My friend Sarah, over at Dreams and False Alarms posted a comment, asking me “Eva, where are you hiding?” Well, Sarah, I’ve been hiding under my bed for the last week or so. When I get overwhelmed sometimes, I hide under my bed with the dust mites and boxes. It’s been a world wind of a week. It was the best of times and the worst of times…

1. 1. November 2, 2008: IUI # 8. My eighth IUI was uneventful. The new facility is state of the art and it went with out a hitch. My donor numbers were impressive:53% motility and the doctor said they look for 40% in frozen sperm. Also they put back 40 million little guys and typically they look for 25 million, so that’s pretty good. After the procedure, I didn’t feel rushed. I felt the love, girls! The only challenge was getting back home during the NYC Marathon. I’m more than halfway through my TWW.
2. 2. November 4, 2008: Mr. President. I felt exhilarated after the election. What a thrill. For the past 22 months, Nadia and I followed the election like two crack heads. I clicked on several left-leaning political websites a gazillion times per day. I couldn’t get enough of it.  What a story and what a country. When I think about everything he overcame to win the Presidency, I feel truly inspired. His win is definitely one of the highlights of my life.

3. November 5, 2008: Not so Funny. A few months back, I wrote a post called, A Funny Thing Happened on the Way To… and it was about how Nadia’s sister become pregnant after knowing the baby’s father for a few months. Of course, I wished her well, but I was jealous. Well, unfortunately, the baby was born on November 5^th at 22 weeks, weighing 2lbs. Ouch! The baby has and 80% chance of survival and a 50% chance of having developmental delays. I feel awful. Nadia went to see her sister and the baby. She says the baby is doing okay and that she measures about 13 inches in height. This brought up so many emotions in me: fear, sadness, and extreme guilt.

4.November 6, 2008: Prop 8: It took a couple of days for all of the votes to be counted but by last Thursday we knew that Prop 8 had passed. Same-sex marriage was effectively banned in the state of California, which totally sucks. And to add insult to injury they saying that 70% of African-American voters who came out in support of Mr. O, voted for the measure. It’s very hard to be a black queer sometimes, well all of the time, but I feel really hurt by this. At the same time, I was very impressed when I received an email from a leading LGBT civil rights group, the National Center for Lesbian Rights, encouraging togetherness and community. This is not the time to point fingers. Unfortunately, there are some pretty hateful things being said to African-American’s at Prop 8 protest rallies, so there is a lot of work to be done in both communities as much as there is a need for a deeper analysis of what really happened there.Pam Spaudling writes a great article about this at the Huffington Post.

5. The C –Word: No date. It looms large in my consciousness and I can’t stop thinking about it. It has made the ttc less relevant for me. Nadia, however, keeps asking me what I’m so worried about and just wants me to proceed as normal. We’ve had a many arguments about the ttc timing. Ugh.

6. The photo: This is a photo of a carving of a wooden hand holding an egg that Mr. O keeps son his desk. It is a Kenyan symbol of the fragility of life. Life is fragile indeed.

 Last week we went to see the second of two surgeons who specialize in the treatment of thyroid cancer. This guy, Dr. Yes We Can, even told us that she may not have to have radiation after the surgery, depending on the pathology.  This was definitely more than we hoped for. I mean, who wants to become radioactive if they don’t have to?

We scheduled her surgery for Thanksgiving week. She will only have to stay in the hospital overnight. Whew! He also reiterated what the first doctor said–she should make a complete recovery because the cancer was found at such an early stage.  We are thrilled. He said that she could return to work whenever she felt ready, but I am hoping that she takes at least two weeks off.  If nothing else, this will give us something more to fight about during our downtime… there is never a dull moment at our house.

As for the TTC, Nadia and I met a new RE this week. Originally, after my failed IVF, I was planning to interview several doctors, to get a sense of my options, but after I learned of Nadia’s diagnosis, I canceled some of those appointments, and just kept the one with the guy who was the most highly recommended. So this week we met Him, the doctor that I have been hearing about since I started my TTC journey.

So did he live up to the hype? Does anyone ever live up to the hype?

Well, before I answer that question, let me tell you about the medical facility. It is the most beautiful, pristine medical facility I have ever seen, and I’m sorry to say that I have seen quite a few in my lifetime. When I entered the building my eyes were drawn to a waterfall and I immediately felt soothed.

When I reached the reproductive endocrinology floor, I thought I heard harps playing in the background. It was very surreal. Everyone was so nice and everything was so organized. While waiting to see the doctor, I totally understood why everyone raved about the place. And I need to add that we only waited about 20 minutes, which included filling out the requisite paper work. At my former RE’s shop, we would wait at least an hour to see him– not including the paper work–even when we had an appointment.

Anyway, when we finally sat down to meet him, Dr. Yoda, he was very pleasant and quiet. I didn’t hear any bells or whistels going off during the consult, but I also didn’t hear him say, my old RE’s refrain, “Well, you are 38 and your eggs are old so…well, what can I say?” This guy was more optimistic and suggested some new approaches including estrogen priming and autologous endometrial co-culture (say that 10x fast!). Estrogen priming involves wearing an estrogen patch the cycle before you start to help with the upcoming protocol. I think it is sometimes used to help (ahem) older women with their egg production. The endometrial co-culture thingy involves growing a patient’s embryos on a layer of her own uterine line, which helps unexplained IVF failures and poor embryo quality in a previous IVF cycle, so this seems like something that would definitely help me–the one only produced one 5-cell embryo her last cycle, but I digress!

Anway, he definitely gave me hope and even Nadia was hopeful and kinda into it. I told him about my insurance nightmare (well, not the whole long boring story but the abbreviated kind, the kind you tell during a 15-minute consultation) and the fact that I needed to do two more natural cycle IUIs so that those bastards at my insurance company would finally pay for the IVF. In response, he suggested that I start right away and do an IUI this weekend.

Huh?

When he said that, I looked at Nadia and told him that she had thyroid cancer, which meant that we were putting all of our energy into her healing process, that the TTC was off for now, and before I could say any thing more, Nadia looked at me like I was crazy and said, “you should totally do it this weekend.”

Huh?

So I cleared my throat and told that doctor that we had to discuss it. But since we left his office, Nadia has been pushing me to do the IUI this weekend. Finally last night, I said, “why do you want me to do this now given everything we are dealing with?” And she said, “well, the sooner you do the IUI’s the sooner you can do IVF.”

Huh?

I have to admit that I don’t understand her. Sometimes I swear she just contradicts herself just to keep me on my toes. I thought she wanted me to table the TTC so we coud focus on her cancer, upcoming surgery, and healing, but I guess I was wrong–again. She said to me, “just because I want to be a priority (when was she not a priority?) doesn’t mean everything has to stop.

Huh?

I love her to pieces, contradictions and all. She is my infuriating angel, sent from heaven just to drive me batty.  I do love her and the fact that she wants me to do an IUI this weekend. I have to admit that am a bit weary of jumping on the ttc hampster wheel so soon after my failed IVF, but the truth of the matter is that this IUI should be pretty low stres–it’s a natural cycle afterall, this is the equivalent of a straight woman going bear back with her husband, except there are about 10 more people involved, including nurses, embryologists and doctors, and lots of cold sterilized instruments, but you know what I mean.  This IUI will give me an opportunity to learn more about this new doctor and new facility.

So it looks like I will be doing an IUI this weekend. And it all starts tomorrow morning with a 7 AM appointment for an ultrasound.

If you read her blog, you know that she’s been through a lot herself–infertilty, a beloved husband with MS, and now the ups and down of surrogacy– but she always seems so upbeat, friendly, and, well, you know, so damn smart! So one day, I just had to ask,  “girl, how do you do it?”

To be brutally hontest when I first discovered her blog, I didn’t fully understand why she needed the cape  but once I got to reading,  and discovered her wit and good humor in spite of it all, I started craving her mojo. I wanted a cape for myself.

Thankfully for me, my timid inquiry about her strength,  and her cape, inspired The Red Cape Award. I’m so very honored to have this distinction. I’ve been walking on air since I heard the news.

Anyhoo, I have to hand out some Hero Awards of my own, which I will do, as soon as I return back to earth. Thanks again, Kym, you really made me smile, and you will never really know much I really needed that.

Nadia remains completely functional  (almost hyper functional) and fearless or delusional, depending on how you look at it. The only reason why I say she might be sort of ‘delusional’ is because she doesn’t seem phased by it.I think that part of it is because she doesn’t have any symptoms. But, if it were me, I would be under my bed, with torn clothes, shaking and screaming ‘why?’ but she hasn’t done any of that. I think that she has the right attitude to beat this thing so I don’t want to bring her down, but I can’t exactly relate. Then again, maybe I don’t need to.

Anyhoo, we went to see a surgeon who told us that she would definitely recover from the c-word. She will have surgery next month and then radiation about two months later, but he was extremely positive and upbeat.  He was very soothing. We left his office feeling a bit high.

Whew!

I was feeling pretty good about what I had read online about papillatory thryoid cancer but, of course, nothing beats hearing a verdict from a seasoned medical professional. He spoke with confidence and looked her directly in the eye. We loved him but I also scheduled another consultation with another doctor tomorrow. I’ve been in love with doctor’s before. I need results. We need to have someone to compare him to. I wish I had done that when selecting an RE, instead of just following the suggstion of my gyno. But I need to move on…

The interview process will start all over again, when we have to select an endocrynologist to administer Nadia’s radiation treatment, but we will cross that bridge when we come to it.

Needless to say, the TTC journey is on the back burner, indefinitely. But you know me. I have to keep the fire simmering. In the meantime and between time, I am seeing a new acupuncturist who is very sweet. I am also taking Chinese herbs twice a day–yuck. Dr. Sweet remmends that women work with her for three months before they try IVF again,  but that the woomen often choose to wait six months, so things might work out for me. I predict that it will take Nadia three to six months to recover completly, probably closer to three months from now, but we will see. I am keeping my fingers crossed.

Next week, Nadia and I are going to see one fertility specialist but I certainly won’t have any inseminations– not even the two natural ones I need to pay for- until she is completely fine and we can start arguing about the whole things again. Those were the days…

I am going to change my blog a little to incorporate this new develompent in my life. I love my Nadia and can’t imagine life without her, thank God I don’t have to, but the c-word is definitely now a part of my life now. I intend to blog about it consitently, now that I am over the initial shock of this nightmare. 

Thanks again for all of your love and support. It means the world to me. 

It’s been a couple of weeks since I posted, so I’ve decided to do a run down of all the news that fit to print since my last post.

Fertility Update

Nadia and I went to see Dr. Feelgood earlier this month. When he entered the room, he said, ‘That last cycle sucked!” No, shit! He talked about my poor response, my age, and my post-fibroid uterus—all factors that will make it difficult for me to get pregnant. He said that we should and could try again with a different protocol. He said that I would probably never have a cycle that would produce 10 eggs but I could produce four mature ones and that could make all the difference.

I responded by telling him the truth. And the truth of the matter is that I’m not sure if I can keep going back there. I really admire him but I associate that office with 9 failed cycles and that’s a big hump for me to get over. I try to imagine myself getting up at 5 AM to go there for one of a trillion sonograms and my mind goes  blank.

Maybe it’s time for a something new?

At the same time, honestly, I don’t know if I have the fortitude to continue at all. I’m definitely not emotionally ready to start again anytime soon. It’s not so much that I didn’t get pregnant, even though that is extremely disappointing, but it’s also the fact that after all of the needles, medication, and sonograms, I only had one embryo to transfer. That makes me feel like a failure, and I told my doctor that. He was very sweet and understanding, assuring me that I’m not responsible for my ovaries or uterus. He told me that if I decided to change doctors, he would completely understand.

Nadia and I have an appointment later this month with another RE to get a second opinion and explore our options.

Insurance Update

But actually, he did have a bit of good news. Because his advocacy with my insurance company, I was given a bit of a reprieve. According to the company, I only have to self-pay for 2 more IUIs before they will cover another IVF. Prior to my doctor’s advocacy, I would have had to pay for 5 more IUI’s, so I guess there is a silver lining to this raincloud. I’m 2 IUIs away from receiving the infertilty diagnosis that I crave. The reason why I wrote, ‘self-pay’ is because this new insurance, the one that Nadia and I are paying extra for, doesn’t pay for IUI’s for women in same-sex relationships. But I guess paying for 2 more IUIs will be cheaper then paying for one more IVF. So, we’ll see.

One option would be for me to do two natural cycle IUI’s and then another round of IVF but who knows when I will feel psychologically ready for that?

The C-Word

So while I have been whining and writing about my fertility struggles, Nadia has been plugging along on her own medical trajectory. Last month she had a routine annual physical. Her doctor noticed some nodules on her thyroid and suggested she get a sonogram. At the time, I thought nothing of it because I read an article on the internet that said that 95% of all thyroid nodules are benign. What would cause me to think that she would be a part of that 5%? So Nadia had the sonogram, sandwiched between giving me fertility shots in the morning and evening and a full day of work.  After the sonogram results, her doctor told her to get a biopsy. Again we thought nothing of it. In fact, we were still very nonchalant about it.  A few years back, I had a biopsy in my breast and nothing ever came up it. It’s better to be safe than sorry right?

So last week, Nadia went in for a thyroid biopsy and it turns out that she has thyroid cancer.

Ouch!

I’ve never gotten punched in the stomach before, but I imagine that it feels as if the wind has been knocked out of you, similar to how I felt when I heard the news.

All my energy, anxiety, strength and hope are now focused on Nadia and her body and her struggle. Since I heard the news this past Tuesday, I’ve done a lot of research, and it turns out that papillary thyroid cancer is “one of the best cancers to have”, that is, if you have to have cancer at all. Most people have a 100% recovery with no incidence of recurrence but we have yet to see a specialist. We have appointments later this month and until then I am holding my breath.

I titled this post, “Rundown to the C-Word” but I should have titled it, “When It Rains, It Pours.”

It’s pouring.

I’m pretty upset about it and will write  more later.

This is my tale of woe. It’s a story about the hidden cost of lesbian infertility.

In spite of my best efforts, my RE’s office did not start calling my insurance company for IVF authorization until 4 days into my cycle. I asked them in May when Nadia and I decided to move forward and I asked them again in July when I received my insurance card. I had the misfortune of speaking to the same receptionist both times and both times she said that they would get the procedure approved once I started. I was a bit leary of her, but at the same time I reminded myself that she did this kind of stuff all of the time, so she would know best. That was my first mistake.

One reason why I did not push it with her is because I myself had called my new insurance company several times to inquire about their fertility coverage. The first time was back in March and Nadia was on the call. In fact, it was Nadia who clearly inquired about health insurance coverage for her partner. We had them on speaker phone so, I chimed in several times to ask clarifying questions. It was on that call that we were told that they did pay for IVF, as long as I could prove medically that I had been trying to conceive for a year. Well, I knew that that would not be a problem for me. After all, I had had 7 IUI’s cycles (with 2 IUI’s per cycle), five of which were medicated, one fertility surgery, and one canceled medicated IUI cycle due to a poor response to medical stimulation. I got really excited about the prospect of subscribing to Nadia’s insurance when her open enrollment period would begin in July. I knew that we could do a few more rounds of IUIs and then if those didn’t work, it was comforting to know that I would not have to pay for the big IVF guns out of my pocket. Once I got my insurance card in July, I called them again to make sure that all of the paper work was in order and to reconfirm the benefits and requirements. I was told that everything was in order.

At the time, there was no way for me to know that with every phone exchange with my insurance company, I was operating under a false assumption that would prove to be very costly. I naively thought that they were operating in good faith. Please don’t ask me why I was stupid enough to think that because I really don’t know.

Imagine my surprise when I learned a couple days before my scheduled retrieval that they would not pay for my IVF treatment. “What?” I asked my doctor’s billing coordinator. “Well, it seems as if the fact that you don’t have a male factor, is a big factor,” she said. Needless to say, I was a bit confused.

It turns out that my health insurance company has different medical standards for women who have “access to sperm” and those who don’t. According to my health insurance, as a member of a same-sex couple, I am required to have 12 medically supervised IUI’s to prove my infertility and only after those 12 IUI cycles would I be eliglbe for IVF coverage.

What that means is that women who have male partners have different medical requirements than those of us who don’t; either because we are single (using donor sperm) or in a same-sex relationships (using donor sperm). Needless to say, finding this out at the 11th hour before my retrieval left me flabbergasted and dejected. I had come so far in my TTC journey only to discover that I had to foot an $8500 bill for IVF, if I was really going to see it through to the end.

There are many things about the situation that make me furious, but the fact of the matter is that each time we spoke with a rep for the company we identified ourselves as lesbian or in a same-sex relationship. We clearly explained that we were calling to confirm fertility benefits for the non-insurance holding female partner. I was never told that the medical standards for women in same-sex relationships were ‘different’, i.e. higher than those for other women. You would think that their employees would be trained to alert same sex callers about the differences, but no. If I had known about these differences, I still would have been outraged, but I could have planned things differently.

For example, maybe I would not have signed on to this health insurance; or maybe I woudn’t have waited three months…or maybe I would have continued with IUI’s until I reached their threshold, or maybe, hell, who knows? I never thought about different medical standards based on relationship status or sexual orientation

Another reason why I never thought to question my same-sex status and it’s effect on my medical coverage was because Nadia’s insurance is based in Massachusetts. Mass. is the first state to authorize same-sex marriage so I thought that made us all equal under the law. I never considered that they were would be ’separate but equal’ medical standards. Their company rules allow her to put me on her insurance–which in many states and for many employers is still a big hurdle same-sex couples must face– yet then they create different rules for us, even though we pay the same premiums.

Under the circumstances, my doctor was understanding. He said that he would help me with the appeal by personally calling my insurance’s medial reviewers, writing letters, and doing whatever he could to help but, obviously, he wanted to make sure that he would be covered, so I had to authorize his office to charge the full $8500 payment to my credit card. According to my doctor, if my ruling is overturned, I will be fully reimbursed.

OUCH!

I am not sure what hurt more, having 4 eggs sucked out of my bloated ovaries or signing that charge receipt.

As is stands now, my doctor has spoken to their medical ‘expert’ and he says it does not look good. They don’t seem inclined to budge on their requirements in spite of the fact that in his expert opinion whether or not I had a male partner, I would still have fertility problems and would qualify for infertility treatments. On my part, I have also written a letter to the company that is awaiting review, but they did answer my question about different medical standards for same-sex couples fairly quickly and this was their response:

“Our policies clearly indicates a member must complete 12 MD supervised IUI’s, which is equal to 12 months or one year of infertility. This has been in policy since 8/03. This is in accordance with the state mandate of one year. State mandate indicates a woman must have one year of infertility prior to coverage, in order to prove one year of infertility in a same sex couple or single female, they must show 12 IUI’s/12 months/ 1 year under the care of a md.”

One thing that they don’t mention in their response is that a woman in a same-sex couple would have to pay for the 12 IUIs. They won’t cover those either. So their fertility coverage for single woman and women in same-sex relationships is really non-coverage.

As of today, I remain embarrassed, angry, sad, humbled and little more broke than I had originally planned. In my case, the diagnosis of ‘lesbian infertile’ remains elusive and costly.

Now, back to my pretty place.

It was an email from my embryologist with this picture of my little one, my 5-cell, day 3 A- embie. Isn’t she beautiful?

The rant post is almost completely gone (for now, anyway) and I’m in a pretty place for the moment, hoping against hope. I will find out this weekend if she took and, until then, I think, for the rest of the week, I’m gonna act like she did.

Folks have been asking me how I’m feeling and truth be told, I feel 45% optimistic, 30% pessimistic, 15% scared out of my wits and 10% exhausted. I have cramps, headaches and lower back pain, but these are exactly the same symptoms I have when I’m about  to have a visit from my Aunt Flo. So who knows? Also, I’m on progesterone so my body is totally out of whack. I can’t trust myself physically right now, but I’m delighted to have this photo.

As I write this, I find myself focusing on baby steps. I’m fighting the urge to fall flat on my face, while I’m struggling to move myself forward one small step at a time.

I know it only takes one embryo to make a baby, but it’s hard to stay positive after my doctor’s bleak tone; however, if there is anyway to keep a positive attitude in the midst of this, I will.

The procedure itself was more invasive than I thought. I was lead into a pseudo-operating room and joined by a nurse, two embryologists, and my doctor. This was the same room where I had my retrieval but, unfortunately, I was awake this time. The lights were bright and it’s cold in there. They had me contort my body in ways I didn’t know I could. My vajayjay acrobatic skills have really developed over the past year and half.  My uterus is still raw from the retrieval 3 days ago, so when he inserted the speculum today it really hurt.

To top things off, I had to have a full bladder during the procedure to help with the imaging of my uterus. The sonogram helps them place the little one in the optimal spot. The one cool thing  was that they showed me a picture of my little one right before the transfer, which they promised to email me. He’s so cute! And, btw, I’m still waiting for that email.

After the transfer, I lay there for 30 minutes, contemplating the meaning of it all and listening to Aretha’s “I Say A Little Prayer of You”.  It is the perfect song for my little one. I go back in two weeks for  blood test. I’m hoping my prayers will be answered then.