Monday, January 16, 2012

Too Wordy to Timeline

This is probably going to be pretty boring to those who aren't interested in the details of how this has all gone, and how it all works. But for those who are curious about the process - how we got here - what is happening now etc, this gets you up to speed. I'm gonna take you from the beginning to the present, so that from now on I can just talk about what is happening, without having to go back and explain a lot of background. So, this is the background!

How we got from there to here (and where is here, anyhow?) - a timeline with lots of facts and words, but minus most emotion:

May 2009 - Ian and I leave to go on our big 14-month journey around the world. At this point I go off of the hormonal birth control that I've been on and off (mostly on) since I was 18 in 1994. We intend to start trying for a baby after our trip, but trying to keep up with hbc while roaming the world seemed impractical at best, so that was that.

June or July 2010 - Stopped all birth control, but weren't officially "trying" until insurance was going to kick in.

September 2010 - Insurance kicks in. We go for it. A friend lends us one of these fertility monitors, so we feel good knowing that each and every month we are hitting the right time:
Around this same time I go to my Ob-Gyn (who I love, by the way) and mention that we are giving this a go. She says, "Great! Come back if it hasn't happened in six months!"

March, 2011 - Went back to check in with Dr. Norrell (Ob-Gyn). She wasn't too concerned. Wanted to make sure we knew how to do it and when to do it. We did. She sent me on my way and said to come back again in 6 more months. Most insurance won't cover any fertility anything before a year of trying, so....

September, 2011 - Normal yearly apptment and more than one-year trying check-in. At this point the doc gave me orders for 3 tests. Two blood tests for me and one semen test for Ian. My tests both had to be on specific days of my cycle.

October/November, 2011 - Tests taken, results normal. My doctor states, "Ian's semen analysis looks great!!!" which makes me laugh. Ian proclaims it the nicest thing a lesbian has ever said about his semen. We decide to do an HSG (a test that looks at my fallopian tubes on an xray) and after that she will give us a referral to a specialist.

December, 2011 - Took a day off work for the HSG. It was really unpleasant and painful and crampy. One fallopian tube is definitely fine. Other tube likely spasmed so we can't be 100% sure, but he thinks it looks fine as well. Doctor Norrell calls me when she gets these results, and refers me to a couple of potential clinics. She tells me, "Call me when you're pregnant!"

We call the clinics and decide to go with the one that takes our insurance (we will be covered 80% vs 50%). This is UCSF.

(Side note on insurance coverage: We will be covered 80% up until the insurance has paid $2000 (which will happen in an instant) and then we pay 100%. If we pay $3500 a year then the insurance kicks back in and covers 100% for the rest of the year. This isn't bad. We don't need pre-authorization and many people don't have any infertility coverage. But insurance is confusing and never really makes sense to me. And we've already spent well over $1000 out of pocket for all of these tests and I have a feeling that doesn't count toward the $3500, but I'm not sure. I feel like I have no grasp at all of how much we will/could spend over the course of this, and ultimately, that depends on a multitude of unknowns, the biggest being: how long will it take and what treatments will we end up receiving? There is good news on this money stuff, though, that we'll get to in a minute.)

I make us an initial appointment with the man who is about to become my new Reproductive Endocrinology and Infertility Specialist, Dr. Tran. I pick him because he has the first available appointment and worry that it means he sucks. We send in about 20 pages worth of paperwork (mostly questionnaires) and all our previous test results.

December 28 - We go meet Dr. Tran. And he is awesome. He is the exact style of doctor I need. He tells me EVERYTHING. He draws me diagrams. He wants our input in the choices we make. He explains things clearly. I almost have to push him to tell me what he thinks is best. For those who know me, you'll know this is PERFECT. So, we walk away from this appointment knowing that we'll hear from his nurse in the next week with all kinds of information.

What we learn at this appointment:
  1. As I expected, IUI, with Chlomid, will be the next step for us.
  2. But before that, we need to figure out what's up with that other fallopian tube. Dr. Tran doesn't think it sounds like a spasm, based on how the HSG was described by the dr. who did it. He wants me to get an exploratory laproscopy to make sure that tube is OK. Some problems with a fallopian tube can really impact fertility. And knowing whether or not that tube works will be the difference between doing 3-4 cycles of IUI or 4-6 (before moving on to something else). He also wants to review the actual xray screens.
  3. I have plenty of plenty of eggs in both ovaries!
  4. If my fallopian tube is fine, our case will be officially what they consider "unexplained infertility" because all our test results come back looking great. But after a year of trying (6 months, actually, for the over 35 crew), you are considered infertile. Cause it ain't working on its own.
  5. I am no longer "a spring chicken" and about 1/3 of my eggs are likely no good.
  6. My pregnancy, should it occur, will be considered high-risk for three different reasons. 1 - I am over 35, 2 - Fertility treatments and 3 - Because I have had a LEEP before.
  7. My thyroid levels are the tiniest bit high for being pregnant. Really ever-so-tiny. But since I am already high risk, he thinks I should take a very small daily dose of thyroid medicine.
  8. There are several more tests to be done before we can get started (many are the same tests we would routinely get after becoming pregnant, if we weren't having these treatments).
  9. If we don't hear from his nurse by the following Wednesday (because of the holiday), give her a call.
December 29 - Dr. Tran's Admin Assistant, Annie, calls me, so I don't have to wait for his nurse to be back in town. We get signed up for the IUI orientation that is required before we can begin treatment, and will be going to that on the first Monday of February. (Due to holidays and travel on our part, we can't go earlier.) Among other things, we will learn how to inject me with hormones at home. Oh boy! Anyhow, she goes over EVERYTHING with me on the phone and emails me all the information I need, including a massively overwhelming checklist of things that I have to get done. I freak out a little. I call Dr. Norrell and leave a message about scheduling a Laproscopy. And I get my thryoid prescription filled. Generic version, since that's what the pharmacy has in.

December 30 - I pick up xray films from the hospital where I had my HSG and head out of town for the weekend.

Dr. Norrell calls me back and tells me that she is in contact with Dr. Tran and that she is happy to do the Laproscopy for me and remove the fallopian tube, if need be, but that she and Dr. Tran decided that he should really look at the xray films first. I love how good both of these doctors are at being in touch with me, and each other.

I make the mistake of looking up more info on the Laproscopy and start to freak out about this surgery and the idea of potentially losing a fallopian tube.

January 3 - I wake up with hives all over my body. Suspect thyroid meds. Begin ODing on Benedryl (for the next week).

I drop off the xray films on my way to work.

That evening I get a call from Dr. Tran. Laproscopy not needed! Once he saw the films, he believed I did, indeed spasm, and all is well with my tubey tubes. So, we can go with the plan of 3-4 IUI cycles and carry on.

January 7 - Ian gets hecka blood drawn.

January 10 - Dr. Tran calls to tell me that he thinks I would qualify for a Government Study being conducted. I would still be treated at UCSF, and he would oversee, but he would no longer be my primary doctor. The pro: FREE FUCKING IUI. UP TO 4 CYCLES!!! Every single thing included. The only potential cons he could see: Might have to have more up-front tests and might end up on a drug with a higher likelihood of multiples than Chlomid (there are 3 potential drugs I could be given). I tell him to please give my name to the study Coordinator.

Gloria, the study coordinator, calls me and asks a bunch of questions and gives me way more info about it. I tell her that my biggest concern is that it'll delay us a long time. She doesn't think it should delay us at all. She emails me all kinds of detailed information.

Ian and I discuss for like 32 seconds and decide to go for it. We're in!

January 11 - Hives are finally gone. I'm back on thryoid meds - this time non-generic (all good so far, knock on something).

Now - So, that's where we are. I still have to get a bunch of blood work done, and we still do the Orientation on the 6th of February. I have an apptment to get a mammogram (before I start fertility drugs, this is important). But beyond those last remaining things that are part of my over-all treatment at UCSF, everything will be moved to the study (which is with Dr. Cedars) I won't pay for apptments, drugs, ultrasounds, or the IUI treatments. If it works within those 4 cycles, that's that! If it doesn't, I'll go back to Dr. Tran and we'll discuss our options from there. We have a very long appointment on the 25th of January, to sign our consent forms, do a bunch of tests, etc. If the timing works out with the timing of my cycle, we should be able to do our first IUI cycle soon after our orientation.

At some point I'll tell you more about the trial - what it means in terms of my treatment, as well as what they are looking at. As a person who totally nerds out about medical stuff, I'm actually pretty excited. And that's that!

So, the end for now. Or more be continued.....


  1. Wow! That is so many steps! I want to say yay that everything checks out good with your girly bits and the sperm, but I suppose it's also frustrating to not know what the cause is.

    How lucky that you qualified for the study! I'd be excited about that, too. You're helping other people!

  2. Sounds like a plan, and I love a plan. I am sure they did, but did they check your progesterone levels? By fluke mine was checked and was found to be really low, so my doc put me on progesterone (and eventually even some estrogen) to help me get prego and then "maintain" the pregnancy. Just wanted to throw that out there. :)

  3. Yes, my progesterone levels were checked and all was good! It was actually one of the first tests my doc ordered. They also will check again before I start IUI (because of the study, they recheck a lot of things).

  4. holy cow! that's alot of stuff to do but i guess its one step at a time. BONUS for getting into the test FREE! we're hoping to try maybe this year or next and im dreading it. getting aunt flo back ain't no fun... :)

  5. Lots of details there. My time line was july 2010 go off birth control. Visit dr in feb 2011, she says lose weight, and they might have to do surgery as next step after that. Jan 2012 haven't lost weight, worried about going back because she'll just say to lose weight. Need to lose weight?

    Glad your progressing along this plan, the trial sounds like a good deal!!

  6. That is SO COOL that you guys are going to be involved in that study! Can't wait to hear more about it. It really surprises me that, for the over 35 bunch, you are officially considered 'infertile' after six months of trying. That is a big freaking stamp to be labeled with, I say. It sounds like you really have fantastic doctors, which is just perfect for the kind of journey you've found yourselves on - I'm kinda jealous about your awesome doctors (though that is weird... and probably entirely inappropriate [so I'll throw in an extra RA! RA! for how awesome you are just in case, haha]... it is just SO HARD to find good doctors here who spend the time with me that I need, explain stuff in a way that assumes intelligence... and oh how I wish there could be someone to draw diagrams!).

    And no surprises, skinny legs, that your thyroid levels are a teeny weeny schmeeny bit high ;) You're gonna be stretch-marked and poppy-outy-belly-buttoned in no time!

  7. Yay!!! Excited for you to finally get started on drugs and IUI! And also excited that it's free!! I only did clomid without IUI or an initial HSG but my insurance didn't cover any infertility, so just my short/relatively minor bout with infertility drugs ended up costing at least a couple thousand bucks and was super unpredictable. Also UCSF rules.
    (this is Melanie)

  8. Oh good! I was wondering what all the steps you'd taken so far were. Now I know. I enjoy being informed.

    I, too, love a good plan and it sounds like you have one! Go team baby making! :)

  9. Thanks for the timeline :). And yay for the free study! (Do I sound like the cheerleader you referenced? :))