Saturday, August 4, 2007

No change

Looks like my response to the blog I linked to the other night didn't get posted. Probably too long. I wasn't belligerant or anything. I'll post it at the bottom of this entry.

The author has posted a new entry. A change of heart! What a pleasant surprise.

I can't really evaluate my emotional health currently. I had a rough night last night. Very sad, very angry. And the sadness hung into today. Every little thing has made me cry today. Normal, I know. Still sucks.

Oddly enough, a lot of my sadness isn't so much about this pregnancy but about my first. My due date is quickly approaching. Knowing that I'd now be in the "baby could come at any minute" stage hurts. A lot. Even just typing those words gave me an ache in my heart. I came across the one ultrasound picture from my first pregnancy (which is lovingly stuffed in a drawer with spare batteries and birthday candles because.. well.. I just don't know what else to do with it. It was on the fridge and that's where I shoved it to get it out of my sight after the first miscarriage.) the other day. Yeah. That was an odd moment. First sadness. Then a deep sigh of wistful. Then I turned it upside down and shoved it further back in the drawer. Sentimental, I know.

Anyway. Physically, about the same. Depends on the hour. Sometimes I'm fine, sometimes I'm certain my uterus is falling out. Still haven't passed the sac. The bleeding has picked up in the last day and have been passing some tissue again tonight, so hopefully soon.

I'm quite ready for this to be over. If not just for the pain & general PITA of bleeding and pads, but because it's one step closer to the NEXT MOVE.

I know I've been working on my patience. All in time. God's time, not my time. Yeah. I'll keep working on that. But really, that is what is keeping me going.

Step 1: Stop freaking bleeding. (After passing everything, thank you.)
Step 2: Start bleeding again.
Step 3: Lots of tests.
Step 4: Find some simple, easy to fix problem.
Step 5: Fix said problem.
Step 6: Start bleeding again.
Step 7: Get pregnant.
Step 8: Have live, healthy baby.

Simple, yes? Let's get started on that.


My response to the blog from my last entry.

I think most of the other infertiles have really commented on the emotional aspects of what I would have to say, so I'll just brush those lightly and then get into what I really want to add.

I see you say that you think that fertiles should adopt just as infertiles should. Do you also think that fertiles who choose not to are "narcissistic" and "selfish?"

There are points where I can understand where ignorance of the full situation would certainly lead to your original thoughts, but that particular one makes my teeth grind a bit.

As for why we (infertiles) want to have our own biological children... well... for the same reasons that fertile people do. That doesn't seem so complicated.

Honestly, wanting children AT ALL is sort of a crazy choice. (Biological, non-biological but home-grown, adopted, whatever.) They are messy, disobedient, expensive, and all leave you in the end. And I can't WAIT to be annoyed as hell.

The desire for this illogical choice has nothing to do with fertile vs infertile. We're just crazy. We believe that the love will outweigh all of the bad stuff.

Not to get too far off track, but why do people want dogs? They smell, pee on your carpet, chew up your belongings, steal your food, escape and piss off the neighbors, and are ultimately fairly expensive. Yet I wouldn't trade a moment with my dog. It's my choice because the love and companionship he provides outweighs everything else.

I've seen many, many references to "just adopt"ing. My problem isn't with the question "why don't you adopt?" It's with that "just" part.

There is NOTHING "just" about it.

The short answer to the question is the honestly, MOST fertility treatments are cheaper, quicker and far less invasive than adopting.

This is going to get sort of technical. Feel free to skip on by this part.

There a lot of options depending on what your diagnosis is. A great number of women who don't ovulate regularly have PCOS. It's the #1 diagnosed "infertility" diagnosis. (I quote that because PCOS can be a very severe medical problem. The short explanation is that you end up with LOTS of cysts on your ovaries. You can imagine that's quite painful, and they can burst (both the cysts and/or the ovary) and that REALLY hurts, and in the case of the ovary, well, you would die w/o help.)

In this case, infertility is a symptom, not really the disease. PCOS is very closely linked to insulin resistance. I won't get any more medical than I already am, but basically your ovaries have insulin receptors on them and if you are not processing insulin properly, things go haywire.

The treatment? A diabetes medicine. Costs about 5 bucks. It has some not-so-pleasant gastrointestinal side effects when you start it, but it also drops your risk of developing diabetes later by a significant amount. (You don't have to take it forever. Just a while.)

Sometimes that drug by itself will kick start ovulation. Sometimes you can combine a drug called Clomid with it. Costs about $25 for 5 pills. Sounds expensive until you find out you only need 5 pills (max of 15) per month. It increases your risk of twins to a little less than 10%. The usual chance is about 3%, so it does go up, but not to a crazy level. And a risk of triplets is a little less than 1%. Again, negligible. And a proper doctor is monitoring you to make sure you're not releasing too many eggs anyway. The pregnancy rate for Clomid is about 40% in three months.

Clomid has been in existence for decades. I'm not sure it's inception, but it was at least in the early 70's as I have friends who are a product of it. I have gotten pregnant (and miscarried, unrelated to my infertility) on it twice. With one baby, for the record.

We combined the Clomid with IUI. My husband's swimmers suck so the hope was to get as many swimmers as possible as close to the egg as possible. (I ovulate on my own, but not well, hence the Clomid.)
IUI is a relatively inexpensive treatment as well. Basically, my husband does his business in a cup; they send the semen through a "wash" which strips the semen and just leave the sperm. The sperm is deposited via catheter into my uterus.

It sounds awful, I know. But honestly, it doesn't really hurt that much. I had a painful one a few months ago (I've had 4 total, resulting in our 2 pregnancies.) but the last one.. I didn't even know she'd put the cath in. It's really not torture. No more invasive than your average pap smear.

As for cost? It depends. The IUI itself is probably 2-300 bucks. (These are all US dollars, btw.) If they do a follicle scan (ultrasound) you might add another 2-300 for that.

(I live in a state with infertility coverage, and the insurance company doesn't pay nearly that much. Not sure how much you know about American insurance, but the out of pocket cost is NOT what an insurance company pays. usually a small percentage, actually. For example, I'm "billed" $183 for an ultrasound. My insurance pays $50. The doctor's office writes off the rest because they are contracted for a certain amount through the insurance company.)

Anyway, so, completely out of pocket, a Clomid/IUI cycle is probably 5-600 dollars, max.

Now, if Clomid doesn't work to make a woman ovulate or doesn't succeed, you can move on to bigger and better drugs. They are also MUCH more expensive - in the range of probably a thousand dollars per cycle. So let's say a cycle of that is approximately $1500. They're also injectible, and let's be honest- needles suck.

The success rate of IUI is hard to state because a lot of it depends on what your diagnosis is. It’s usually quoted at 20%/cycle, but that's sort of misleading.

For us, our odds of IUI were quoted at around 10-15% to start off with. The sperm issues really drop it, so they weren't great. And sadly, there wasn't anything they could do for my husband to increase his chances. They couldn't find any "reason" for his count to be so low so there wasn't anything to fix, really.
We lucked out and my husband's sperm washes well. Meaning that the treatment they give it for the IUI usually doubles his motile count. As I've mentioned, our pregnancy rate is 50% in 4 months currently.

IVF for my area would be about $12,000. With my age and diagnosis, success rate is about 45% per cycle.
It is FAR more invasive, yes. Lots of shots, lots of monitoring, and ultimately a surgery to retrieve the eggs. There's very little chance we'll need to do it because we've proven that IUI will get us pregnant. But with our original diagnosis, IVF was our most likely chance at pregnancy so we certainly looked at it.

At one point you said:

"This makes perfect sense to me. I’m all for reducing the invasiveness of fertility treatments. My question, though, is: repeating the cycle, isn’t that going to be just as if not more invasive? how to balance out these options?"

The answer is not necessarily. If you respond as you should for an IVF, you'll probably get around 10 eggs. Those eggs are then fertilized and you wait and see. If things go well, you might end up with 7 or 8 fertilized eggs. The (usually) 2 best are transferred back with hopes of implantation 3 or 5 days later, depending on how well they're growing. That leaves maybe 5 fertilized eggs still growing. maybe all 5 still look good at the 5 day mark. Maybe 1 or 2 do, but certainly, most people have a few still good. Those are frozen.

Now what happens is that if the transferred embryos don't take hold, do take hold but don't make it, or if they do and you then later decide you'd like more, you can do a FET. (Frozen Egg Transfer.) That means much less invasion because you don't have to go through the egg retrieval again (which is the worst part.)

Here's where coverage for infertility can make things less invasive (and less costly, which I think is part of your problem with all of this.)

A woman paying for these options out of pocket is looking to up her odds of getting pregnant.
I'll use me as an example. I'm a healthy 30 year old. Odds are, if you put an embryo (1) into me, it will implant and grow. But if I'm laying out 12k, I want to up those odds a bit. So they'll put 2 back just to make sure. I might only HAVE enough money for 1 cycle, so my eggs are LITERALLY in one "basket."
This means a few things. First, I’m now much more likely to have twins. Multiple gestation pregnancy is expensive. The risk of complication goes up exponentially. That means hospital stays for the mother. $$$$. They are often born early, which means hospital (NICU) stays for the babies. $$$$$
All of which you're already paying for. No debate.

Secondly, it means fewer eggs are left to try for a FET later. Which means starting the IVF process from scratch all over again.

There have been a number of studies done showing that IVFs/FETs with less embryos put back cost far less over the long run than those with more. But the difference is that people just plain can't afford to do it less. They may only have enough savings for one shot, so they can't hold out for a FET.

Now, I know I've gone on FOREVER here and probably bored you to death, but I think that often the problem is ignorance about infertility treatments. People see a 60 year old woman or a woman birthing 6 babies on the news and they become the face of infertility. When, in fact, they are no more an accurate representation of infertiles than O.J. Simpson is of African Americans. They make the news because they're ODDITIES.

I just wanted to add some adoption facts to the discussion.

Domestic adoption of an infant costs a minimum of about 25K (averages closer to about 40k) and takes 2-3 years. It is fraught with disappointment and invasion. Sometimes even physical invasion just like infertility. You'll have to prove your health. Plus the invasion into your home, past, finances, etc.

International adoption is even MORE expensive. I did some research into it last year and the cheapest fee was around $6400 (Columbia & Mexico.) That's the fee to the agency. That does not include travel, paperwork, visas, hotel stays, etc etc etc. By the time it's all said and done, it's usually in the 30k range. Not to mention all the time off required. Countries like Russia require two trips to visit with a lengthy stay each time. That requires a lot of time off from work, which isn't a fee, but is certainly a cost.

I had someone ask me recently why I didn't just adopt because I'm so disappointed when a cycle fails. As though adoption is better.
Domestic adoption is the worst as far as emotional risks because in many states, the birth mother has up to a YEAR to change her mind. You think I'm disappointed in a negative pregnancy test? Imagine what I'd be like holding a baby in my arms for 6 months only to have to give it back.

Then there is adoption through the foster care system. It's pretty cheap fee-wise most of the time. Sometimes only a few hundred dollars, depends on the age of the child and some other factors. However, as a previous poster pointed out, adoptable kids actually aren't that readily available.

A friend waited several years for a placement of a toddler aged child who was "probably" going to be available for adoption.
What this meant is that she took a developmentally delayed, behavior issue filled toddler into her home. His birth mother comes to visit. To their home. This is a woman who has had her child taken from her. Let's just say she's not the usual houseguest my friend would have. Talk about invasive. My friend is responsible for taking the child to get togethers with his extended family. And the aftermath of those visits isn't pleasant. It's upsetting for the child in many ways.

Never mind the costs involved with his therapy. It is currently being covered by the state because he is still their ward, but eventually it will become their responsibility IF the birth mother REALLY terminates her rights as she keeps promising. And the mother may not. My friend could ultimately lose the child anyway.

So, a breakdown.
Basic infertility treatment: $500/month Success rate: ~40% in three months
Upgraded infertility treatment: $1500/month Success rate similar to basic.
IVF: $12k/cycle success rate: from 30-50% per cycle depending on age/health of the woman.
Adoption: $25k-$50k Success rate: Not sure on this one. Probably somewhere close to 100% as long as you're approved. (I can't find any good statistics on this, I'm sorry.) Average time to adopt: 2-3 years.

In the end, my point is that there are NO easy solutions. There is no "just" in any of it. As for being selfish.. I can't imagine how you could possibly be selfish and choose ANY of them because they're all difficult.

For us, we thought we'd try the easiest, cheapest way first- Clomid/IUI. That the child will be biologically ours is a benefit. YES. A BENEFIT. It isn't a non-negotiable benefit, but yes, I do dream of looking into my child's eyes and see their father looking back at me. If it wouldn't ultimately work, I'd love the eyes looking back at me no matter what, but the ideal situation is, indeed, a biological child.

We made our choice, just as you make yours to remain child-free. I don't think that makes either of us selfish.

Anyway, I apologize for being so verbose. It's just something I feel strongly about and quite frankly, I talk a lot anyway.


niobe said...

I love your response to that blog entry. You explain all the things that those of us who have experienced them already know and take for granted, but are not at all obvious to those on the outside. Yes, your response is long, but it really needed to be to cover all the complex factual variations and issues.

I'm sorry that you're (understandably) in such a bad place right now. Everything about this is difficult and unfair. I'll be thinking of you.

Marz said...

Awesome response Trish! Good for you!
I'm glad she had a change of heart.
I'm sorry you're going thru the "baby could come anytime now" stage. That must be very difficult. ((((HUGS))))

I would love to see pics of your boxer. Pop by my site again today as it's Leia's birthday & I posted more pics.

Inconceivable said...

thinking of you - and that post is an awesome job of explaining this hard to explain situation!

thinking girl said...

Hi Trish,

thanks for your response to my post. sorry, your comment got caught in the spamulator. It's been rescued. :)


Caro said...

Nice response. Thanks for coming over to my blog and sorry for what you're going through right now.

Mel said...

Gosh Trish you were so much nicer than I would have been, whether she's had a change of heart or not (excuse the french ladies) I still think she's a dickhead! I hope life gets better for you soon.

Erin said...

My post didn't make it either, but I wasn't as nice as you. I'm glad she's had a change of heart, but I found it annoying that she was so abrasive and judgmental in her post. Provoking thought and conversation are one thing, namecalling and judging are quite another. Great post you wrote, though.