Preggers Again SOON!

I finally heard back from the IVF clinic on Thursday. I had been contacted by the mail-order pharmacy that sends out the hormones for IVF cycles for the clinic, and they were told they needed to get my meds to me by Friday, so that I could start my meds Friday evening at the latest. Since I hadn’t had any instructions or updates from the IVF clinic themselves, I called and left a message explaining that I had been contacted by the pharmacy but had no instructions. Fun.

The IVF doctor’s nurse called me back Thursday afternoon and wanted me to go have blood drawn to verify that the cycle I started on Thursday was a “true cycle.” But they wanted the results right away, and my local hospital’s fastest turnaround on blood tests is two days, since they send the blood to the big hospital for the actual testing. So I had to go to the big hospital. And Hubs had a dental appointment Friday morning, so I wound up just taking Friday off.

Anyway, I got blood drawn (holy CRAP was the girl good with that needle!) and puttered around for a while; picked up a pizza stone for Hubs for $7.00 and a new CD player for Munchkin, as the one her grandmother gave her when she was two years old finally croaked. Drove home, worked on the RP game I’m building for some old college buddies and a handful of others to play via Skype. (Yes, I’m a geek. This is no secret.)

I got the call from the IVF clinic late Friday afternoon verifying that yes, I was indeed undergoing a “true cycle” and so I should start taking my meds right away. So one little blue 2mg Estrace pill three times a day, and the Vivelle patch to be changed every fourth day. I’m scheduled for ultrasound monitoring at the IVF clinic on June 20^th and 26^th, and assuming everything looks good on the 26^th; I’ll have the embryo transfer on the June 29^th. Ha. Pregnant by the end of June. Not bad, considering I was expecting it to be more like May.

I’m also going insane a little bit. Again. Not nearly as bad as I was last time, though. I’m cranky. Some of it is legitimately situational, and some of it is batshit crazy hormone lady. I’ll get a handle on it, though, not to worry. No one will lose their heads over this.

Underinformed

I did get a very curt message back from the satellite IVF Clinic’s nurse:

“Good day. We are need to arrange finical details prior to proceeding.  Once the cycle is ready to proceed, you will be notified. Sincerely, [Nurse].”

I’m not even going to touch on the grammar and spelling. But honestly, I very sincerely hope that this isn’t how they treat women trying to get pregnant with their own children after who knows how much trial and tribulation. I did forward the response to the main IVF Clinic. The woman with whom I had been corresponding called to explain that the main Clinic only deals with fresh embryo cycles, so that’s why I’m dealing with the satellite Clinic instead, and that she was very sorry I felt blown off.

It’s been two weeks now. I haven’t heard a PEEP out of the satellite Clinic. What I HAVE heard is from I.F. who says he was told that the financial coordinator is waiting for the final prescriptions to come from the IVF doctor so that they can send the payment and schedule the cycle. Apparently he was told that this should go very quickly. Would be nice if they bothered to share this information with me, as I’m the one who’s going to be traveling for the transfer and carrying the baby to term.

I’m basically in frustration mode, generally speaking, lately. So maybe I’m overreacting to this. Suffice it to say that I have recent reason to truly appreciate the family and friends I have who make it clear by their actions that they do care about me, and on whom I can unfailingly count for support.

Legwork

Lacking the full medical details from the photos and report of the hysteroscopy, I understand that I have been cleared to proceed with surrogacy number two. What a fiasco it was to get the photos and report to the IVF clinic, though!

First the big hospital called me to ask how I wanted them to send the photos… To me. Um, sorry, I’m not driving 3+ hours, including traffic, to deliver what turned out to be only have of what the IVF clinic needed. I asked if they could scan and email the photos, and the nurse to whom I spoke said she would check and get back to me. Then the woman from the IVF clinic told me that often scanned images wind up being distorted, so would I please ask the big hospital to mail the photos. I did so. Then the woman from the IVF clinic emails me to ask about a report (which the nurse had originally told me did not exist.) We went back and forth on this a couple times, so I finally broke down and called the big hospital to ask that the report be faxed to the woman at the IVF clinic. I did not receive any notification that this had been done until the woman from the IVF clinic emailed to tell me that I was good to go for surrobaby number two, and that I should reach out to the IVF doctor’s nurse to get information on dates.

Ok people, seriously?! Why should I have to do all the legwork? Is it so much to expect that the doctors talk to each other?! The IVF clinic ordered the hysteroscopy in the first place. I didn’t have to sign any release of information forms. I was not harangued about confidentiality when I called to ask that the photos and report be send to the IVF clinic, so why couldn’t they make the call, themselves? Is it so much to expect that their nurses contact me without being prompted? Isn’t it their job to contact patients to schedule procedures and keep them abreast of their situations? I don’t remember being held responsible for nearly this much of the process last time. I had to call the pharmacy before I ran out of meds, and once I was given the go-ahead from the IVF doctor to transfer to a regular OB, I made those arrangements. I’m not really angry per se, but I am definitely annoyed.

I emailed the IVF doctor’s nurse this morning (I was indirectly provided her email address by the woman at the IVF clinic, who incidentally is working in a different city altogether). Haven’t heard back yet. -grumble-

Surgery Success

I woke up yesterday morning a bundle full of nerves, around 6:30. Stumbled out of bed and went into the guest room to check on the munckin's new kitten, played with him for a little while since she's at her grandpa's house for the remainder of this week, then shuffled down to the garage to procure a large piece of plywood to set at the top of the stairs so that kitten can run around the upstairs and not make contact with my stepdad's crotchety old cat. The older cat can't jump very well anymore, and the kitten is still too small to make it, so there's no risk of a tiff while the humanz iz away.

It turns out that when I'm nervous, I clean. And ramble on about stupid things. First off, my last surgery left me nauseous to the point of involuntary retching and more unpleasant things. So when the anesthesiologist at the big hospital looked at my chart, he noticed that I do not react well to waking up post-op. He offered me a spinal, but I told him that I'm wary about a spinal because epidurals only work on the left side of my body. He said spinals are different, but that it was fine; they have all kinds of new drugs to kill the nausea. I still have the scopolamine patch behind my ear, and the anesthesia aide gave me a shot of intravenous benadryl. It. Worked. Beauty.

I remember all of the pre-op waiting; the nurse was very good with the lidocaine to numb my hand before the IV went in. The doctor and a team of 3 residents, plus two OR nurses to assist, and I met all of them. Anyway, they wheeled me into the OR and helped me scoot onto a teeny-tiny table with what felt like leg-hammocks. They strapped leg massagers on, stuck electrodes all over me (I don't know why I had a big streak of iodine on the outside of my left thigh, but whatever. The anesthesia aide held a mask over my mouth and told me to breathe normally; I didn't even get to count backwards from ten; I was just out. When I woke up, I was in post-op on my right side (just the way I like to sleep. Seriously.) I looked around, didn't see anyone, noticed a distinct lack of nausea and decided to go back to sleep. I guess the doctor went out and told Hubs that the procedure was a success, and that one of the nurses would come get him when I had woken up, because they wanted to let me sleep.

After Hubs came in, the doctor showed us pictures of my uterus, which didn't make much sense to me at the time, so I just kind of smiled and nodded. What she DID tell me was that it looked as though I had been shedding scar tissue on my own, and that the remaining tissue pretty much came away when they filled my uterus with saline. She said she would send the pictures to the IVF clinic right away, and that she doesn't foresee any more delays being needed in this surrogacy cycle. There's no balloon or IUD in my uterus right now, so I guess she's really, really confident. Hopefully the doctor at the IVF clinic agrees.

When I got home, the kitten decided he couldn't bear to be without me, so he figured out how to climb up onto my bed so he could spend the greater part of the night alternately bathing himself and snuggling either tight up against me or ON me while he bathed, then fell asleep. I sincerely hope he does the same with the munchkin, or she's gonna be a very sad girl.

EEK

I have to admit that minor though next Wednesday's hysteroscopy may be; I’m still really nervous about it. Regardless of my size or health, I’ve always had exemplary reproductive bits. I feel somehow diminished because of this. I don’t really know how to explain it. I’m uneasy and stressed and nothing I do can really alleviate the problem.

The doctor has assured me that this procedure is so simple and so easy and that she’s done it enough times that she could do it with one hand tied behind her back (she promises not to, though). Even still, I hate, hate, HATE the fact that it’s necessary at all. I can handle the idea of having my guts cut open. I’ve had a cholesystectomy (I have no gall bladder). I’ve had my wisdom teeth pulled. I could handle having my tonsils removed; possibly even my spleen, if I had to. But this; it feels like they’re telling me that my identity is faulty.

I'm sure I'm being a drama queen. My dad tells me that I have enough insecurities. That it happens. That I've given birth to two children and all. His thought is that I'm "in remarkable health, reproductively, given the abuse [my] body has endured." I'm sure he has a point, and stuff. And I'm sure other stresses need to be factored in to my current mood.

Oh well. I'll get over it.

Surgery

Went to see the gynecological specialist at the Big Hospital today. She was reassuring, but said I definitely need to have a hysteroscopy, and made it clear that she wanted it to happen soon. She was friendly and outgoing, and I liked her immediately. She actually reminds me quite a bit of the doctor who delivered Wiggle-Worm. She gave me a pelvic exam (which I think made hubs a little uncomfortable, as I told him to stay in the room with me. He stood up by my head) but said she was comfortable going on the ultrasound results from the fertility clinic, and I therefore wouldn't have to have another hystriosonogramthingyofdoom.

So I have surgery scheduled for April 25. I'm sure the big boss lady is less than excited about this, as we have fieldwork scheduled for that week. Honestly, though; this is something bigger than just prepping for another surrogacy. This is something I would need to have done regardless. The doctor says I need it. My immediate supervisor has given me her blessing, so that's that.

On the subject of my new boss: I'd like to say that so far, she's turning out to be just as easy to get along with as my former boss. Old Boss Lady was friendly and a little aggressive, but not offensive. We had a lot of fun picking on each other on long car rides (and, admittedly, in the office) and we laughed a lot. New Boss Lady is quieter, but just as friendly and just as willing to laugh. Now, I realize that they aren't there to be my friend. They're there to be my supervisor and to make sure I'm doing my job and doing it well. But I know my job. I do my job well anyway. So there's a little bit of room to be friends, and that makes the job so much more pleasant.

Also: I've lost a total of six pounds so far, between watching my calories and exercising. I think I may have gained a little bit back this week, due to a little caloric overindulgence and a bit less exercise than usual. I was wiped out when we got back from the Big Hospital today, so I skipped the usual extra-eleven-mile bike ride and 90-minute hot yoga class I do on Wednesdays. I've been practically religious about exercise and diet, though; so a slip-up here and there can be forgiven, I think. If nothing else, I can always do the biking and yoga on Friday if I feel up to it. I just might do that. Or do some riding this weekend. We'll see.

Anyway, back on topic: The doctor says that even if she has to do some major cutting where the scarring is concerned, she's confident that an estrogen regimen, followed by a reintroduction of progesterone and estrogen together, and then a reintroduction to birth control pills should put me right. Now, depending on how much cutting she needs to do, I may wind up with what amounts to a balloon in my uterus for up to 5 days post-op, or I may be able to get away with a copper IUD (intrauterine device; it's a T-shaped piece of plastic wound up in copper, usually used as a birth control method. I had a plastic IUD with low level hormones from 2005-2010. Fabulous thing.) The intent is to prevent the interior of my uterus healing and therefore fusing itself to another part of my uterus. These are things I can live with.

The doctor also reassured me that this shouldn't put me more than a month behind our original schedule, so that should put I.F. and the agency at their ease. And while this is nice, it really did me good to hear it. Regardless of the surrogacy (sorry, I.F.) the idea of not being able to have any more babies of my own scared the bejesus out of me.

And yes Hubs: you were right. Again. As usual.

Scary Words

Phrases like “scarring” and “possible uterine adhesion” and “hysteroscopy” are very scary when you’ve never heard them before, and the only explanation you get is from your own online research. Sometimes I think professionals in the medical field get so desensitized to their own terminology that it doesn’t occur to them that big phrases like the ones above can freak the hell out of a layperson. Like me.

The results of the test that was performed at our screening at the IVF clinic (during which they pumped my uterus full of saline solution so they could do an internal ultrasound) showed that I have a band of scar tissue at the top, front, left sector of my uterus; where Wiggle-Worm’s placenta was attached. I shared with them (because the big hospital neglected to) that the obstetrician who delivered Wiggle Worm went in and manually scraped the placenta out, and that’s likely what caused it. (In retrospect, this rather disturbs me, as they really didn’t wait at all to see if it would detach on its own so I could push it out myself.)

I was informed via email that this was the case, and that the doctor wanted me to get a hysteroscopy because he was concerned that there might be some adhesion. No statements of reassurance; no explanations, no nothing. So of course I went looking for definitions, indications, etc. on the interwebs.

About.com gives this information on uterine adhesions:

“Intrauterine adhesions can be asymptomatic and of no clinical significance. Symptoms associated with clinically significant intrauterine adhesions include:

- Infertility
- Menstrual irregularities (hypomenorrhea, amenorrhea)
- Cyclic pelvic pain
-Recurrent pregnancy loss.

Infertility is the most common reason patients present for evaluation: 43 percent of women with intrauterine adhesions have some degree of infertility. Menstrual irregularities are also a common presentation; however, the extent of adhesions seen on hysteroscopy does not correlate well with degree of menstrual irregularity and nearly 40 percent of patients with adhesions documented on hysteroscopy report no menstrual irregularities.”

WebMD gives the following information regarding hysteroscopy:

“Hysteroscopy is a diagnostic and surgical procedure that makes examining the inside of the uterus possible without making an abdominal cut (incision). During hysteroscopy, a lighted viewing instrument called a hysteroscope is inserted through the vagina and cervix and into the uterus. Treatment can also be done through the hysteroscope during the same procedure.
Hysteroscopy usually takes 30 to 45 minutes and is done as an outpatient procedure. General anesthesia is usually used, although local or spinal anesthesia can be used instead. You should not eat or drink for at least 4 to 8 hours before having the test. A gynecologist or surgeon performs the procedure.”


Okay, so my brain read “infertility” and “recurrent pregnancy loss” and “general anesthesia” and kinda sorta flipped out. I have never had anything but PERFECT reproductive health. I’ve had surgical procedures and an IUD and nothing ever messed with my bits, but now I have scarring on the inside of my uterus that could prevent me from ever having kids again, and the doctors want to put me out so they can inspect my womb with cameras, and on top of all that, The Agency wants me to try to get this paid through my insurance and I’m just supposed to smile and hop about without a care in the world?! I don’t think so!

So I emailed the woman from the IVF clinic who initially informed me about all this, and told her that I was flipping out; that I’d been near tears for almost two days over the whole thing, and I thought it was really insensitive of The Agency to make me do all the legwork in light of what I had just been told, and please, PLEASE tell me if I was overreacting, because I was having a really hard time holding it together.

I should point out that it’s not easy to make me cry, as a rule. I tend to take things as they come and deal with them. I holler sometimes. I worry occasionally. But I rarely actually cry. Just to give you a little perspective on the nature of my assumptions here.

Within half an hour of emailing the lady at the clinic, she had called me personally. She told me that sometimes it’s easy for them to just breeze through stuff like this without realizing the kind of effect it can have on people who don’t do fertility medicine as a profession. She told me that the doctor isn’t operating under the impression that there’s anything so significantly wrong with me that it would stop the surrogacy process, let alone prevent me from being able to have children later on. He just wants to make sure he knows everything that’s going on, and to be 100% certain that the scar tissue ISN’T going to pose a problem for me or for a baby.

BIG, DEEP SIGH OF RELIEF HERE.

Hubs and I had a phone conference with the social worker at the IVF clinic last night. We realize that it’s part of the process, no matter how many times we’ve done surrogacy, but at the same time, it would have been a lot easier to just fill out a questionnaire or something. Yeesh.