False Alarm Every Ten Minutes

They call it the "TWW" or "two week wait" at the fertility clinic and on the online fertility sites. I'm not a very patient person, but this is really trying whatever patience I do have. Because of the progesterone vaginal inserts that I have to take, I'm a little oozy . . . that ooziness feels like I'm getting my period. So every ten minutes or so, I have the feeling that I've gotten my period, and so far, it's just been progesterone ooze.

I guess I could cut down on this false alarm phenomenon by taking the progesterone at night like I'm supposed to, but I find it unappealing to have sex with the progesterone insert in for an hour (precisely because of ooziness), which is what the blogsters out there suggest. My doctor said to insert the progesterone pill AFTER having sex -- this was his answer, after receiving an anxious text from me asking if we could have sex at all for the 21 days I am using the inserts -- but I like to fall blissfully asleep after sex, so the idea of having to go in and put the insert in after sex was not appealing.

At any rate, my period should have come yesterday, today, or tomorrow (depending on what online calendar you use). I have a doctor's appointment Wednesday morning for a pregnancy test, so all I can do until then is try to resist running to the bathroom every ten minutes to check.

My heart sinks, and then it's happy . . . but no matter, I have to keep reminding myself that this was the first month of this type of intervention and it isn't necessarily going to be successful.

What's funny is how similar this "false alarm" feeling is to a "false alarm" feeling when you DON'T want to be pregnant . . . the waiting for the period to come.

New York Magazine had a really interesting story this month called "Waking Up From the Pill: Fifty years ago, birth-control pills gave women control of their bodies, while making it easy to forget their basic biology—until in some cases, it’s too late." I found the article to be perfectly relevant to what I'm dealing with now. Like this passage:

Now many New York women have shifted their attempts at conception back about ten years. And the experience of trying to get pregnant at that age amounts to a new stage in women’s lives, a kind of second adolescence. For many, this passage into childbearing—a Gail Sheehy–esque one, with its own secrets and rituals—is as fraught a time as the one before was carefree.

Suddenly, one anxiety—Am I pregnant?—is replaced by another: Can I get pregnant? The days of gobbling down the Pill and running out to CVS at 3 a.m. for a pregnancy test recede in the distance, replaced by a new set of obsessions. The Pill didn’t create the field of infertility medicine, but it turned it into an enormous industry. Inadvertently, indirectly, infertility has become the Pill’s primary side effect.

One of my colleagues in the women's rights/reproductive rights field thought that the article blamed the pill too much for women postponing childbearing, but I don't think that was the point of the article at all. What the pill did, I think the article argues, is relieve women of having to think so much about their reproductive capabilities. Like the author explains:

. . . [W]omen are half-consciously rebelling against the artificiality of the Pill’s regime. Removal from one’s true biological processes was more appealing in the Mad Men era, when machines were going to save the world and pills could fix everything, even the ennui of housewives. But for the wheatgrass-and-yoga generation, there’s something about taking a pill every day that’s insulting to one’s sense of self, as an accomplished, adult woman. “I feel like I’ve gotten a message over the years that the less I have to do with the nitty-gritty biological stuff of being a woman, the better, and that’s a weird message,” says Sophia, 35, who was on the Pill for fourteen years. “In my ninth-grade health class, I remember the teacher saying, ‘You can get pregnant any day of the month, so always use protection,’ and I kind of knew that wasn’t true, but because I was on the Pill, I never really cared about finding out the right answer. The Pill takes a certain knowledge away from you, and that knowledge is empowering.”

And, in fact, what I think the article argues for, although I think it could have done so more thoughtfully, is that women should be made aware of ALL of the risks and implications of taking the pill. I am constantly surprised at how much I don't know about my own body: blame it on inadequate sex education in school or at home, whatever. The fact is, before taking a drug that prevents conception, we should really understand conception altogether, and at least for me, I know I didn't. Of course I knew that waiting too long would make it more difficult to get pregnant, but I like the fact that the author talks about how easy it is to hit the "off switch" on fertility for a while with the pill, and not have to think about your body so much.

To arrive at the stage when one stops taking the Pill and starts timing one’s ovulations is to enter a new and anxious universe. After that, if you’re unlucky, you may enter a kind of medical and bureaucratic purgatory of doctors’ waiting rooms and insurance companies and worries that’s very far indeed from the freedom you enjoyed before.

On the Pill, it’s easy to forget the truths about biology. Specifically, that as much as athleticism or taut cheekbones are, fertility is a gift of youth. The body that you wake up with after fifteen or more years on the Pill is, in significant ways, not the one you started out with.

The notion of "choice" and "sexual freedom" in this discussion of the pill was also fascinating. The author talks about how NARAL and Planned Parenthood and other "choice" groups don't want there to be any public discussion about the relationship between the pill and infertility. It may be true that, as my colleague suggests, that the article overdoes it by actually insinuating that a "side effect" of the Pill is infertility ("Inadvertently, indirectly, infertility has become the Pill’s primary side effect."), I do believe that choice groups don't want to talk about how these issues intersect. As the author explains:

[I]ronically, this most basic of women’s issues is one that traditional feminism has a very hard time processing—the notion that this freedom might have a cost is thought to be so dangerous it shouldn’t be mentioned.

. . .

Sexual freedom is a fantastic thing, worth paying a lot for. But it’s not anti-feminist to want to be clearer about exactly what is being paid. Anger, regret, repeated miscarriages, the financial strain of assisted reproductive technologies, and the inevitable damage to careers and relationships in one’s thirties and forties that all this involve deserve to be weighed and discussed. The next stage in feminism, in fact, may be to come to terms, without guilt trips or defensiveness, with issues like this.

Choice is a more accurate word when the chooser—us—is aware of all the possible consequences of taking different possible paths. But reality has a hard time getting into these areas, let alone the Brave New World of infertility medicine.

Henna Tradition

I love Alanis Morissette. This is a picture of her surrounded by other women with a henna tattoo on her stomach. Apparently, there is a tradition in India and Morocco to have a henna design painted on the belly during the third trimester. The custom is said to "protect and bless the mother and child from any evil or malicious spirits that may be near during delivery," according to the Henna Caravan website. I have to remember this if we are successful.

What's Going On Up in There?

It's so mysterious, this female reproductive system of mine. As prescribed, D and I made love this morning and I stayed still for 30 minutes after as I imagined the journey of the millions of little spermatazoa, excited by their sense of the egg(s)--their destination. All day long, I've been walking around thinking: Did they make it? Did more than one make it to more than one egg? If three made it, will all three attach to the lining of the uterus? What's going on in there? I want to go to a lab, hop on a table, and have them look inside and show me what's happening. It's hard to believe that such life-altering, momentus things might be happening (or not) inside my body while I walk through the mundanities of my life--doing dishes, feeding the cats, sitting in meetings . . .

Flex Spending Revelations

A few months ago, our Communications Director, J., said that she had something small to tell us. "About the size of a lime," she said. She revealed that she was pregnant, and my heart fell. It's not that I wasn't happy for her--I really was. It was just that I felt like every woman my age or just a little younger in the office was a mother. We recently had a spate of pregnancies in my office--one development person, two staff attorneys, our deputy director, and an administrative assistant. The joke was that the pregnancy was contagious in our office. I would always think in my own mind when I heard this: "Except I'm immune." So when J told us, I felt like I was the only one who was struggling with this.

Well, I'm not. And this is how I know.

Our office offers Flexible Spending Accounts (FSAs) that allow you to set aside a certain amount of money for health-related expenses pre-tax; meaning, you put money into an account through paycheck deductions that reduce the amount of taxable income you earn. It's a great tool if you manage it well. One year, I had about $1200 left in my account and I convinced my dermatologist to give me a prescribed chemical peel ($1000) and stocked up on band-aids and cough syrup. Last year, I missed the deadline so I didn't have one. You can use the money for co-pays, expenses not covered by insurance, eyeglasses and supplies, counseling, and over-the-counter medical supplies.

This year, I wanted to estimate correctly, so D and I counted up all of the chiropractor visits we expected to make, the crown he wanted to replace, the prescriptions that we thought we might need at $20 a pop, and . . . then I remembered that if I got pregnant, there would be a load of expenses. How to estimate THAT?

Well, we're planning to find a midwife and see if we can do a home birth, so I knew the expenses would not be easy to determine with a web search. I decided to confide in J, who has also chosen to deal with a midwife for prenatal care and to have a home birth, and ask her for an estimate of what she was paying. J and I aren't close, but I like her and I trust her. When I went to her office to talk to her, she immediately confided in me that it had taken years for her to conceive. She did the whole fertility treatment dealeo . . . innumerable visits, shots, medication, etc. She said it took quite a toll. She said this pregnancy was a long time in the making. She spoke of how hard it was to see all of her friends get pregnant one after another. She talked about the expectations that people had of her, assuming that she was waiting until her career was more established before choosing to have a baby. She told me that she didn't talk to anyone about this while she was trying.

I was grateful to hear all of this. I was grateful that I wasn't alone among the people I knew. I wonder how many other women I know are struggling and not talking. I think it would be helpful to talk about it. I have to admit that on some level, it feels like a giant female failure to not be able to get pregnant easily.

At any rate, we did get to discuss expenses, and while I'll write about this in another blog entry, I should say that the estimate for a home birth (including prenatal care from the midwife) is about $7,500. A lot less than I thought it would be, and it seems that Cigna might cover 80% of that. They better, cause I think that's probably a lot less than what it would cost in a hospital.

Drugs

A few weeks ago, I started getting a series of calls from Cigna saying that I had ordered some drugs and where did I want them delivered. I'm like: "what drugs? I didn't order drugs! Put me on your 'do not call' list." Then I find out that the drugs my doctor prescribed were supposed to be delivered to me, and Cigna was calling me to confirm delivery address and get my credit card number for the copay. Fed Ex next day delivery to my office the next day allowed me to start this course of treatment this month. Thank you Fed Ex. Except one more problem: they didn't send the pre-filled syringe of hCG that they were going to--the shot that releases the eggs. Apparently it's a controlled substance and they only fill it upon a written scrip. So I call the doctor back, and they say that Cigna is notorious for this kind of screw-up; of course they mailed the scrip. Cigna just always loses them. So I ask to speak to the doctor to see if I can figure out whether the rest of the drugs (the clomid, the ones pictured here) will boost my chances enough so that I can risk maybe not doing the shot this month, or whether the hCG shot works in tandem with the rest of the drugs such that I should fork over the $90 out-of-pocket expense. The doctor's assistant got back on the phone after about 15 minutes and said that the doctor just happened to have an extra shot in the office and they'd administer it for free. Bingo. So, off to the doctor I go again, shot in the butt, and I'm off. Doctor advised us to make love that night, and then again Friday morning. (The math is just crazy: shot releases the eggs in 40 hours; sperm lives for 72 hours; egg lives for 12-24 hours unfertilized; sperm takes 30 minutes to reach an existing egg...) Unfortunately, I was so exhausted from work and running around all week that I just could not muster the energy for seduction. Thankfully, D knew what he had to do, and while it didn't work out that night, he dutifully performed the next morning. We were prescribed one more try on Friday morning (several hours after the eggs are supposed to have been released), and I've already arranged to go into work a little late, so we're cool. Pregnancy test on December 1, and if we're not successful, we try again in December. It's super exhausting to deal with all of this, but I feel like we're taking the right steps.

Ovarian Amphetamines

A doctor friend of mind coined this euphemism for the drug "Clomid" or "Clomiphene Citrate," the drug I'm now taking to spark egg production. I like to call it my "twin pills," because I'm convinced that now that I'm taking it, I'm going to conceive, carry, and bear twins--or worse. I remember thinking, not so long ago, that I would never do this. And I remember darker thoughts: that women who did were selfish, foolish, and over-consumers of health care resources. In presentations that I would give to audiences about moms who were struggling with drug addiction, I asked folks to consider the moral, economic, and legal issues raised by moms who used illicit drugs, compared to moms who used fertility drugs. Didn't it cost society more to care for multiples than to care for an infant with drugs in its system at birth? Wasn't the harm greater?

But here I am. Taking one of these little pills twice a day for ten days. And hoping for many things at once. Including grace.

Offbeat Mama

I just read an amazing blogpost on Offbeat Mama. The founder of Offbeat Bride, the book and accompanying social networking site that helped me keep my sanity during our year-long wedding planning process, started Offbeat Mama, right around the time of our wedding last May. I check back every now and then to see if she creates a feature, like the Waiting Room on the Offbeat Bride Tribe website, for women who are trying to get pregnant. I don't think she did (yet), but I did find this post, by Ariel, the founder herself. She introduces her own story of problems conceiving with a video by a woman who poses a series of "what if" questions...questions that have been swirling around in my mind about infertility for the past year. I have been searching for something to read, something that I could identify with, around all of this for the longest time. My husband is so certain that it will all work out in the end, he insists on speaking in terms of "whens" as opposed to "ifs." Ariel's story was poignant, and scary . . . I hope I only have to go partway through the course of action she had to take in order to become pregnant. But I've already gone farther than I thought I would in order to conceive.

Two parts of Ariel's post particularly resonated with me:

the weight of the trying and failing got heavier and heavier. After a year of trying to conceive, it's not so much fun. It's depressing. It starts to mess with your head. I started feeling like a core part of my body had become an untrustworthy stranger. A breech of trust with your own body is emotionally brutal.

And this one, which describes so many things in my life about which I've harbored fear and loathing:

IVF was this terrible awful procedure that I'd invested a lot of fear in. It just didn't fit with my identity — who's heard of offbeat infertility? Offbeat IVF? Pshaw. It was the expensive invasive terror that desperate people indulged themselves in. It was like gambling: this thing that you keep tossing money at hoping that this time you'll win but ultimately the house always wins and you always lose. Of course you lose. It makes you crazy, and worst part? It doesn't even work most of the time.

. . .

What I want to say is this: I was wrong. I invested years of my life living in fear, seeing something (in this case Western fertility treatments and especially IVF) as the awful boogey man in my hippie closet, the terrible admission of defeat that would forever turn me into a person I hated myself for being. Ultimately, I was wrong. This makes me wonder ... what other massive fears of mine are completely unfounded? What other things that I see as the worst WORST case scenario could actually lead me to a place of profound happiness? What other paralyzing grief and fear could I release?