Our Infertility Journey (1.8): Needles Here…Needles There…Needle Pokes Everywhere!

I was nervous but excited to start IVF. This was our chance to make a baby! I stared at the needles, willing myself to see them as a golden ticket to motherhood rather than a necessary evil. The nurse pulled out her sample syringes and models. She demonstrated how to draw up the medication from the vial and then how to inject the needle like a dart into my belly or leg. I could do this. What was a little poke in the belly?

She then moved onto shot number two which would stimulate my ovaries. This shot came as a dial-up pen that I would use twice daily. I simply had to attach the needle, dial to the correct dose, and then stab myself again in the belly or leg. The nurse recommended using my belly as much as possible. Since the abdomen has more subcutaneous fat it causes less bruising and is a little less painful. She told me that pinching my skin a little would help prevent bruising, and applying an ice-cube to numb it might help minimize the sting.Beautiful woman is doing injection herself. In home.

The final shot was the big one…progesterone. Unlike the others which used a short needle, this shot had to be injected in the bottom twice daily with a 2 1/2 inch long needle! Yikes! My other option was a creamy gel that I could squeeze into my vagina twice daily. I opted for the creamy gunk! I could put up with panty-liners for a few weeks.

After I was given my prescriptions, I headed to the pharmacy. Thankfully, since my husband was an employee at the hospital we got a huge break on the medications. What should have cost us several thousand dollars only cost several hundred. This was a relief considering we would soon be paying our large upfront deposit for the cycle.

This med center was pay as you go for infertility treatments. They didn’t have the lump packages like some medical centers and private clinics. In those packages you get a break for paying for several cycles up front. If you get pregnant on the first cycle, then you lose a pretty chunk of change. But, if you aren’t pregnant, then it’s a good thing that you bought the discounted insurance package because you can get right back to it. For many plans if you aren’t pregnant after 5 cycles, then you get your money back! What a deal! One of the problems with this scenario, however, is that getting pregnant and carrying a baby to term or delivery are two very different things. Pregnancy rates don’t equal baby in your arm rates.Happy Mother Breast Feeding Her Baby Infant

So, I was okay that our center just did the traditional pay as you go. They of course required a chunk up-front. We looked through our finances and decided that we would just have to make it work. What other option did we have? Ten to 15 thousand dollars was a huge chunk of change to us, but I had gotten a bonus at work, and we had been saving diligently since we had started residency. We told ourselves that it would be worth every penny even if it cost us our savings. Besides, if it didn’t work the first time, we would most likely have frozen embryos left over that we could use in a subsequent cycle. Frozen cycles only cost about $1500. What a bargain!

I rushed home to put the medications in the fridge. My period eventually came after what seemed like forever; how ironic that I was now hoping for my period to arrive. I was ready to start the shots. I pulled out my medication and opened the box of follistem, assuming that the injection pen would be included. It was not. As I examined the medication box I noted that it clearly said, “Pen not included.” The pharmacy was now closed. The IVF clinic was closed. This was the day based on my cycle that I had to start the medication! What was I going to do?

I quickly looked for the physician on-call number. I paged the physician and waited…and waited… and waited. I paged the number again. After 2 hours I received a return call from a resident. Yes, I had just been a resident one year prior, but I wasn’t in the mood to talk with someone who wasn’t an infertility expert. I was paying too much money and had too much on the line to speak with a novice.Couple of doctors talking and using a tablet computer

Unfortunately, a novice is exactly what I got. It must have been her first day on the infertility rotation because she had no clue about the medications. I calmly explained that I could not give myself the shot without the pen. She explained that the pen should have been with the medication. Back and forth we went. I asked how I could get the pen. She then simply said I should use a syringe to draw up the medication. But, I calmly explained that the follistem vials were only to be used with the pen.Money in syringe

She then tried to educate me on how to draw up medication. I had to stop her there. I tersely informed her that I was a physician and knew how to draw up medication, and I knew what the pen looked like. I was not confused about how to do it, and NO, I did not have the pen in my possession! Since she didn’t have a clue how to get me a pen, her advice was to call the clinic in the morning to sort things out. By now I was more than frustrated and irritated. I couldn’t wait until the morning. I needed a correct answer right now…not just a guess at what should be done. For $15,000 I felt entitled to concierge care not a first year intern’s best guess.  I asked her to page the attending on-call. When she balked at the idea (because most attendings don’t want to be bothered on a Friday evening) I told her that I wasn’t suggesting this…I was demanding it. I’m usually pretty laid back, but in that moment, the combination of infertility, an empty bank account, and a box of needles and meds that I could do nothing with pushed me over the edge.

She wasn’t pleased with my authoritative attitude, but she agreed to touch base with them. Oh, the poor resident! It is so hard learning on the job. I am sure that she had her strengths, but she just wasn’t yet familiar with the infertility process. I didn’t want to be too hard on her. Goodness, I had my own moments of weakness as a resident.

After another hour, the now timid resident told me that the IVF clinic should have given me the pen at my education session. The pharmacy didn’t carry them. I would have to push back the medications by a day and get the pen in the morning at the clinic before work. The mix up was a result of the usual training nurse being on vacation the day that I had been trained on the medications. The fill in nurse thought that the usual nurse had given me the pen. Clearly not!

Now I had to run to the opposite side of town to pick up the pen before I headed to work in the morning. Since I hadn’t pushed back my own schedule of patients, I would now have an incredibly unhappy waiting room full of patients. I rushed to the hospital bathroom stall, hiked up my skirt and stabbed myself with the pen. What a way to start my first cycle of IVF.Abdomen Subcutaneous Insulin Syringe Pen Injection Vaccination

From The Mom in Me, MD

Our Infertility Journey (1.5): Feet in the Stirrups!

I had read all that I could. I came up with my list of questions…that every physician hates…and I prepared myself for success. I scheduled my hysteroscopy and determined that I didn’t need a hand to hold; well, because I wouldn’t have one. As a surgical resident, my husband wasn’t given much leniency in time off. According to his residency program nothing could be more important than work-not his wife, and certainly not a baby…what a distraction! I prided myself on being tough. I was a fighter. This wouldn’t be too bad. Besides, all they had to do was take a quick peek with a tiny camera inside of my uterus.

Determination

The woman who took me back to the exam room was indifferent. Was my infertility story less intriguing that other women’s? Less dramatic? Less heartfelt? Or, was she numb from years of rooming infertility patients? I excused her insensitive air by deciding that it was early, and she was simply having an “off” day. She must care, right?

My scrutiny of her cold behavior was interrupted by the white sheet that she thrust at my waist. “Undress from the waist down, and cover up with the sheet,” were her parting words. I can’t tell you how many times I heard, “from the waist down” over the subsequent year! It was as though I didn’t have anything above my waist.

I sat in the room for what seemed like an eternity. I’m not complaining considering that I have made patients wait much longer in the past. However, I have gained an appreciation for what it feels like to wait…to wait for good news…to wait for bad news…to wait for a cycle…to wait for a test…to wait for a doctor…to wait for a procedure. Life seemed to turn into a big waiting game; with the main objective being to wait for a baby.bright background, autumn bokeh and wooden floor

My biological clock was ticking. I was 30 years old. I had done everything right. I had gone to college, gone to med school, finished residency. I was working on my MPH from the most prestigious school of public health in the nation. I had done all of these things first instead of having a baby because this was the “right” way to do things. I now felt each click on the clock. With each stroke I felt my egg supply diminishing and my already limited fertility ticking away.

Were these the things I was thinking about while waiting for the hysteroscopy? Probably, but to be honest I don’t remember. All I remember is that I was having a pity party-and rightfully so! Who wants to have a camera stuck into their uterus on a Monday morning before heading into work?The Equipement Of Gynecologist Room

I had taken my Motrin prior to arriving, as recommended. The speculum was in, and the camera was inserted through my cervix. “Okay, this is not supposed to be painful,” I told myself. I took a deep breath and tried to relax. The physician’s assessment that, “You might feel a little bit of cramping,” was highly understated. I held my breath and started counting the seconds. My mind was like a record stuck on repeat. “This is almost over. This is almost over!” It was as though by reciting this phrase I thought I would miraculously speed up the procedure. The cramping felt like labor, and the duration of the procedure felt like a full term pregnancy. At that moment, I not only would have appreciated a hand to hold, I would have preferred one to crush!

The good news was that I was given good news. Everything looked beautiful, and my uterus was the perfect place to grow a baby. I was excited and relieved. At least one thing was going our way. I quickly dressed and then waited once again to speak with the doctor. She told me that we could proceed with IVF as soon as I was ready. Who knows if and when they are ready for IVF? How can you ever know if you are ready for something so intense and unnatural? I didn’t know if I was ready for IVF, but I did know that I was over-ready for a baby!Mother and her Newborn Baby. Happy Mother and Baby kissing and h

As I headed to the check out counter, my goal was to leave as quickly and stealthily as possible. If I haven’t mentioned it yet, this was the med center where I had completed my residency. I knew a lot of people here! Because I had moved onto a different medical center after residency, any and every acquaintance I ran into always wanted to find out why I was there and what was new in my life. When someone sees you in an OB/GYN office, and you are in your 20’s and 30’s, their automatic assumption is that you are pregnant. Not only do they assume this…they feel that they must confirm their assumption by coyly asking, “So, umm do you have some news?” I decided on this particular day that my answer would be, “Yes, I’m pleased to say that I have a uterus!” Clearly, avoidance was a better tactic.

Without fail, on the several recent occasions that I had been to the gyn office, I happened to run into the same physician assistant each time. He was dutifully accompanying his wife to her prenatal visits. Of course, he assumed that pregnancy was my purpose as well. I began to wonder how many times I could get away with “routine gyn exam” as my excuse. Hmm, those are usually done yearly; I had now said this to him three times in 2 months! He thought I simply wasn’t ready to share my exciting pregnancy news. In response to my, “No, I’m not pregnant,” he actually teased and said, “What’s wrong with Dave! Do we need to check his sperm?”Crying woman

I tried not to cringe, but my body wanted to physically revolt and recoil. I felt every word of his insensitive statement. It was like a line drive into my chest, my stomach, and my heart. I wanted to sarcastically retort, “No, that has already been done. And, yes, I would like to have a baby more than anything in this world, but unlike you…we can’t get pregnant.” Instead, I smiled and mustered up a little laugh. “Good one. Maybe we should get him checked.” Again, what a way to start a Monday morning.

From The Mom in Me, MD

Our Infertility Journey (1.3): My turn to be the patient!

Young beautiful woman with depressionI stared at the computer screen, overwhelmed, dazed, and mad that we had wasted time trying to fix something that was a long shot. I regretted waiting to meet with the Reproductive Endocrinologist. That should have been our first stop instead of our last-ditch effort. Paging through countless infertility clinic profiles online was getting me nowhere. I needed to make an appointment somewhere…and I needed to do it NOW. I wanted to be a mother more than anything! I didn’t have any time to waste. Each second-hand strike on the clock was another moment counting against me, my ovaries, and my sanity.

I picked up the phone and made the call. I was sitting in the middle of the hospital cafeteria, surrounded by coworkers and strangers. It was the only place that I could get good reception and the only time that I had during the day while the infertility office was open. Not ideal! I’m already known to speak softly, and since I didn’t want to announce to everyone eating lunch that I needed an infertility appointment, my voice (which I thought was booming) was probably a faint whisper. The secretary on the line couldn’t hear a word of what I was saying. I felt my face turn ten shades of red as I turned up my volume. “I need an infertility appointment…I can’t get pregnant! Sex doesn’t work!” Had I really just screamed that at the top of my lungs? I quickly looked around, expecting to see shocked stares. Instead…nothing. No one even met my glance. My secret was safe, but strangely that only made me feel more isolated.Young sad woman alone in a black stone beach.

Hearing the woman’s voice on the other end of the phone jolted me back to reality. Three months? That was the next available appointment? Four months to get in with the doctor I preferred? The secretary reassured me that if a cancellation came up they would let me know. “Right,” I said to myself… like I would be top of the call list. I knew how these things worked. The only call I would be getting would be to reschedule to a later date…and I was right!

Four and a half months later,  my infertility appointment finally arrived. I was nervous but excited to finally get some answers and come up with a “get pregnant” plan. Choosing which infertility specialist to see had been challenging. Word of mouth was how I finally decided on my physician. Knowing OB/GYN residents who had worked with the doctors in the reproductive endocrinology practice was the most helpful. They were able to give me the inside scoop on personality, bedside manner, procedure skill level, and expertise. I had chosen a female physician who came highly recommended. I was told that she was “to the point,” but she was great at what she did. I needed great. I wanted amazing bedside manner too, but if I had to choose between success at getting pregnant and feeling cozy without getting pregnant… I was 100% for success.

Choosing a female physician wasn’t coincidental. As a female physician, I tell my male patients who are uncomfortable with a woman examining them that since I see so many body parts all day long, nothing shocks or embarrasses me. Penis, vagina, testicles, breasts…it’s all part of the job. However, as a patient, I wanted a female physician. Somehow, I felt like it would be just a little less uncomfortable discussing my most intimate concerns with another woman.Honeymoon couple romantic in love at beach sunset. Newlywed happ

Although Dave was able to make it to our first appointment, I still felt slightly alone and uncomfortable. Anytime you are discussing infertility it just gets touchy. Trading in my white coat for a patient gown wasn’t my idea of fun either. At that point in my life, I wasn’t much of a crier. Yes, at home, I could have as good of a melt down as anyone, but never in public. I recounted our story feeling hopeful that the Reproductive Endocrinologist would simply say, “No, problem. We will get you pregnant in no time.” I knew that she would want to rule out any female factor contributing to our inability to get pregnant, but I was “pretty” sure nothing was wrong with me. My cycles were like clock work. I never missed. Deep down, I was hoping that there was nothing wrong with me. I am not sure why it made it easier, but it did make it just a little easier to know that I wasn’t the reason we were infertile. I wasn’t mad at Dave. It wasn’t his fault. But, somehow, it made me feel better to know that it really wasn’t my fault. Looking back, it is strange to think that it would make a difference; but, when you can’t get pregnant you get this feeling of shame…this ultimate sense of barrenness. It is hard to describe other than as a feeling of insufficiency and brokenness. Being able to say out loud or even say to yourself that,  “Nothing is wrong with me,” somehow makes being pregnantless a little less painful.

Our Reproductive Endocrinologist confirmed my thoughts on our next step. I would need a full work up, and Dave would need additional testing to see if there was any other reason for his low sperm count other than the varicocele. While sitting in the exam room, I noticed a fancy ultrasound sitting by the bedside. The vaginal probe was covered in blue medical gel and then carefully covered over with a condom. Very appealing indeed! Even more appealing, when she informed me that the probe and I would be making a very intimate acquaintance in a few moments. I was asked to undress from the waist down for the ultrasound. Feeling more than half-naked in my gown, socks and that paper-thin sheet, I dreaded what was to come next. It is funny how uncomfortable I initially felt about the ultrasound probe. 20-30 condom covered ultrasound probes down the road, vaginal ultrasounds felt as routine as brushing my teeth…okay, maybe not that normal!

With the ultrasound done, I was told to get dressed so that we could discuss results and options. If you don’t already know this, the one wipe and tiny tissue box the nurse leaves you to clean up the blue gel is pathetically insufficient. I actually discovered one reason to love the paper-thin sheet…extra large towelette! To my relief, I was told that the ultrasound looked great. Finally, some good news! I’m a bad news first kind of girl, so what came next threw me completely off guard.Worried woman looking at a pregnancy test in the bathroom.

I was expecting that we would start with intrauterine insemination. Dave would give a “sample.”  I would poke myself with a few shots…they would squirt the sample into me…we would get pregnant. To my dismay, this idea was quickly shot down. Because of Dave’s low counts the physician matter-of-factly told us that our best and only option was to go straight to IVF (in vitro fertilization), and not just IVF, but a more specialized type called ICSI (intra cytoplasmic sperm insemination).

As I mentioned, I am not a crier. Medicine teaches you to develop a thick skin. You can’t treat patients effectively if you cry with all of them. It teaches you to desensitize while at the same time to show sensitivity. Remove yourself one step away or you will become consumed and lose rationality and perspective. It teaches you these things, but when your heart is broken all in one moment for yourself, it is hard to keep from crying. I started swallowing so many tears that my nose began to run. All I could think of was IVF! Somehow, that felt like a punishment, a worst case scenario. IVF was a last resort, not the first step.

From The Mom in Me, MD