Thursday, March 29, 2012

First Appointment with a Fertility Specialist

So, the big day was today. After waiting a little over two weeks for my appointmnet with a Reproductive Endocrinologist, this morning, at 8:00, Matt and I had our first meeting on what will no doubt be an interesting and challenging journey with Shady Grove Fertility. And I have to say, the appointment went as good as it could possibly go.

In this post I plan to detail what the first appointment was like, what the next steps will be, and what my feelings are about the whole process. So, if you would prefer not to hear about fallopian tubes, and the such, then feel free to stop reading now :) But the reason I will include the details is so that if someone else googles "What to expect at a first fertility appointment?" or "What to expect when meeting with a reproductive endocrinologist" they will find this blog and find it helpful.

So, Matt and I got to the clinic at 7:40, as we were instructed to get there early so that they could organize the medical records I brought from my OB as well as the male and female questionnaires, and various other paperwork that were mailed to us ahead of time.

The Physician, Dr. Mottla came out at exactly 8:00. I was impressed right from the start because how often does a Physician greet you in the waiting room himself? Not very often. In fact, never in my previous experience. He brought us back to his office and I told him that we, two Boston College grads, would try not to hold it against him that he went to Boston University. He laughed, and we were off to a great start.

He started by saying, "So, what can I do for you today?" I explained (I'll give the shortened version here) that we have been trying for our second child for 8 months now, with no success. And given my history of an appendectomy and a c-section (abdominal surgery is a risk factor for blocked Fallopian Tubes) that I am concerned I have blocked tubes. I explained that I know my body, and that I just have a sense that something is not right. He said, "In the many years I have been doing this I have learned to trust a woman's instinct. So, I definitely think I can help you. We'll talk about some tests that we can run, and hopefully, we will run them, the results will be normal, and that will give you assurance that everything is fine and you just need more time. And if not, then we will talk about next steps." We then talked for about an hour. He was engaging, honest, and soon realized that having spent my working career in medical institions that I know my stuff. He valued my opinion. He was sensitive to Matt who isn't as familiar with the medical world. He took time to not only get to know us from a medical perspective, but also personally. He wanted to know how we ended up going to school in Boston, how we ended up in Maryland, what we do for a living, etc. He didn't just ask. He engaged in conversation. To say I was impressed is an understatement. (And I am difficult to impress when it comes to doctors. I have high expectations!)

So, what did we learn and what will happen next? He has ordered diagnostic blood work (to test various hormone levels at a specific time in my cycle, day 3-5 to be exact), a baseline ultrasound (to check for things like fibroids, the thickness of the lining of the uterus early in my cycle, etc) as well as a hysterosalpingogram (HSG) which is a procedure done by a radiologist in which they inject die into your uterus and check to see that it is flowing out of the fallopian tubes appropriately. If it doesn't, that means blocked tubes. He will also do a semen analysis just to be sure, but we don't expect there to be any issues there. The best news: All of this testing is covered by my insurance and can start NOW! (Well, as soon as I reach the correct day of my cycle). This information INFURIATED me! When I saw my OB after trying for 6 months she gave me a "there, there, don't worry about it everything will be fine, just keep trying." She then explained that nothing will be covered by insurance until we have been trying for a year....WRONG! I am sure this is the case for some people. But not for us. She shouldn't make a blanket statement. She should have said, "Well, give your insurance a call and see what testing will be covered. And then, we can go from there." Overall, I love my OB practice. And I hope she ends up being right, that everything is fine, and we just need to give it more time. But I will certainly be having a conversation with her about how all insurance policies are different.

But in the meantime, I am panicked that I have blocked fallopian tubes. Not just because if I do it means we probably can't conceive naturally, but because it also can lead to ectopic pregnancy, and that can be deadly for a woman if not caught quickly. So, I am very worried about that, and I simply want the test done to know one way or another.

So, what happens if I have blocked tubes? Well, (and this is the part of the day that was a real downer for me) then we jump right to IVF. This surprised me. I read that there is a surgery that can be done that can open up the tubes. And Dr. Mottla said this isn't typically done anymore because it doesn't result in a significantly increased chance of pregnancy. He explained it this way: Imagine you have stream that is blocked by a huge bolder, and you take a bull dozer in there to clear it out. You may clear the stream in such a way that it now flows easily, but in the process you have also cleared away the small rocks, the grasses, and all the other comforting places where the fish spawn. The water may flow, but no babies are being made. Likewise, they may be able to "open" your fallopian tubes, but the cillia and tissues and other things that make it a welcoming environment for a sperm to fertilize an egg are no longer present (either from the scarred tissue, or from the procedure itself to open them up). So, even with the surgery, pregnancy is still unlikely. The surgery is rarely done now because it doesn't make sense to put a woman through a surgery without much benefit. Where as IVF has a very high success rate for otherwise healthy, fertile couples. Needless to say, I was sad. I would like to avoid IVF at all cost. I would just prefer to do things as naturally as possible, but if that is what we have to do, we will. (I also learned that my insurance has a $25,000 lifetime max for fertility treatments, and we could hit that VERY quickly as soon as we go down the IVF route, and that scares me too...But I refuse to freak out about that just yet.) So, I am definitely hoping my instincts are wrong, and those tubes are WIIIIDE OPEN!

When we finished with Dr. Mottla he shook our hands and said, "It was a pleasure meeting you, and I look forward to seeing you again soon." I said, "It was a pleasure as well. But I hope I never have to see you again. I hope I end up being pregnant this month." To which he responded, "Oh, come on. If you are pregnant let me do the first ultra sound and then I will send you on your way back to your regular OB. I need to get to do the fun parts of this job, too! So, yes, I hope I see you again, VERY soon." I said, "That's fair enough." Did I mention that this guy impressed me?

After meeting with Dr. Mottla we met with Crystal, the nurse who will be our "guide" through this whole process. She will be our primary contact from here on out. She was great and also very personable and kind. I think we can definitely work well with her. Crystal went over in more detail when the tests will be done and how to go about getting them scheduled. She was great.

And after that we met with Darlene, the Financial Counselor who reviewed our insurance benefits.

Shady Grove Fertility is very thorough, and in many ways runs like a machine. But at the same time, they have caring, kind people working for them. So, it may be a well oiled machine, but it is a machine made of soft, smooth fabrics, not harsh metals (if such a machine could exist).

So, that's where we leave off. How am I feeling about it all? Well, I am glad that I got exactly what I was hoping for today. I will have the appropriate tests done to determine if I have blocked tubes or not. If not then great, we keep trying. If I do, then we move forward from there, and at least we can move forward NOW instead of starting this whole thing in August, which is what my OB said was our only choice, as August will mark a year of trying. I definitely plan to look into what Dr. Mottla said about surgery to open blocked tubes. I want to learn more about success rates and such before jumping head first into IVF if we have to go down that path. A path I definitely dread.

And lastly, I can't write this post without mentioning the many things for which I am grateful in relation to this whole process:

1. My sister in law who watched Ryan for us (at 7:00 this morning!) so that Matt and I could attend this appointment together. She is also willing to help out, as much as her work schedule will allow, with watching Ryan as I schedule the various tests. THANK YOU, CINDY!

2. My parents who are already on board to watch Ryan and my nieces so that I can get these tests done. My mom will be having knee surgery. She still said, "We'll make it work." We'll see about that. But her dedication to her kids, grandkids, and not-yet-born grandkids is amazing.

3. Friends and acquaintences who have been BEYOND kind and thoughtful as we begin this journey. So many people have been willing to share their own stories of infertility struggles, and I have been overwhelmed by their kindness. Jessica, Abbey, Casey, Kerri, and anyone else whom I am forgetting, THANK YOU!

4. Last but not least, my amazing husband. Knowing I have the most supportive and caring husband in the world right beside me through this whole process, wherever it may take us, is my greatest source of comfort. I love you, Matt!

So, that's where we are. I will be sure to keep you posted. And if you are a woman who is just beginning this journey yourself, then please, don't hesitate to leave a comment or e-mail me. I have been gifted by women willing to share their story, and I hope I can do the same for others.

I'll keep you posted! And in the meantime, I need to get back to posting about Ryan. He is just so amazing these days. So, there will be a post about him soon. But I will leave you with this: last night, as I was putting him to sleep he said, "Mama, I love you! You da sweetest Mama in da woooold!" That, that right there and for so many other reasons is why we want to do this parenting thing all over again! (fingers crossed!!!)

Thursday, March 22, 2012

An Open Apology to My Mom

Dear Mom,

Today I saw a friend on Facebook who had made an Octopus out of a hotdog for her 3 year old son's lunch. She clearly did this with excitement and creativity in her heart. His response was, "I don't want to eat an OCTOPUS!" And this immediately brought to mind for me St. Patrick's Day circa 1987.

I vividly remember that on this St. Patrick's Day you had the creative idea to make our entire dinner (or at least as much of it as you could) green. I remember there being green mashed potatoes, and green lemonade to drink, and something for dessert, perhaps a cake, that was also green. I remember you telling us there was a surprise involved in dinner and I can still hear the excitement in your voice. I remember John, Mark, and I walking into the kitchen, seeing the spread of green foods, and all of us saying, "Eeeww! It's green!" I remember you laughing, but now, I suspect you wanted to cry!

As a Mom, I can now fully understand the effort and love that went into this meal, and the let down you must have felt when your three charming children were less than appreciative of your efforts. Given that I so vividly remember this day, I suspect I felt a tinge of guilt at the time. But I didn't understand it on the same level that I can now. As parents we go to great efforts to do fun things that we think our kids will enjoy. We plan outings, we spend money on tickets and classes, and we make creative meals. Sometimes it goes over with great joy, and other times, well, it falls flatter than flat. I know this kind of frustration now, as a Mom. Like when Matt and I were all excited to take Ryan to the Aquarium for the first time. And he was far more excited by the elevators and escalators than any of the fish, dolphins or sharks. We could have gone to Kohl's and rode the elevators/escalators and he would have been just as pleased.

So, Mom, this is an apology for all the times you and Dad went to great efforts for us as kids, and your efforts were not greeted with adequate levels of excitement and/or appreciation. I hope you know how very much your efforts then and now are so very, very appreciated. And I hope the joy we all experience in regards to the AMAZING St. Patrick's Day feast you serve every year can make up for our less than enthusiastic response to your efforts circa 1987.


Your humbly grateful daughter, Kristen

Wednesday, March 21, 2012

That Illusive Balance

DISCLAIMER: I know by venturing into the topic of "Stay at Home Mom" (SAHM) vs "Working Mom" I am treading on dangerous ground. Please know that my thoughts in this post are simply MY musings on MY situation with MY family. It is not a judgement on anyone else. Every woman and family must do what works best for them. And we can each only know what is best for ourselves, not for anyone else.

I consider the SAHM/Working Mom balance that I have for myself at this time to be "the best of both worlds" in many ways. And yet, I have on occasion been given opportunities that make me wonder if my balance should shift in some way.

First of all, for those that don't know, I spend 4 days a week getting paid to watch my two adorable nieces while their parents are at work. This means that M-Th I go to my brother and sister-in-law's house and spend the day with Ryan, Julia (22 months), and Caitlin (5 years). I play with the little ones, pick Caitlin up from school (with the two little ones in tow), serve lunches, put them down for nap, go to the park, read books, do crafts, eat snacks, play more, etc, etc, etc. It is a mostly busy, at times boring, but generally great day. On Fridays I work a full day as a Clinical Social Worker for a pediatric Hospice. I provide therapy to kids who are dying and those with life-limiting illness and their families. I also do a lot of work for the Hospice from home on the evenings (writing notes, program development, etc), and on occasion go to see a family in our in patient unit or at home on a weekend. I get paid by the hour, which is actually REALLY GREAT because it means I can clock every minute I spend doing work. Which is a HUGE shift from when I was a full-time Social Worker at a large pediatric medical center. When working full time I would often leave at 6:00, come home, and then have to write notes from home. I got paid for 40 hours a week, whether I worked 40 or 60.

Before I had children I always said I planned to be a "mostly stay at home Mom." Though, financially, I knew I would have to make at least a little money. My current situation is in many ways perfect. I get to continue working in my profession of choice, doing something about which I am extremly passionate, while also getting to spend the majority of my time with my son. Not to mention, I am getting to play an integral role in my nieces lives, and that is an honor and a privilege. Most days, I am very fufilled, and wouldn't trade my set up for anything.

But then, I have a day like yesterday. I was invited to facilitate a parent panel at the first ever Psychosocial Symposium on Childhood Cancer on Capitol Hill. It was hosted by the Mattie Miracle Foundation (check out their website and read about an amazing little boy: I met the inspiring parents who started this foundation when they were panelists on another panel I facilitated at another national conference. I was honored that they invited me to participate in this very meaningful day.

After making sure all three kids were settled in with my Mom and Dad who would be watching them for the day I headed off to DC. I took the Metro (as the Capitol is nearly impossible to access by car). It was a beautiful day, and as I walked up to the Capitol building, with cherry blossoms lining my walk, I was, to say the least, impressed. I can harp on politicians, and get frustrated with the state of our Government, but there is something inspiring about that gleaming white building with the huge dome. I thought, "Wow! This would indeed be a cool place to work every day!" Before my presentation I sat through various other presentations by researchers, including a woman with a PhD in Social Work, who inspired me beyond belief. Dr. Lori Weiner does amazing clinical work with children with HIV/AIDS and Cancer as a clinician working at NIH. As her talk finished I thought, "I want to do what she does." After my panel presentation I spoke with parents who had less than ideal Hospice experiences with their children and I thought, "I want to REALLY make a difference in this area; Not just one family at a time, but on a National scale."

It was a fulfilling, thought provoking day. I left energized and excited. As I rode the Metro back home I thought, "I could do this type of thing more than one day a week. I wonder if I should look into working more days a week sometime sooner than I had planned." But then I got home, and Ryan was waiting outside with my parents, waiving excitedly, and jumping up and down. Those thoughts immediately left my head. I knew in that moment that with him is where I am supposed to be the majority of the time.

But, I'd be lying if I didn't admit that at night, laying in bed as I fell asleep, those same "Hmmm....I wonder...." thoughts crept back in. And then, another thought came to mind, "I wonder, is any parent ever certain they've found the illusive 'perfect balance?'" I doubt it. But for now, I am content to know that I have come pretty close.

Tuesday, March 13, 2012

Warning: This post is political!

I have never previously posted anything in this blog that is at all political. But, this is one issue about which I cannot keep quiet.

First, go here and read this well-written blog post by Dr. Jen Gunter. Yes, if you follow me on Facebook I have shared a few of her recent articles.

The legislation that Arizona is trying to (and 9 other states have already) pass disgusts me. Regardless of your views on abortion, this type of legislation is scary! It is a perfect example of uninformed law-makers doing what they think is right without knowing all the information. I know so many children who are alive today simply BECAUSE their moms were informed about a complex, life-threatening diagnosis and they were able to seek appropriate care that saved their child's life. Had those mom's OBs been able to withhold that information their children would be dead today. The moms would not have known to deliver their baby at a hospital that would be able to do such complex procedures as exit to ECMO or an atrial septostomy immediately following birth. These laws could kill as many babies as they are hoping to save.  Not to mention, that a doctor should NEVER be able to withhold information from a woman about the baby inside her because they "think" it may cause her to do something with which they disagree. I get so confused when people extol the importance of "limited government" and then they support laws like this.

Monday, March 12, 2012

And So, We Will Try Again....

I am really trying hard not to focus on the negative. But man, it sure is overwhelming to feel like your body is betraying you every single month! I have such compassion for woman who go through this for years and years. It is truly painful. I was so hopeful this month, for so many reasons, and it didn't happen again.

But on the bright side, I called and checked with my insurance, and at the very least a consultation with a reproductive endocrinologist will be covered at this point. So, we have an appointment on March 29th. It is possible that some testing (if needed) could be covered as well. The only thing our insurance company puts a clear timeline on regarding fertility issues are the actual fertility treatments (IUI, IVF, etc). To pursue those you have to have been trying for a year. But, I sure hope we don't have to go down that road. Though, if we do, I feel incredibly lucky. Our insurance covers them at 100% as long as it is in network. We are truly fortunate that the company Matt works for has such AMAZING coverage.

We will have been trying for 8 months on April 1st (not that I'm counting! ;) Let's hope we don't get to 9......

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