Entry Number One: Two Plus One

2015-05-09 15.41.18

For the past few months I’ve pretty much been keeping things to myself when it comes to this whole reproduction thing. Being 41 years old, your expectations are all over the place. So in a way that is unlike me, for the most part I kept what’s going on with my husband and I in that area to a few lighthearted comments on the blog. But being a longtime blogger, one thing I know is the community of writers, particularly women, has been pretty incredible.

I’m glad I never got pregnant in my earlier years. When people say “oh you shouldn’t have waited so long” or magazines say “women should plan having their families earlier to avoid infertility issues” I want to punch them.  I think, Yeah so I should have just gotten off the pill when I was with my alcoholic first husband? Or gotten preggers with the farmer who I learned was dating a girl by the same name as me around the time my father died? Ooh, or how about the vicious-tempered English bloke who claimed that I didn’t understand his culture because he liked to drink a bottle of cheap liquor in one night? Yeah that would have been thoughtful parenting, for sure.  Hey I’d love it if I could change history and have my husband earlier, but both of us went through what we had to go through to get to this awesome place we are at in our lives today, and so we are working with the cards we’ve been dealt.

Assessing My Thyroid

Along with my amazing partner, I am most grateful for my naturopath. She specializes in fertility and made improving my thyroid health number one priority. You see, a few years ago a naturopath in the neighborhood got me off Synthroid and onto Armour and then disappeared. The clinic closed, and she stopped communicating entirely, even though she said she’d let me know where she landed. So I kept taking the dose of Armour that I was at, and after finally giving up on her, found my current provider who took my blood and saw that my hypothyroidism was totally out of whack even at the highest doses.

Why do I mention thyroid so much? Because as I learned (I had no idea!), poor thyroid function impacts fertility. From irregular ovulation to hormonal issues, you’ve got to get your thyroid in good shape if you want to have the best chance of getting pregnant. And here’s what I love about this particular naturopath: she’s not against using regular medications to get things where they need to be. Like she said “let’s get your thyroid working so you can get pregnant…we’ll deal with natural remedies for this after you have a baby”. Some NDs won’t even bring this idea up, so I appreciated this a lot.

When we first tested my blood with my thyroid still in chaos, my FSH was at 18…almost twice what it should be. I cried. Twelve weeks back on Synthroid, it’s down to 6. Not perfect (the goal is 2.0-2.5) but we’re progressing. Tuesday we test it again so hopefully there’s another nice drop 🙂

The other common test I needed to take to indicate was the AMH, which basically helps estimate  how many eggs I have left. Those results were heartbreaking, as it shows I am in the 10th percentile for my age at 0.1. With a shorter cycle of 23 days, these AMH and FSH numbers, my age, and being on the curvy side, my heart took a real beating and my husband and I talked about what we wanted to do next. Like he and I said when we first got together, we didn’t care if our child was “homegrown or store bought”, it would be ours and worth the journey.

As a side note, my insecurities with my curves really got the best of me and yet my ND said lots of women way bigger than me get pregnant and that even with my extra curves, I’m in great health. I also learned that weight is only a factor in 10% of infertility cases. It’s all about the ovulation and what happens after that. And fortunately, I’m still ovulating. Like my doc said “it only takes one good egg.”

My ND was a huge source of comfort to me and talked to me about many options. She first recommended I see a fertility specialist and referred me to one she’d worked with in the past, and talked about options ranging from medications to IUI all the way to IVF. Before actively planning to start a family, I’d always thought I would never want to have any “assistance” in getting pregnant.

Boy do your heart and mind go through an evolution during all this!

So what we decided to do was to attack things from all angles rather than taking a “wait and see” on each option. A three-pronged strategy looking simultaneously into local foster, international adoption, and fertility. With all of them taking a long time, why not do them all at once?

Foster/Adopt through DHS

First, we scheduled ourselves to attend an information session with DHS on the foster/adoption process here in Oregon. Unlike in some other states, here there is no “foster-to-adopt” program (kind of like temp-to-hire). You do one or the other – so if you foster a kid, even if they’re with you for years and they come to consider you their mom and dad, you don’t get to adopt them.

So it always interests me how the marketing and bureaucracy come together in ways that benefit no one. Here’s what our story has looked like with them:

* DHS stressed the tremendous need for parents in their programs yet they put the information session at 4:00pm, when most people are still at work, and way out in the outskirts of town, requiring us to rent a Zipcar for the two hour round-trip plus time for the actual session.

* Five weeks after sending in the VERY long application (y’all they go into everything from your relationship with your parents as a teenager to how your parents interacted and much, much more) from the post office, we heard nothing and so I emailed the contact. She said “did you use the envelope provided?” (duh, of course) and said they didn’t have our paperwork. Great.

* Two days after that email, suddenly they had everything in process and the new social worker called and emailed us asking to make an appointment but made sure we knew she was “only a part timer”. We responded to her email same-day providing our availability. It’s been 11 days and no response back from her.

* Yesterday, we received a packet in the mail from them and our friends received their reference check forms. In OUR forms, they provided a fingerprint check form that had my husband’s name as “John” on it (obviously can’t use that form), a second letter telling us they’d given our private cell numbers to “another foster parent so they could call us” (without telling us their names, or getting our authorization to share our numbers), and a third letter instructing us to sign up for classes which began in January and end in less than two weeks. At the session they said classes wouldn’t start until the fall, but apparently this social workers think we have a time machine. And that my husband’s name is John. I emailed her again about all of this and followed up again on the appointment but of course, no response yet.

Along with this debacle so far, we’ve met with a couple of folks who tried to adopt through DHS and they were told “you’ll be a great family in 5 years”. FIVE YEARS. Good grief. One also told us about how they’re known for pitting multiple foster families against each other in court and making the child choose. They claim they’re looking out for the child’s best interests but anyone who’s been a child of divorce knows that this is not a healthy way of determining custody.

So, needless to say, we’re not terribly optimistic on this particular strategy.

International Adoption

I’ve always been a huge fan of adoption and wanted to do it no matter what happened with me physically, and so we looked into a number of DHS-recommended agencies, and what we learned about international adoption was really surprising!

* It’s much harder to adopt internationally now because of the repulsive black market out there where kids are being bought and sold to the highest bidder and because of kidnapping from families.

* Even China is much harder now – primarily they’re only offering severely disabled kids up for adoption (as first time parents, we’re not ready for that, and even my husband who worked with the disabled for 16 years did not want to go down that path).

* Most countries require you be married between 2-5 years. We’ve been married one year.

* Most countries have an “age difference requirement”, meaning you can’t be 40-45 years older than the child you’re adopting. My husband turns 48 this year, and I’m 41. Ironic since most folks, ourselves included, are financially much more stable than couples in their 20’s.

* Some countries won’t allow you to adopt if you’ve been divorced in the past. Yup, that be me.

* A lot of countries on agency sites have recently stopped adoption, including many n Central America, Africa and Asia.

* Oh yes, and the cost of adoption in the US versus international? Almost identical – $20-30K.

So with all that research, the country that best suited us has turned out to be Ethiopia. Coincidentally, I’d just rented What to Expect When Your Expecting and Jennifer Lopez’s character adopted from there and it had me all “sookie” as my husband says.

We wanted to work with a Portland agency so we’ve reached out to one, and asked for adoptive parents who we can talk to about their experience adopting from Ethiopia, and he gave me a long list. One stood out for me so we set up a time and had coffee with them a couple of weeks ago and it was amazing! They had adopted 3 times with this agency from Ethiopia, were self-employed, and had 7 other kids at home already! Serious “experts” for us to talk to, but what was most impactful is how thoughtful and realistic they were in describing the process, the waits, the stress, the joys, and everything in between. Really genuine, kind human beings who we’re grateful to have met. So with that, we’re going to meet with the agency head next.

Fertility Treatment

Going to see a fertility doctor had me a bit nervous, but my ND recommended her so we went on her advice. Upon sitting down, her words to us were “so you know you’re chances are pretty bad you’ll get pregnant, right?” in a monotone. Wow. What a way to welcome us. I gulped and said I knew it would be an uphill battle but that my ND recommended we talk to her. She proceeded to quiz us on family history info we’d already provided and said we could try a Clomid or Femara (the drugs) along with IUI and see what happens, and her other suggestion was us getting a donor egg which we’d “have to do somewhere else”. Her “bedside manner” was cold but my ND said she had a very “matter of fact” style to her so I tried to let it roll off. She then didn’t seem to get why I was on fertility-enhancing supplements from my ND and then proceeded to give me a hard time for not getting a pap smear for 3 years (even though my doctor said I didn’t need it more than every 3 years), along with looking at me like I was an idiot when I mentioned I’d gotten thermography instead of mammograms. Oh yes and she didn’t understand why I didn’t want to pay for genetic testing for the breast cancer gene, which was irrelevant to this whole appointment. I agreed to do the Femara (she said it had fewer side effects and might be covered by our insurance because it’s primarily used for breast cancer patients) and IUI (short for insemination: basically they take the hubby’s sperm, wash it and inseminate me with only the strongest boys on the team; it’s also the cheapest at around $400 total) and she said at the end that I’d get an email with an overview of the process including timing, ultrasound, etc. I was to tell them when I got my period and they’d call in the prescription. I also was recommended to get an HSG to make sure my fallopian tubes were OK, to have done the day after I finished the round of Femara.

The next day (end of April) I called in that I’d gotten it and went to pick up the prescription to start Femara on Day 3. Later I checked my email and still hadn’t received anything so left them a message trying to confirm what I remember talking about in the appointment and the assistant said I should have an email with everything. I didn’t and told her that. What I got in return was an overview of the IUI process and that “on the rare occasion the doctor is not there on the weekends” that I could have the IUI done at one of two clinics. My ND also does IUI so I let them know if that were the case I’d want to have her do it since I know her. I also let them know that I ovulate usually on Day 10 so it looked to be on a weekend, and they said she was not available then. I asked them again about the ultrasound timing and they kept saying “we’ll cross that bridge when we come to it”. Hmm.

So I took Femara for 5 days and side effects ranged from wanting to sleep all day to complete lack of libido (my husband might as well have been a robot) to headaches to a body ache that completely debilitated me for more than a day. It was so bad that I told my husband that it honestly just felt wrong to go through this kind of pain to MAKE a baby. One thing to go through labor, but isn’t making it supposed to be at least a little bit enjoyable? 🙂

Then I went and got the HSG, and let me tell you I read WAY too much on the internet about how painful it was for many women. So much so I almost canceled, but my ND said hey, along with it making sure your tubes are in good shape (why do fertility treatments if your eggs can’t leave the shop they were made in), it also cleans them out and can actually enhance fertility. So we got another Zipcar and drove out to the ‘burbs to have it done. Our blessing was that the radiologist goddess who does the HSG is basically the gal who wrote the book on it. She’s like an HSG rock star. They put an apron on Dan so he could sit at the top of the table and hold my hand and we could both watch it on the monitor. Now I’m the kind that won’t watch a needle going into my body, but the opportunity to see my uterus and fallopian tubes on the big screen? Soooooo cool. Along with her expertise, Dr Thurmond had this warm Jane Goodall vibe and called out “all clear!” (meaning my tubes looked good) and squeezed my hand at the end. Complete 180 experience from the fertility doctor.

Anyhow, I emailed the fertility doctor about my side effects and got no response, and still no answer about when I should schedule the ultrasound even though there was a high probability it’d be happening that weekend. I also asked why the instructions on the IUI specified to use the Ovulation Predictor Kit (OPK) on your second pee of the morning when the OPK specifically said doing that would give false results and to always do it on your first urine after at least 4 hours of sleep. No response.

That Friday I called the alternate fertility clinic that served as a backup and they said I was all set up, that I could just call on Saturday first thing to confirm and them come in between 7-11am to have the IUI done. So we reserved (another) Zipcar for the next day. At 6:30am Saturday I got the “solid smiley face” indicator on the OPK as per the photo at the top of this blog post, and left them a message. We got up, got dressed, and by 7am were in the car when they called me back and said they had no record of me. I said I talked to them yesterday and repeated what they told me and they said ‘we don’t do that, you’d have to make an appointment’ and said it would have to be for the next day. With my husband working that Sunday – and an integral part of this procedure obviously – that was not going to happen and I asked her if she could please look again for my file and try to help us. She finally found the file right in front of her (and was rude to boot about it!) and got her “head nurse” on the phone who also said there was nothing they could do to help us. I was in tears by that point in time and not once did they even impart a remote bit of compassion, it was stunning. They actually had the nerve to say “you can try again next month”. And they totally refused to work with my ND. What assholes. I gave them a few choice words and hung up and called the other clinic and texted my ND who, by some miracle, was available to do the IUI, so after doing the “washing” at OHSU we took the car to her office and had the procedure (which took a total of 20 minutes including rest time afterwards), dropped the car off, and walked home exhausted but, again, grateful for my ND.

(As a side note, through the IUI we learned that my husband’s swimmers are in top form, yay!)

I then learned that the ultrasound is supposed to happen around the time of ovulation to make sure – duh – you’ve got some good healthy eggs, following the Femara round, to inseminate. So I went through IUI not knowing if it was a complete waste of time or not. A couple days after the IUI I got a response about the OPK from the doctor’s assistant (mind you the doctor herself never answered a single message addressed to her) telling me again to use the second urine and when I argued against it and typed in verbatim what the ClearBlue Advanced Digital OPK test’s instructions said? She finally emailed saying “just go with what the box said”. I asked again about the ultrasound and she said “since the doctor was out we couldn’t do it” – ummm, you couldn’t have had another doctor do the ultrasound along with the IUI? WTF! And so I challenged them – and let me tell you, some egos just can’t handle that. I asked them why they didn’t make sure this was part of the process as I just spent $400+ of my own money on this and what did I get? An email from the cold doctor herself saying she’s “never available on the weekends” (a direct contradiction to her paperwork and what she said in the appointment) and that she “heard what happened over the weekend” and suggested I go to another provider.

So let’s just say I was pissed that I didn’t get to do the breakup first (I suppose I was hoping for an apology, not cold rejection, from a place that’s dealing with women in often the most challenging hormonal and physical situations short of cancer), but more upset that I spent all this time working with someone who my instincts told me right away was not on my side, who could care less about me as a patient. And on curiosity, when I later went to see if either of these providers were on Yelp? Yikes. Terrible reviews, even more so for the backup clinic who was so rude to me on Saturday morning, from mean staff to unclean facilities to jacked up prices to only serving those who would keep their “success rates” high. My naivete about this area of the healthcare system was severely tested.

What now? Well with that Yelp scanning I noticed one smaller clinic (there aren’t a ton out there) with only five star reviews, talking about the warm fuzzies of the office matched with a whole-health perspective matched with a doc with 30 years of experience whose wife went through fertility issues herself. I called them up, and they were so nice I almost forgot about the past 3 weeks. And the lady on the phone actually said she’d heard a lot of horror stories about those other two clinics and was dumbfounded as well. Sigh… so we head there for a consult next week to see if this is indeed the fit we’re hoping for. And one thing that I learned? It is NOT to much to ask for the warm fuzzies to go along with fertility treatment providers.

So that’s the first segment of our efforts to go homemade or storebought. 🙂 My husband is a total champ and has been an active participant (as any good partner should be) who’s not been afraid to share his concerns, fears, joys, etc. , through the process. Having recently been cured of a serious 20+ year medical problem of his own, he really can empathize at how our roles have switched while he received treatment and I’ve been truly able to lean on him in so many ways. Whatta man whatta man whatta mighty good man…

I’ll write more in a month or so when things have progressed on all three prongs…in the meantime, it’s all about the brazil nuts, the meditation, and reminding myself that I am okay…just as I am.

If any of you reading have experienced any of this I would love to hear your stories. Too many of us keep this to ourselves, feeling ashamed or embarrassed or “broken”. I used that last word too many times this past month and now I’m done feeling bad. We’re going to have a family, and soon enough I’ll be writing on here how that all began…because I sure ain’t broke.

“I remember thinking about how mothers were prepared to run into burning buildings to save their children’s lives. I thought I should be able to go through a bit more suffering, a bit more inconvenience to give my children life. It made me feel noble. But now I realize I’m a crazy woman running into a burning house for children who don’t exist.”
― Liane Moriarty, “What Alice Forgot”

 

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