9 1/2 weeks
A couple of weeks ago, I heard a women read an essay on being 9 1/2 weeks pregnant. It was beautiful and funny (with wry references to the movie), and poignant in noting such things as the fetus being the size of a grape. I was very envious, not only of her lovely writing but for her sentimentality with being pregnant, with valuing this new life and the life around her.
I, on the other hand, am a bit of a crank at 9 1/2 weeks. I’m not feeling very sentimental, and R. gets visibly upset when I make a dour comment about being inhabited or wonder about whether or not things are still ticking away down there. Didn’t that writer have any anxiety? I didn’t detect it in her words. Only love and hope and joy, some gentle caressing of her belly, a rueful wish for a homeless person. I don’t caress my belly. If I recall, that writer looked rather slim. I stare at my distended stomach in horror and wonder if it is this large now what will it be like in two months? Six? Eight? Friends, my mother, my sister try not to laugh at me. What did you think being pregnant was going to be like? they say. My sister seemed quite bothered by the fact I wasn’t “excited.” I was cheered when she told me her two boys (10 and 13) were guessing what name we’d choose. Why can’t I have that optimism? Believe me, I’m not complaining. I just had no idea what I was in for. As Dr. M. told me yesterday as I was splayed on the examining table: “You are possessed!” She said it with glee, with urging that I accept my condition and get on with it.
“You are possessed!” These words hit home when she turned the ultrasound towards me and showed me this:
My, how it had grown. Up to 2 cm. Dr. M. was thrilled. “Look at that growth! Look at that heartbeat!” She chided me when I asked where the head was. “You know where the head is,” she said, pointing at the larger end of the bulbous kidney bean. This was a beautiful site, and put my fears to rest that the screen would appear blank that morning. “That’s what is possessing you,” she said. At this moment, I loved Dr. M. because she was expressing more happiness that I could. Of course I’m happy! But I’m overwhelmed by what is happening. Maybe if this process hadn’t been so closely monitored and documented, it would feel more natural, more spontaneous. It’s easier for me to think of this life growing inside me as a visitor, one who is taking over for a while (and who will continue to for the next lifetime?). And since I’m not one who likes to be put out of my way, I’m having some issues dealing with it. I truly believe if I wasn’t so sick half the time I’d be embracing this with more grace, like the essayist who so eloquently put into words her joy and wonder, the words that I seem to be lacking.
So I will continue to mention to R. that I hope the paddles that have formed will indeed turn into limbs, and the head will continue to grow at a faster rate that the rest of the body (but not too big). In fact, the fuzzy little guy is kind of cute, in an ET sort of way, balled up in it’s signature fetal position, all cozy in that deep dark space that is me.
IVF Costs and Financial Assistance
This past Sunday, I had lunch with a friend who I haven’t seen in a while. We were with another friend who was “in the know”, so it was hard to not break my rule of telling any more people than necessary. It was nice to talk about the pregnancy in a positive way. I tried not to make too many disclaimers regarding the eight week mark. I mentioned the IVF, not really wanting to go into that part of it, and she said her sister-in-law had just completed her first cycle with negative results. I felt a little ill thinking of someone going through that same disappointment. It’s hard, isn’t it? she asked. God, I said. It’s so hard. I wouldn’t wish it on anyone.
Now, we know I’m more of a wimp than most people, and that many women go through IVF with varying degrees of bloating and discomfort and cramping. But it’s the emotional part that can be so devastating. Having to deal with filling syringes with god-knows-what hormones, sucking it up and saying you can get through it, that it’s not for so long, that it will all be worth it. And it isn’t so bad when there is a payoff. It’s easy to say it will be worth it. But the hard part is dealing with those failed attempts.
My friend said, “I don’t know how they are doing it. It’s very expensive.” Yes, indeed. R. and I were lucky. Our insurance covers four cycles of IVF in a lifetime. How’s that for pressure? This cycle we went to a doctor who didn’t take insurance. We paid for everything upfront and are now waiting (anxiously) to see how we will be reimbursed. R. and I push the insurance statements back and forth between us with a “you deal with it” shrug — this particular insurance company is quite skillful at confusion. But it is the rare insurance plan that covers IVF. I suppose there is the question of medical necessity. And there are age limits involved. Our plan doesn’t cover it if the patient is over 44. And I think that is generous, because I kick myself for waiting so long to try to get pregnant. At times I wondered who I thought I was to even try, to defy nature and my body.
Cycles run anywhere from 10K to 15K, depending on the length of treatment and extra procedures. I’m sure in some practices it is even more. The medications themselves cost hundreds WITH insurance. Without, they cost upwards of $3000. We are very lucky to have good insurance. But not everyone does, which makes all of this even more frustrating.
My friend said, “People don’t talk about this.” I recognized the awe of the uninitiated. It reminded me of why I even started this blog. I had one too many conversations where someone said, “People don’t talk about this.” I went online and found that people were certainly talking about it, but in their own circles. I am lucky enough to have friends who have dealt with this and who offered excellent recommendations (not to mention moral support).
But there are financial options. One friend told me about Columbia Presbyterian’s (Center for Reproductive Care) financial assistance program. We didn’t quality because we had coverage, but Columbia participates in the New York State Department of Health Infertility Demonstration Program, which provides assistance to insured patients without fertility coverage. I’m sure other states have these programs. They must. I told my friend about it, so she could tell her sister-in-law, who sounds like she could qualify. Columbia also offered a loan assitance program. A nice thought, but it’s hard to think about going into debt to just try to get pregnant. When I looked at those forms, I shot ahead seventeen years to when I might be filling out college loan applications. At the time I thought, wouldn’t that be nice?
Protein 8, what are you?
This week started out promising. On Sunday, I stopped all hormonal treatments (progesterone and estrogen). On Monday, I had bloodwork done to see if my levels were good and if I could stay off the junk. When I woke up on Monday morning, I felt more clear-headed than I had in a while. The opposite of waking up with a hangover, I suppose. The nurse called to tell me my levels were good, so no more shots and patches! It felt great. But she also told me she forgot to give me a requisition for more bloodwork. What? Dr. M. wants me to have additional bloodwork. Can I come back to pick up the form? No, I said. I was pissed that they forgot to give it to me, and with my new queasy way of life making the trip cross and up town is like climbing Everest. The nurse said she would mail me the form, so I didn’t think much of it.
Last night Dr. M. called to give me some OB recommendations.Bboth generalists and high-risk were on the list because she didn’t know if I needed to go high-risk. My latest labs had not come back yet, and they would determine whether I was high risk or not. What? I told her I hadn’t had the tests yet. I was led to believe they weren’t critical. She said I tested inconclusive on the Protein 8 test (I have no idea what this is, but apparently it indicates a clotting issue). I need to retest to see what range I’m in, as a poor result (or deficiency?) will put me at high-risk. High risk for what? I ask. Miscarriage, pre-term, she tells me, and I detect a bit of exasperation in her voice. What the heck do I think “high risk” means?? If the results are low, I may need to be on heparin, a blood thinner, for the duration of my pregnancy. More shots. More worry.
Now, what I love about Dr. M. is that she is so thorough. She leaves no stone unturned. But this just blows. She told me to have the test done immediately because at eight weeks she’d like to treat this condition if I indeed have it. Shit. Just as I was feeling happy and confident about the pregnancy, I suddenly feel fragile again.
Last night, for the first time in weeks, I didn’t drop off to sleep two minutes after picking up a book. I worried, with my new worry of the week, and prayed the test would be conclusive this time, to my benefit.
I’ll go to the lab this morning, but it might be a few days before I get the results. This may be one extra long weekend.
Salt relief
Salt is where I’m at right now. I wake up and eat a saltine. I lie in bed to test my state of queasiness. One morning I woke up with a little vomit in my mouth. Of course, R. was alarmed and brought up Jimi Hendrix. It wasn’t like that, I said. It was just a little backwash. What I can eat and not eat isn’t the issue. It’s what I want to eat. Which, today, is salt.
Yesterday I felt fairly good. My acupuncturist fastened these electromagnetic strips to my wrist (after laughing at my ill-placed Sea Bands — I’d missed the pressure point by half and inch). They are basically circular band aids with an electromagnetic ball in the center. Much more comfortable than the bands, and more fashionable as I can forgo the fuzzy terrycloth tennis look. They seem to be more effective as I don’t feel queasy ALL the time now. But if I don’t watch it, I can push myself over the edge.
Last night R. and I ate at Rice, one of my favorite little restaurants in the city. I was starving, and because we shared most of the dishes, I ate too fast (for fear of not getting my share?). I was full by the time my main dish came — a pho, a big bowl of beef and noodles in broth. I have never ordered this before in my life, but I think I wanted the condiments that come with it. Plum sauce and hot sauce and lime and cilantro and basil. I was less interested in the noodles than the plum sauce. I felt sick immediately after eating. Too much, too fast. My body can’t digest the way it used to, not that I have a super efficient digestive system. At home, I crashed and waited to throw up. My stomach was in revolt. I went to bed early, but got up after midnight and took refuge on the couch with the trash bin nestled nearby.
I didn’t throw up. But I’m suspicious of all that I put in my mouth now, however hard to control what goes in there. But salt is like a magnet. Pretzels for breakfast, even the salty crumbs on the bottom of the bag. I made a grocery list and only afterwards noted a pattern: saltines, cheese, fresh ham, whipped butter (w/salt). Hmm. I’m usually more of a sugar person.
I’ve been taking an independent survey of morning sickness patterns. I read that morning sickness tends to be more severe with women carrying girls than boys. I think about my oldest sister, mother of three, who terrorizes me with her stories of morning sickness. The first time, pregnant with twins, she threw up six times a day. By the end of her first trimester she had lost thirteen pounds. During her second pregnancy, she was sick for five months and couldn’t even drive. I read that morning sickness can run in the family, so I call my other sister. Yes, she too had it bad. With her first son (there goes the girl myth) she felt nauseous but didn’t throw up a lot, but with the second son she threw all the time. She told me she threw up in her lap while driving. And since she couldn’t eat, she was throwing up bile. A good friend told R. it is good that I’m not throwing up, that she felt nausea too, but didn’t heave. I don’t know why I am obsessed with this vomiting thing. I don’t like to, and I’ve never been a bit heaving. It takes a lot to make me sick like that. I can keep a lot down. But I suppose I think it will provide some relief. Or maybe it seems like that’s what is supposed to happen, perhaps that I’ll have some closure.
Instead, I continue to make a dent in a family size bag of Baked Lays chips.
Week 7: How did this happen?
Dr. M. proclaimed me seven and a half weeks pregnant yesterday. The ultrasound is more encouraging this week. First, she points out the head and body and how it has started to separate from the yolk sac. The body looks like the head and the head looks like the body, but really, it looks like a like bulbous catepillar hanging on a tree. Yeah, I know. Can’t I be more doting? I’m sure that will come later. I hope that will come later. The fetus has grown nicely and the heartbeat is very strong. I am a bit surprised at the size of the fetus. It has more than doubled, if not tripled or quadrupled, and has taken on a more distinct shape. At first I can’t see the heartbeat, but once she points it out I see that it is beating so fast it appears to not be moving at all.
More good news — my uterus is stretching out and the aforementioned arcuate shape is going away. The ovarian cysts still remain honking large — haunting dark orbs floating around the ultrasound screen. Go away, I want to scream. They will, Dr. M. says. Give it three or four weeks. Continue to not exercise, to not have sex. I’m feeling less and less like doing anything but eating butter and cream cheese any way. And potatoes. Baked, mashed, fried, in any form of chip, including Wise, Lays, and Baked Sour Cream and Cheddar. Yes, gross. This morning I ate whipped butter out of the container. Hey, don’t knock it. I’m not convinced these are so-called cravings, or attempts to calm my stomach. I keep waiting to throw up. Last night in bed, I felt like a child with a stomach ache. One of those nagging upset stomachs that you can’t do anything about. I thought throwing up might relieve it. But just burps for now.
I sleep as if I’m drugged and I guess I am. But more good news. Last night we started to taper off the progesterone. Half doses until Sunday, when I stop both the progesterone and estrogen. On Monday, more bloodwork. If my levels are good, I assume I quit the hormones altogether.
I ask Dr. M., when can I start feeling more comfortable with all this? (“all this” of course meaning the pregnancy). She smiles, and tells me that the chances of miscarriage have gone down significantly at this point. Up to now, the chances were 45%. 45%??? I am shocked. I am so glad I did not know that before. Sometimes ignorance is bliss. She mentions the chance of miscarriage going down to 8 or 10%, but I’m not sure if that is for now or next week or the week after. Again, brain fog in the examining room. But I’m just glad the 45% days are past. Jesus. That scared the hell out of me.
I am also ready to graduate from fertility school. At least, I think I am. My next task is to find an OB and set up an appointment by the last week in May. If I don’t have one lined up by then, I’ll go back to see Dr. M. as she doesn’t want me to go too long without medical eyeballs on my uterus. I have made no effort to identifiy a doctor. R. and I have been dealing with this a day at a time, barely a week at a time. Lining up a doctor would have been too presumptuous. Plus, I’ve been waiting for a recommendation from Dr. M. and she keeps holding off. Now she asks me to send her a list of doctors in my network. She assures me that no one she recommends takes insurance.
As Dr. M. is wrapping up my exam, she says, I know this sounds like I’m jumping ahead, but after you deliver the baby, come back to see me to let me know how things went. I don’t know what to say. A friend told me she never counted on her babies being “real” until they were in her arms. But the denial has to end for me some time. Okay, I tell her. Yeah, sure, I’ll come back. And then it hits me that this is probably the last time I’ll see Dr. M. Next week I come back for bloodwork only and the nurses do that. And I will bust a gut to find an OB by the end of the month, hopefully negating the need to come back to Dr. M. for an ultrasound. As I pay my bill and sign my records release form, Dr. M. stands to the side scribbling in my file. I’m still not sure if I won’t see her until our post-delivery meeting. My brain works ever so slowly these days, especially in the presence of doctors. Should I hug her? Should I shake her hand? How do you thank the woman who has presented you with a miracle? Yes, that’s corny. But true. Okay, we still have weeks to go for whatever assurances we are looking for. But we are in a good place. Do I send her a card? Flowers? A tasteful fruit basket?
That queasy feeling
Being pregnant, I thought I might be preoccupied with thoughts of a cuddly baby, the future stretched ahead, perhaps a new found connection with my body as incubator and nourisher. But I think about none of these things. Instead, I am blindsided by what I suppose is morning sickness (although I feel a steady nausea all day) combined with the side effects of the hormones I continue to take. I can only watch the Mother’s Days festivities from afar, not connecting myself with this holiday. So no warm fuzzy thought for me. I struggle to keep from sinking into self pity. I mean, this is what I want. This is the process. But most pregnant women haven’t gone through six months of IVF and hormones, haven’t already sacrificed what it is to feel like themselves. I know, I’m complaining. Stop complaining. Many women endure far more discomfort and pain and suffering that I have, than I do. And I’m still in that in-between state of having conceived and crossing that magical 14 week threshold.
But I’m not really complaining. I think I’m more amazed at where I am right now. How hard it is muster up joy. It’s hard to see the bright side of things when you just want to crawl into bed each hour of the day.
My acupuncturist suggested I wear Sea Bands for the nausea. They were originally designed to alleviate motion sickness. The terry cloth wristbands have an embedded plastic stud that applies pressure on the Nei Kuan acupressure point. I chose the light blue over navy, and feel very John McEnroe when I wear them. Do they work? I’m not sure. But they leave deep purple impressions between the tendons on the inside of my wrist. Sometimes I feel less queasy and almost normal.
Week 6: ultrasound
I saw the kidney bean shaped yolk sac. I even saw the heart beat – a black and white rapid flash in my uterus. Dr. M. kept asking me to believe her, as if I don’t hang on to every word she says. I was fairly confident we’d find our yolk sac because I felt nauseas and generally crappy all day. I wasn’t prepared for the other revelations that included the discovery of my arcuate uterus. Arcuate means “heart shaped.” The uterus is generally triangular, an upside down triangle. The top of my upside down triangle dips, creating the heart, and this puts me at higher risk for pre-term. Dr. M. tried to point out the shape on the ultrasound (again, “believe me”) but my civilian eye could not decipher the web of black and white tissue or faint edges of the uterus. I believed. But what does that mean? I can’t comprehend half the things Dr. M. tells me. Granted, it doesn’t help that I’m splayed out on my back, legs in the air, while she stands at the counter scribbling on my file. It’s not like I can take notes. So I ask again and again, what does this mean, and she says, we’ll have to keep an eye on it. She gives me a sympathetic look, which I hate, and says I will, after all, need to see a high risk OB. I thought I would because of my age, but before the exam she didn’t think so. Because she didn’t do my HSG (about a year ago) she doesn’t know if it was always this shape, or if it is a result from the treatments. Does this means it might correct itself? I won’t be graduating from the fertility office next week. She wants me to come back two more weeks to keep an eye on me.
She also points out several large ovarian cysts that have formed since the transfer. This is normal, she says, but they are large and numerous enough for her to tell me to stop exercising. But I’ve only been walking and doing gentle yoga. No long walks, she says. You need to be more specific, I say. No 20 block walks. That’s a mile. I can’t walk a mile? I don’t point out that I probably walk at least a mile a day between home and subway and work and even getting to this appointment. Walking has saved me these past few weeks. The no long walks instruction depresses me more than anything. I feel shallow, for thinking of myself, my sanity, my need to stretch my legs, my need to get the blood flowing in my body. How about yoga, I ask? No inversions, she says.
More research to come on the arcuate uterus. Anyone out there have one?
Fears
Only the truly diligent know they are even pregnant at this stage. It is too early to think about it, talk about, plan for anything. I may not even be pregnant right now. That is the horror of it. You are only as good as your last pregnancy test. I’ve learned to be comforted by exhaustion, by cramps, by painful bowel movements. These are all signs that something is going on down there. I even like the fleeting moments of nausea I experienced last week, that vague carsick wooziness. A loosening in the jaws, the need to eat a cracker to calm my stomach.
But some time last week, I think Thursday, I stopped feeling so awful. The cramps stopped. The fatigue remained (thank god), but no more debilitating lower abdominal pain. And you know what? This makes me nervous. My acupuncturist told me she doesn’t have needles large enough for me. Am I really that bad? I’m sure most women are this anxious. The further along you are, the closer you are to something. But as more time passes, there is more to lose.
My ultrasound is on Tuesday. They will look for the yolk sac. At eight weeks, it is considered a fetus. Right now, it’s still in the prep stage. I think about my age and how lucky we are to be where we are. I think about my age and the things that can go wrong.
Yesterday, R. and I spent the day shopping in New Jersey. The malls and large department stores, especially Target, present a frightening cross section of all that can go wrong in the world. When I crossed paths with a child or adolescent with an obvious disability, my heart sank.
I refuse to look at statistics. I know they will be revealed later. For now I distract myself, which is probably why I haven’t posted as often this week. I’m trying to spare others of my craziness. I’m trying to hide all these fears.
