray for God to give me a clear direction and take away my fear, because fears do not come from Him.  If God leads us to one direction, God will see us through.  I just wish that I always have that faith about God and what He intends to do in my life with His plans.

My infertile pregnant friend continues to write me daily messages.  I have not had the guts or energy to write her an email telling her off.  So she continues her way.  She finally declared that she would go back to work on Monday.  I was so happy because that would mean that she won’t have time to write me online messages as her job is demanding.  The other day she wrote me and said, “By the way, do not give up!  My mom’s cousin’s wife did a few rounds and she finally gave birth this past weekend.”  I said, “You know, giving up is the last thing that I’d do.”  Then she said, “Good. I’m hopeful that you can do it.”  Really, I know she means well, but she does rub me the wrong way sometimes.

I shared with another friend of mine over lunch of our IVF journey.  I debated whether I should share or not.  I eventually decided that I would, since it has been a big part in our lives.  This friend is 40 years old and not married.  She has already given up on having kids in her life.  So after I shared with her, she asked two questions.  The first one was if we had considered or would consider adoption.  My answer was, Yes.  Then I asked her, “Do you know how much adoption would cost?”  I told her the figure.  Then she said, “It seems like doing IVF would cost as much, right?”  Well, I wasn’t going to go into details about the differences and the hardships for both and all that.  The second question hits home a little bit harder.  She asked if I had ever thought about the possibility of not having a normal pregnancy or having a special needs child at this age.  What I said was, “Even younger people have a chance of having children with birth defects.”  Do we stop living life and living out our dreams because we fear that there is a possibility of having babies with health concerns?  I don’t know.  I wasn’t particularly bugged by either question but I am just amazed at how quickly people come to conclusions about other people’s fertility.   I wonder what she would fall off her chair if I had shared with her my thoughts on donor egg and donor embryos.

Anyhow, this is it for an update.  I would let you know how everything goes at the wedding and if I would get bombarded with questions about babies.

 

What IS the next step?

Looks like this is the trend that I don’t have much time to blog until the weekend.  How’s everyone doing?  Hi to those who are here for ICLW!  This is where I am at in my TTC journey.  My husband and I have been TTC for 21 months.  That does not quite equate to 21 cycles because of my short cycles due to diminished ovarian reserve.  At one point my cycles were 23 to 24 days depending on when I ovulated.  Sometimes ovulation could be as early as CD9.  Acupuncture has helped me push back ovulation to day 12 and even 13, which makes my cycle a little longer.  Anyhow, Bob and I have done two egg retrievals.  The first one resulted in a day 6 blastocyst that was graded 2BB.  We had it frozen and was waiting for it to be transfer back at our second retrieval.  The second retrieval in September resulted in zero embryos to be transfer.  We also couldn’t transfer back our one frozen embryo because of a fibroid that looked like it was in the uterine cavity.   We have yet to do a transfer.

I am relieved to report that my visit to the RE last Thursday was great.  The fibroids are NOT in the uterine cavity!  So we’re all cleared to move onto the next step.  Now here is the fuzzy part.  What IS the next step?  Well, it all depends on what we choose to do.  

A few possible scenarios:

1) Do a fresh cycle with Dr. E and thaw Clay (our little frozen embaby) no matter what so we have something to transfer

2) Do a frozen embryo transfer only and thaw Clay

3) Begin to go down to Southern California and start trying to bank embryos at L.ife IVF hoping that we will be able to bank at least four to five blastocysts before we start doing frozen embryo transfers

Why so many choices? Well, they all have to do with money.  My husband’s employer currently offers $10,000 lifetime maximum of fertility insurance that surprisingly goes a long way when it comes to cycling with a doctor who is in network.  Compared to the $12,400 price tag as a cash-paying patient, a doctor agrees to be paid at a discounted, contractual rate by the insurance company.  Since we have not done a full cycle and just the two retrievals, we should have at least a couple of thousand dollars left.  Now here comes the problem.  Since we only have a couple of thousands left, the doctor’s office is not going to take the risk of billing the insurance company first.  Since the remaining amount is not enough to do a fresh cycle, we will become cash-paying patients if we want to do a fresh cycle that includes a retrieval and a transfer.  I have been emailing Dr. E’s financial person back and forth.  Now I understand that we will pay the whole $12400 package price up front, in full, at our first monitoring ultrasound.  We will get a super bill from Dr. E’s office with the full amount that we paid and ask the insurance company for a reimbursement of a portion of the cost.  So we will no longer have the fortunate privilege of paying a $35 copayment at every visit.  We will pay 350 times of that.  On top of that, Dr. E recommends going back to the first protocol which was 4 vials of Menopur and Omnitrope.  The reason?  I responded well to it and we have one blastocyst.  The second protocol was a lot cheaper (Femara was covered by insurance) but nothing resulted from it.  Did it really have to do with the protocol?  Or just the egg quality for that particular cycle?  Really, nobody knows.  But we would want to be safe and do the one protocol that seemed to work.  The downside is that it will cost about $5000 in medication.  Are you doing the math for me in your head?  Don’t you think that this is A. LOT. OF. MONEY for ONE CYCLE?

If I had all the money in the world, I would do a fresh cycle with Dr. E because she knows my body.  With DOR, you just need to try your luck every single cycle hoping that you will encounter that one good normal egg.  But, I don’t have all the money in the world.  So what do we do?

We could potentially just do a transfer and see if Clay would stick.  That way, insurance should cover for the whole FET and we don’t have to worry about meds and other things.  If it works, then it’d be great!  But we do want to have two children.  If we could do a fresh cycle now and gamble to get more eggs/embryos, we may have something to freeze with younger eggs/embryos so that we can help Clay get a sibling in the future.  Younger embryos are theoretically better than older embryos.  

Another question is whether or not we could switch from Insurance Company A to Insurance Company B and still get a new batch of $10,000 lifetime maximum.  If so, then we could start our new insurance in January.  If not, then we have to seriously think about how to spend our savings on subsequent IVF cycles.  

Our last resort is to travel 500 miles to L.ife IVF and try doing natural IVF or mini-IVF.  The pros are that it’s a lot cheaper ($9900 for three cycles) and the cost of medication is also a lot cheaper (Dr. Y there is known for using Clomid).  The cons are that we will have to travel there monthly to do egg retrievals and I’ll have to take a few days off each month to do that.  I was thinking that this would be the way to go since I only get one embryo or no embryo each IVF cycle so far.  The cheaper option will mean a higher chance at pregnancy but also a lot more taxing on my persistence and patience in this process.  The lab at L.ife is known to be good at culturing blastocysts.  However, recently I have read that the policy for out of town patients has changed for the worse, i.e. OOT patients do not get their instructions until noon time the next day AFTER a blood draw or a monitoring ultrasound.  L.ife is simply getting too big and a little more chaotic.  It makes me nervous to know that it will be stressful and hectic to get information and to ask questions.  

Bob and I have a lot to pray about.  If we go with Dr. E for more cycles, our IVF fund will be depleted quite quickly.  If we go with Dr. Y at L.ife, we will have more chances at a lower cost without compromising the quality of the embryos/blastocysts.  L.ife is a lot farther away and requires out of town monitoring and traveling.  I love Dr. E and love the care and attention that I get.  It’s such a tough decision.  

My thought so far: We’ll do a fresh cycle with Dr. E in November and thaw Clay no matter what.  We’ll have to pay out of pocket for this visit.  Why November?  Because Dr. E will be gone for four days in October (for Disneyland with her kids, how cute is that?) which will coincide with my egg retrieval.  I am paying HER money for the cycle so I don’t want other people to be doing my egg retrieval.  If we do a cycle in November, I’ll be guaranteed to have Dr. E doing all the procedures and also have the time to figure out the insurance money part.  If we don’t get pregnant after that, then we will most likely sign up for L.ife IVF in January as it is more wallet friendly and makes the most sense.  I will hate to part with Dr. E but financial reality will force us to do so.  

Life is so complicated when money is a requirement to do the simplest thing such as making a baby.  I know I have thought about this a lot and really want to have some control over it.  But really, who is in control?  We have to go back to God and ask God for wisdom, strength, and His timing.  Not an easy task, but I am trying to depend on Him.  And I am grateful that we have a chance and the means to try.