Infertility and Finances

Infertility sucks.

It can be draining on your health. It can be draining on your marriage. It can be draining on your social life. It can be draining on your finances.

It's crazy to me just how much it costs to do fertility treatments. Attempts and trials to create life. Some successes and some failures.

I feel like for every failure there should be some kind of refund (even a partial one). Right?

I commend all the couples who have plunked down tens of thousands of dollars on failed attempts. I don't know if I could be that strong. Who knows, maybe we will be.

Recently, I went in for a baseline ultrasound and bloodwork following another failed IUI cycle. When I went to check out with the receptionist, she told me that we had a balance of $XXXX. While I was expecting a balance of some kind based on our previous IUI cycle, I had no idea that it would be five times the amount of the previous time!

I did a double take and asked her to say that again.

I couldn't understand how or why there was such a disparity in the pricing for the EXACT. SAME. PROCEDURE.

Sure, there was a little more monitoring in the way of ultrasounds and bloodwork for this most recent cycle. But in the end, the IUI method was the exact same method.

I talked to the insurance/billing coordinator at the doctor's office to find out what I could about the billing. I was really praying that it was a mistake.

Unfortunately, to my dismay, because the IUI cycle was considered a "Combo Cycle" because we started with straight injectables (Follistim) rather than pills (Femara or Clomid), it was considered an "S-Code" that doesn't get billed until AFTER the IUI procedure and all in one lump some. Some kind of "contractual obligation" to bill that way.

It's a load of insurance mumbo jumbo bull if you ask me. It's how the insurance company gets out of paying for anything and just having this "applied to the deductible".

When I went in for my baseline ultrasound, the ultrasound tech said she saw a cyst, so I figured that meant that we'd have to wait until that cleared. The nurse called me later that day letting me know that I'd be able to start on injections that evening.

Enter the financial conundrum.

Considering that the most recent cycle cost $XXXX, we had to talk about if we could even do another cycle based on the amount that it cost. Yes, we'd get closer to our deductible, making IVF more within reach (if we decided to go down that path)...but seriously, the financial side of this stuff is no joke!

Given our current circumstances, including looking into buying a house, we just can't swing another unexpected lump sum of money...on something that might not work.

I know, I should be thinking "but what if it does work?" and knowing full well that if it were to work, it would have be totally worth whatever we had to shell out.

However, coming from a place of pure pragmatism...it just doesn't seem wise at this time.

It's disappointing.

It feels oftentimes like I have to choose between a house or a baby. We'd like to move to another house for the sake of our future baby. And we'd like a baby.

Too much to ask for!?

Our Infertility Journey

Going through infertility is probably one of the hardest things I've had to deal with in my adult life. It's kind of weird because it's not a life-threatening condition, per se, but it is a disease. One that people often suffer in silence with. 

However, infertility has also proved to be a great blessing. How? If it wasn't for being on this journey through the waters of infertility, I would have never met the amazing community of ladies who are going through the same thing. We all belong to a club that we wish we weren't a part of, and each wait for the day when our membership is revoked. We can't wait to be kicked out of the club.

I don't think I've shared our own infertility journey, and if anything, it needs a little updating. 

We got married in July 2009 and because we dated long distance for three years, we wanted to spend the first couple of years of marriage as a couple. We knew we wanted children, but we wanted to savor the time just the two of us. 

In 2012, during my annual well woman exam at my OBGYN's office, I was officially diagnosed with PCOS - polycystic ovarian syndrome. I had the symptoms: trouble losing weight, craving carbs, unwanted facial hair, thinning hair, irregular periods... All "manageable" symptoms through nutrition and exercise, but annoying nonetheless. Since we were not yet trying to start a family, I continued on the pill to regulate my cycles.

In 2013, we were ready to start trying for a family. I came off the pill and knew that it could take a couple of months for my hormones to regulate. We made it to the end of 2013 with no success.

In 2014, after about a year of trying, we saw my OBGYN to try some medicated, timed intercourse cycles. We did Femara/Letrozole and also tried Clomid. I seemed to respond decently to the medication, but no pregnancies. 

In June 2014, my OBGYN referred me to a reproductive endocrinologist - the office whose Letrozole and Clomid protocols she was following. I made the appointment and went to my first RE consultation.

I went to the consultation by myself and walked away overwhelmed and unimpressed. The doctor I met with didn't take any time to get any of my history (which I thought was important) and quickly launched into a standard protocol of Clomid and trigger shot.

At the time I wasn't as familiar with medicated cycle protocols as I am now, and I felt like the doctor was not listening to me. My OBGYN had suggested that I had a uterine lining issue (it was thinner than ideal), and told me to tell the RE. Well, he didn't even listen to that. I felt like I was wasting my time if he was just suggesting the same thing I had already done at my OBGYN's office.

I was annoyed. I didn't like that he didn't get to know me at all. I felt like a number and he was just giving me the standard plan of care. I felt like if I was going to have to pay out of pocket for this anyway, I needed to like my healthcare provider.

Needless to say, I did not return to his office ever again. 

At the end of 2014, I did return to my OBGYN's office for two more medicated cycle attempts. When our final attempt had no progress, we decided to take a break from medicated cycles. Around the same time, I also started seeing the nutrition testing specialist through my chiropractor. We started supplementing what I was deficient in to help rebalance my hormones.

I continued to see the nutrition testing specialist through the beginning of 2015. I was a lot of vitamins and supplements, and I felt like if I could help my issues in a natural way, that would be great. 

After about a six month break, I started to look into a new reproductive endocrinologist. There were a few top offices in our area that I found.

I had a couple important criteria I wanted in a doctor:

• female doctor
• experience with PCOS
• compassionate, empathetic, kind

While I know that male doctors are probably just as qualified as female doctors, I believe that female doctors understand these issues on a level that a man cannot. I feel way more comfortable with a female doctor and it helps when she can empathize (NOT sympathize) with me.

In July 2015, I made an appointment with an RE at a new practice. Based on her online profile, she seemed to fit most of my criteria. The personality component would be determined at our consultation.

Well, long story short, I LOVE our RE! She fits all the criteria and really appreciated that she spent about an hour with us going over our family histories, our personal medical histories, and personally did my first baseline ultrasound. I was impressed. She was kind and carefully reviewed our case to give us her honest suggested plan of care.

In August 2015, while waiting for my cycle to start before we could move forward with the plan of care with our RE, I was on cycle day 40...and I took a pregnancy test. It was positive! I had never seen a positive test before! Coincidentally, the RE's office called that same day to have me come in for routine bloodwork. I told them that I had a positive home pregnancy test and they said they'd do a beta Hcg test as well.

Later that day, it was confirmed that I was indeed pregnant, with an hCG level of over 9,000! (If you're new to beta numbers, that's super high! I didn't really know at the time how high that was). The following week, we went in for our first ultrasound and we got to see the gestational sacs...there were two! But only one looked to be growing. However...based on the date of my last period, it looked like the size was a little bit behind, so they had me come in the following week to check again.

The following week, there was no progress in growth. The doctor seemed to be cautiously optimistic about it, and had me come in the following week. She said that if there were no changes or heartbeat the next week, then we'd have to discuss options.

Well, in September 2015, I miscarried. Our baby stopped growing at about 5 weeks. We never got an accurate reading/measurement and never saw a heartbeat. I opted to take the medication to help move the miscarriage along after waiting two weeks to miscarry naturally. You can read about that here.

After the miscarriage, I had to wait for my cycle to return. My first period post-miscarriage was insanely heavy. Like...crazy heavy. The second cycle was a little bit more normal.

In November 2015 after my cycle started, I had my original testing done (that didn't happen because we took a detour with a positive pregnancy test), and that included an HSG and hysteroscopy. My doctor found a polyp during the hysteroscopy and my tubes were clear following the HSG. I experienced minimal pain with both, but I have a higher tolerance for pain.

In December 2015, I had a hysteroscopic polypectomy to remove the polyp. It was pretty easy. I was nervous about the anesthesia, but it turned out to be an amazing nap. I went home that morning and had another great nap. I felt pretty good the next day.

At the end of December, we tried a Letrozole cycle with trigger, except during my Day 12 soon, I had already ovulated.

We did a Letrozole + Ovidrel trigger at the end of January 2016.

In February 2016, we did Letrozole + Follistim + Ovidrel trigger + IUI.

In March 2016, when I went in for my baseline, they found a cyst lingering on my ovary, after having a super light period.

About two and a half weeks later when I thought my cycle started again, they saw the same cyst, but it was smaller. So I had to wait until it cleared.

My normal cycle started at the end of April 2016, however, because I was going to be out of town and unable to come in for monitoring, we have to wait until the next cycle.

I feel like waiting is the story of my life lately!

So here we are...waiting....waiting...waiting.

I'm a professional at waiting!

#StartAsking and Advocate for Yourself

This week is National Infertility Awareness Week. I know that when I started out on my journey of starting a family, I had no idea what was in store. I never thought that becoming a parent would involve thousands of dollars, endless blood draws, countless ultrasounds (and not the kind in the movies on the outside of the belly....) or even surgery.

Our path has.

I remember when I first learned that it was going to be more complicated to start a family. I was overwhelmed. There was so much information and so little information. And if you don't know anyone who has gone through infertility, you can get lost quickly!

When my OBGYN referred me to a specialist, I was really nervous because I didn't completely understand the process. You'd think that biology and health classes in high school and college would explain it, but it's such a complicated process! When you're not actively trying to conceive, you kind of ignore the details...I know I did!

If you come to the place where you are ready to meet with a specialist, you must advocate for yourself. The first reproductive endocrinologist seemed to be in a hurry. There I was, nervous, didn't understand all the infertility/fertility terms or procedures, and here was this guy spewing all the tests that we had to do. He didn't take time to get to know me or my history. He launched directly into his standard protocol of treatment.

I was not comfortable with that.

I never went back.

Then I heard he left that practice.

When I was ready to dip my toe in the RE pool again, I did my research. I knew that I wanted to find a female doctor (if possible), and hopefully one who had experience treating women with PCOS. I wanted to find someone who would listen to my concerns, answer my questions, and get to know my husband and I a little bit before advising treatment.

After lots of research, I found our current RE, who is wonderful and everything that I could ask for in a reproductive endocrinologist. She has fantastic beside manner, is kind, empathetic, and explains everything in plain English. She is the best!

That experience taught me that if I had gone blindly with the other specialist...who knows where I would be. I know at the very least, I'd be a little disappointed in my care!

This journey is HARD. You must advocate for yourself. Ask questions. Find support.

When you're looking at spending thousands of dollars (with and without insurance!), you shouldn't have to just go to "anyone". If you have the ability to choose your doctor, do so. Even if it means you have to interview multiple specialists. You should feel 100% comfortable with your doctor!

Some facts about infertility, from Resolve.org

Infertility is defined as the inability to conceive for 12 months or to carry a pregnancy through a live birth

• 1 in 8 couples go through infertility. Yes, that means someone you know is currently going through it whether they are open about it or not.
• 1/3 of the diagnosis have to do with problems with the female, 1/3 is male and 1/3 are both
• Only 15 states have an insurance mandate to offer some form of insurance

Now onto the #StartAsking theme: What questions can you start asking?

• Ask your doctor about tests, diagnosis, medical procedures, and options
• Ask yourself what natural steps you can take to increase your fertility
• Ask your spouse where they stand on medical intervention, adoption, etc
• Ask your friends and family to support and pray for you
• Ask your insurance what coverage you have
• Ask your employer for better coverage for infertility
• Ask your spouse how they are doing
• Ask your friends who are going through infertility how they are doing
• Ask your church to acknowledge infertility
• Ask your congressmen for better coverage for infertility.

#StartAsking the Media

I wish that the media would talk about infertility more often.

The topic is hinted at every now and then, but it's never really a focus of news reports, television shows, or movies.

Every now and then, there will be a brave celebrity who brings up the topic. If we're being totally honest, the celebrity experience with infertility is far removed from the average woman's experience.

Why do I think that?

Often, celebrities have the means and resources to achieve motherhood. IVF - in vitro fertilization - is a common treatment and procedure for infertility patients. It's also one of the most expensive. Many states do not mandate infertility coverage. (Some mandate that it's offered, but not necessarily covered.) As a result, many women cannot pursue this type of treatment because of the financial aspect.

IVF costs thousands and well into the tens of thousands of dollars. That goes for when it's paid out of pocket and even with insurance "coverage." Insurance coverage doesn't guarantee that you're covered for everything. Often, coverage includes only the procedures and not all the prescription medications needed.

What baffles my mind is how easily someone can terminate a pregnancy, and yet for those who are trying to achieve pregnancy, the road can be long and difficult. 

I think that rather than fight over abortion rights and all the politics that surround that, more energy should be focused on helping those who want to start their families. It's insane how expensive fertility cost are. It seems that it's the lucky few who either live in a fertility-covered state or happen to have awesome insurance that have access. 

I know ladies from my virtual support groups who live all over the country and each one of them has a different experience. Some have great access and coverage, others have none and must pay out of pocket 100%. 

I don't think anyone who wants to start a family envisions having to spend upwards of $25,000+ to make it happen. 

They find out about it as they get further into their journey. Usually unexpectedly. 

I find that the media covers infertility as it relates to extreme and sensational cases - remember the "Octomom" and recently a woman whose mom was her gestational carrier.

Considering that infertility is so common, you'd think that it would hit the media more often.

The most comforting thing for me reading about other cases. Knowing that I am not the only one experiencing this road to a family. My favorite is reading about the success stories of women who have similar conditions and their eventual ability to overcome them.

Thankfully, there is an amazing online infertility blogging community. 

Here are some Infertility blogs I recommend, that merely scrapes the surface of bloggers:

In Due Time

Waiting for Baby Bird

Starbucks, Peace, and the Pursuit of a Baby

Amateur Nester

Dreaming of Diapers

Don't Count Your Eggs

Baby Ridley Bump

Unpregnant Chicken

Time to #StartAsking

I never imagined that my life would be led down this path. I never thought that infertility would be part of my story.

The experience is both heart wrenching and amazing at the same time.

Infertility sucks. Plain and simple. You want one thing more than anything in the world and yet it's the one thing you can't have. Or it's a lot more complicated and involved to make it happen. You see everyone else around you get what you want. Pregnancy announcements. Baby showers. Pregnancy symptom complaints.

You think to yourself, "I'd give anything to be able to complain about that."

And on the other hand, it's also amazing. Why? The community that I have found through this journey has been awesome. A tribe of ladies who are in the trenches with you. Some with more serious cases of infertility, some with milder cases, some who are in the thick of IVF and on the road ahead of you, and some who are just getting started.

I have to ask though, why is the support mostly virtual?

I've been extremely lucky to get involved in two in-person support groups locally. However, before I discovered those resources, most of the support I could find was online.

So few people talk about infertility. I get it. It's a very personal topic. Society has made it almost taboo. I know that in my own life, I struggle to open up about it. I don't want to be considered "less than" or "not enough". While that's merely a story that I tell myself, I know that it's what so many women tell themselves.

"Why can't I fulfill this desire?"
"What's wrong with me?
"Why is SHE able and I am not?" - I know this is a question I've asked myself so much.

It feels like a matter of our self-worth.

I know it does for me.

While I also know that all these external things - career, motherhood, wife - don't define my self-worth, motherhood feels like it does. My current inability to become a mother makes me feel less than whole.

April 24-30, 2016 is National Infertility Awareness Week, where we have the opportunity to bring more light to this very common condition.

Infertility affects 1 in 8 couples, meaning that you probably know someone who is going through infertility, whether they share their struggle openly or not.

A common practice that I see in the infertility community is sharing your story with others going through infertility, and then once you cross over to "the other side" -- a successful pregnancy, your story can be shared.

But I would argue that our stories should be shared as we walk through it, where we are currently in the process, and not waiting until we find success.

This doesn't mean you have to spill your guts to the Internet or make a public service announcement on Facebook.

It may look like sharing your journey with a close friend or family member. It may look like joining a support group where you can share your struggles with others who are on a similar path. It may look like having monthly check-ins with a friend.

There's one common thing that we all need, especially if you're going through infertility: it's SUPPORT.

I know when we found out that starting our family was going to take a little more work and effort than others, I felt so isolated and alone. It wasn't until I was able to connect with other women who shared their stories both online and off that I realized that infertility is a quite common, though of course undesired, condition.

Having support through this journey is a huge help. Knowing that there are other couples who are coping with similar things reminds you that you are not alone. Being able to talk about topics that only other people who have been through or are currently going through infertility is so important for our sanity. People who get it.

What can our friends and family who have not experienced infertility but would like to be supportive do?

• Be there to listen. 
• Ask how you can help and be supportive.
• Show that you care, even though you may not fully understand.
• Check in occasionally, especially if you know that there are some procedures or tests coming up.
• Offer to drive or come with us to appointments if you feel led in that direction.
• Please refrain from suggesting techniques, old wives' remedies, and superstitions that may help getting pregnant. We've heard most of them, and have probably given them a go. 
• Understand if we hesitate to RSVP to your baby showers, kids birthday parties, or other baby-centric events. It's not because we don't love you and them, it's because the emotional toll is too much. We'll be happy to send a gift. Please understand, it's not you, it's us.
• If you're currently pregnant, please try not to complain about your pregnancy symptoms in front of us. We'd give anything to be suffering through morning sickness and food aversions. We understand your discomfort, but we're the wrong people to complain to.

For more information about infertility, support groups, and how to get involved, visit Resolve.org

Empire made me cry

I am not the type of person to cry easily when it comes to TV or movies. I can probably list on one hand the number of times that a TV show or movie made me cry. Does this make me heartless? No, I don't think so. My triggers for tears come in other formats.

My hubby and I watch Empire, however since we typically volunteer at church on Wednesday nights, we catch up on episodes on the weekend thanks to Hulu. If you watch Empire and are not caught up, I won't spoil it for you, and if you saw the mid-season finale, then you know what happened.

Anyway, there's a song that Jamal and Hakeem write for their brother Dre, called "Good People". And oh my gosh...like I said, I don't cry easily, but this song, listening to the words made me tear up. Okay, I'll have to spoil just a small detail, but you would have guessed it anyway. Dre and Rhonda lose their baby after Rhonda's accident (where she was pushed down a flight of stairs).

While the song isn't exclusively about miscarriage, it is about loss, and I think this song will resonate with so many people who have gone through loss. For me, I really listened to all of the words in the song and just kept thinking to myself, "Yes. Yes. Yes" to the way I feel and felt about our own miscarriage. 

You question yourself, you question God, you question what you did wrong for this to happen. It's likely we'll never know. In fact, 1 in 4 pregnancies end in loss, it's just that most of the time, the loss happens before the pregnancy is confirmed. It appears as a period. I think that's why the stat is so high, but it doesn't seem like it in real life. 

Next week is National Infertility Awareness month and the theme this year is #StartAsking. I think that infertility is one of those subjects that feels taboo, or society has made taboo, and in effect, there are SO MANY couples going through infertility and yet they feel alone. I know that as soon as I started to research infertility and support groups I discovered so many others going through the same thing. While I think that the scales are generally tipped in the direction of those who get pregnant easily on my social media feeds, it helps to know that I am not the only one going through this experience. 

Today would have been our due date...

I remember when we saw that positive pregnancy test. We were overjoyed. It was probably the happiest moment I can remember since we started trying to conceive. And of course, one of the first things I did was enter my information into a pregnancy due date calculator to see when our bundle of joy would be expected to make an appearance.

April 11. 2016.

Today's date.

It struck me that it was also the date of my grandfather's death anniversary. Twenty three years ago he passed away. I saw it as almost a "sign" that this was meant to be. Kind of like a passing of a torch or something metaphorical I thought up to assign significance to the date.

The days and months following the news that the miscarriage were altered significantly. But it happened in a super subtle way. I felt like the spark and drive that I normally possess dissipated. My motivation evaporated. Things that normally felt easy just felt hard. I didn't want to do anything. I wanted and longed for the one thing I couldn't have.

I think that I didn't really process my grief. I did...but I didn't. Because it happened so early, part of me felt like I wasn't attached, but that was a lie I was telling myself. I now understand the gravity of a positive pregnancy test and that first ultrasound... As soon as I saw that plus sign, I became a mother. My heart doubled in size to carry this new life.

And then it was ripped away.

I went on the for the next few months and I was okay. The memory of the miscarriage tucked away. It would surface when I went to my support group and would tell my story. It would surface when I thought about last summer's extreme highs and deep lows. But I carried on. I tried to focus on other things.

April rolled around. I don't even know how we're already four months into 2016, but we are. I thought about it this weekend. I thought about how things would be different if I didn't have a miscarriage. How this past weekend, I'd either be waiting for labor, in the hospital, or with a new family member that I had prayed for so long.

That wasn't the case. The day came and went. And our arms are empty.

While I didn't spend the day moping around or crying into my pillow, I still thought about the significance that today's date had. What could of been. I know that there's no going back in reverse and the only way to move is forward, but it's definitely something that crosses your mind.

At what point are we at now? Waiting for my cycle to start...again.

I think I've become a professional waiter...as in I'm really good at waiting.

The Cost of Infertility

Sometimes, I wonder if pharmaceutical companies are in cahoots.

Actually, I assume they totally are.

After talking to my RE about next steps, I was prescribed Follistim in a low dose as well as Ovidrel. I remember the first time I paid for Ovidrel and it wasn't covered by our insurance. It was about $175 cash price. 

I thought that was expensive.

Then I was introduced to Follistim.

I received a phone call from the specialty cash pharmacy on my way to my doctor's appointment. I asked about my options and when I would need to ship the meds by. Well, since I would need the medication on Monday, and I was talking to them on Friday, they would have to ship on Friday for Saturday delivery since you have to keep the stuff refrigerated.

Then I asked the amount. 

I kindly asked if I could call them back after I had been to my doctor's appointment.

After going to the doctor, they instructed me to also give my insurance provider's pharmacy a call. For us, it's Caremark/CVS. Now, I must say that they are great and also not so great. They are great if the medication is something generic and general. 

I'm thrilled to say that the Metformin 90-day supply (that I take for PCOS) is $0.36! Yeah, ridiculously cheap. Even the Letrozole, because it's an off-label use is just $0.22. Like, I felt bad swiping a card to pay that little amount. 

Now fertility meds on the other hand, not so great. Like flipping expensive...like I imagine how depressing it would be to be going through infertility and then have the barrier of how expensive it is keep you from moving forward. And through Caremark, with some unknown amount of coverage was still more than twice the cost from the cash pharmacy!

I ended up ordering Ovidrel from our insurance pharmacy (since cost was the same as the cash pharmacy) and Follistim through the cash pharmacy.

Out of curiosity, I checked another online pharmacy that carries Follistim...that was another $100 more than Caremark!

My heart goes out to all the people who are going through infertility and doing IVF and have a PLETHORA more medications compared to what I had to order. I can't even imagine paying for all of that out of pocket.

It's pretty ridiculous. Why is it SO expensive to get help to have a baby? And yet it's so simple to terminate a pregnancy? I don't want to get into a political debate about it all, but it just feels like women who need assistance conceiving are penalized over something they can't control. And that premium? 

Cahoots. 

Tired of Failing

My cycle started last Wednesday.

And I took it harder than I expected.

My RE's office told me that I could take an HPT on Monday 2/8, but me, being ever the pragmatist, waited. I knew I should wait a few extra days, instead of "wasting" an HPT on a negative result. I think I need to get some of those cheap tests off Amazon.

According to my period tracking app, Glow, it said that my period was due on Wednesday 2/10. That morning, I had no signs of it starting. I don't generally experience very many PMS symptoms (I know, I'm lucky), and there were no physical signs. Throughout the day, there was some light spotting, and of course I tried to tell myself that it was implantation spotting...anything but my period starting.

By that evening, it started. And I was mad. I was sad. I was disappointed. I was frustrated.

I keep going back to thinking about how pregnancy is totally not an accident...it truly is a miracle. I know there are women out who blink and get pregnant, but for the rest of us, we pray, we plead, we beg...

So instead of calling my RE's office to report a positive HPT on Thursday, I got to call them to report a new cycle. We talked about getting a little more aggressive in treatment since I had just completed two cycles of Letrozole. One without a trigger shot and one with. They brought me in for a baseline ultrasound that next day and taught me how to inject myself with Follistim.

My doctor prescribed two days of Follistim alongside of taking Letrozole. I go in for a follow up sonogram on Wednesday to see if we can trigger and do an IUI.

I think the hardest part of this journey is that every month you feel like you're putting all your eggs in one basket (no pun with "eggs" intended) and hold on to hope that this will be it.

One the one hand, you don't want to lose hope. On the other, it's exhausting and frustrating and disappointing when you don't get your desired result. I know that I have to remain confident in the path that we are taking and to NOT compare my journey with anyone else. I will just get upset if I think about all the "OOPS" babies that have been conceived and may be terminated. Knowing what a freakin' miracle conception is, I don't take it for granted for one second.

Where are we now

After the miscarriage happened, I had to take a step back and just allow myself to feel all the feelings. Once the physical part of the process had passed, a lot of my grief and frustration felt like it passed as well. I think I was most sad, and felt the most feelings, between finding out and going through the miscarriage.

It was kind of weird. I guess grieving is such a personal process, that there is no "right" way of doing it.

But I'll be honest, I felt a little guilty that I wasn't more sad. Is that weird? Once it had all passed, it was therapeutic (albeit the worst physical thing I've gone through so far in life). I felt guilty that I "got over it" so quickly. Perhaps it was because it was only at 5 weeks. We didn't know the gender or pick a name....

I had to wait until my next cycle started before doing anything else. I also had to go into my doctor's office for a blood draw to check my hCG levels. I did that bi-weekly until I got down to zero. However, the last blood draw I had, the level was still only at 1.3... the hCG just lingered in my system. It went from like 1400, to 300, to 4, to 1.3....

Also, what I wish I could have known before the start of my first cycle post-miscarriage, is that your period can be SUPER HEAVY. Like SUPER HEAVY. I know this probably doesn't happen to everyone, but just know that it's a possibility. Honestly, it was kind of like the flow I experienced in my miscarriage, but drawn out over 7 days. And clots. LOTS of clots. (Sorry for the TMI) But I would have wanted to know.

My doctor's office told me to wait until my next cycle before coming in again.

All the waiting. So much waiting. But I guess that's just what is required in this journey. Waiting.

The thing you worry about...

Last week, we went in for our first ultrasound. Based on my LMP, the reproductive endocrinologist and ultrasound tech had estimated me to be at about 7 weeks. However, when they did the ultrasound, the fetus was measuring more at 6 weeks. This didn't surprise me because that was the estimate I was going off of based on my irregular cycles. I know that I don't ovulate right at 14 days, it could have been anywhere between day 16-20 really. The RE asked us to come back in a week to do another scan to see how it progresses.

It felt like the longest week of my life, but I tried my best to stay calm, occupied, and free of worry. I didn't want to worry about something that was just in my head. But when it's your first pregnancy you just don't know what to feel or to expect.

I have been having the classic pregnancy symptoms for about two and a half weeks. Sore breasts, frequent urination, some fatigue, and a little morning sickness - mostly just feeling queasy. Even though I wasn't feeling awesome, I figured that having symptoms was a good sign.

We nicknamed the baby "The Nugget" and my husband would talk to my belly and tell the Nugget to keep growing. It's the cutest thing.

I prayed a lot. I did my best to concentrate on other things. I worked out. I indulged a little. I did some work. I tried to reduce any stress I was feeling. But a week is a long time.

In the back of my mind, I couldn't help but think about if something was wrong. What if the baby hadn't progressed in growth? What if I had a miscarriage?

I haven't had any spotting. I haven't had any cramps. I've been feeling pretty good, aside from some of the general symptoms. So I figured that I should just tell my worries to be quiet and wait for the appointment.

Well, our appointment was yesterday. We do the usual drill, another vaginal ultrasound. The tech does the initial scan, and while I'm not trained in reading ultrasounds, I can kind of tell that there's something not quite right. From what I can see on the screen, there doesn't appear to be much if any growth of the fetus since last week.

And I have to say that the ultrasound tech is quite nice and has good bedside manner, but when she says, "I'm just going to have the doctor come in and take a second look," and "It doesn't look like there was any growth, unfortunately," I couldn't help but see my worst fears come to light.

I mean, obviously, if there was no progress, that can't be a great thing. I was desperately hoping to see progress, to see the heartbeat flicker, to have proof that the baby growing inside me is doing well and getting bigger.

As we waited for the doctor to come in, I could only lay there and think worst case scenario. My husband grabbed my hand and we just looked at each other, not saying a word.

The doctor came in, did a second ultrasound scan, and while she could see the yolk sac/fetal pole, she said that it didn't look like the pregnancy was progress like she had hoped it would. She wanted to talk to us in her office after I got dressed.

She compared the ultrasound from this week to last weeks, and the look on her face basically said it. While she didn't rule it a pregnancy loss yet, she wants us to come in on Tuesday for a final scan to see what happens. She said that by that point we should be able to see a heartbeat, and if we can't....then we will discuss "options".

It just feels so grim.

Knowing, but also not knowing, that there's potentially a non-viable fetus inside of me.

It's the unknown that's the hardest. I feel like I have no control...and I while I know that I don't have control because all this is in God's court, still, I wish I could understand what and why this is happening. I feel like it's been an arduous journey to even get here to this point, only to have the rug pulled out from under us in a hot second.

We're in a place of wait and see.

It's crazy to me how we could go from such pure joy to devastation in a matter of seconds. While I don't know if I will have a miscarriage or not at this point, my gut tells me that we probably will. The optimistic side of my brain is grasping to the tiny shred of hope that the baby may progress at least a little bit by Tuesday.

However, I will say, that I am so thankful and grateful that we were even able to get pregnant naturally...or as the office calls it "spontaneously". Seeing that positive pregnancy test was pure joy. I was shocked and couldn't believe my eyes. I know that for many, many couples out there, this isn't even a possibility. So I am really thankful that we know that getting pregnant is a possibility for us. I'm trying to find the silver lining in between sobbing for the unknown.

Have you ever been through something like this?

Our New RE // Cycle Day 37

Last week we had our appointment with a new reproductive endocrinologist.

It was a great experience! I'm so happy that we have found her and feel so reassured after meeting with her. Like a mentioned in my previous post, it was important to me to find a female reproductive endocrinologist. It's not that I don't trust men, it's just that I don't think male doctors who work in the lady part department will ever FULLY grasp what it's like. Sure they can try to empathize and if their wife has ever gone through infertility they can kind of get it....but it's just not quite the same as a female doctor who has had experience with infertility herself.

The experience was excellent from the get-go. I called the make the appointment and the receptionist was super friendly and got me set up in a jiffy. The day before my appointment someone called to confirm and had a bright and cheerful voice on the phone. (I point this out because the medical assistant at my OBGYN's office has the worst phone voice ever...as if it's torture for her to be talking on the phone - she sounds so bored and annoyed.)

That, in and of itself, made me calmer and look forward to the appointment.

My husband came to the appointment with me and though he technically was not required to be there, I was really happy to have him by my side. After the usual wait in a doctor's office and filling out some additional paperwork, I had my vitals taken, and we were led into the doctor's office.

Her office was bright, with comfy chairs and colorful pillows - definitely a woman's office! Dr. T came in and greeted us with a smile on her face. (I point out these details because they make a difference - to me at least!) She took time to take our history and ask relevant questions. I could tell that she was really listening and trying to get a good understanding of our current situation. It felt nice to talk to someone who was really listening and interested. We talked about my PCOS, when I was diagnosed, what I've done to manage it, and she even gave me some more understanding about what was going on.

My husband had just had an SA the week before this RE appointment. Unfortunately, we had not yet received the results...which you know can make anyone nervous. We didn't receive the results until the end of the week and spoiler alert - he's normal!

After taking our histories, the doctor took us in for an ultrasound to check things out. It was the first time that I had a doctor (and not an ultrasound tech) do the vaginal ultrasound. She pointed out everything as she was going and it was the first time that anything had ever been really pointed out to me. Good news, she counted follicles (so it seems like eggs are not currently an issue) and it looked like one of them was nice and big for ovulation. She ordered a blood test to check to see if I had ovulated as well.

Overall, I was just thrilled with how the appointment went. She was very friendly and warm - something that I feel is hard to come by with doctors. When it comes to something like this, infertility, I need someone who is going to be empathetic and sensitive to the experience. I wouldn't do well with someone who was all "JUST THE FACTS". I know some people prefer that, but not me. I like the warm fuzzies. It helps so much with the trust factor.

It was such a contrast from my experience last year. I also had a year of infertility experience and further understanding, but also the doctor herself was a dream in comparison. And let's just say that I had heard no reassuring comments about last year's doctor through the grapevine.

So the plan is to wait until my next cycle, do one more medicated cycle but with Femara, and see what happens before exploring IUI's etc. The doctor says we're "boring" (in a good way) and that because of the PCOS we may just need a little extra nudge in the direction of getting knocked up.

And now we wait.

Oh waiting. It's not for the faint of heart or the patient. Ha.

Well, I got the lab results from my blood test to check for ovulation and I measured at 16. The nurse said that they like anything above an 11 to indicate ovulation, so I hope this is good sign. The great thing is that even if this cycle doesn't result in pregnancy, I feel 110% confident in my new doctor to help us.

Here we are...cycle day 37.

I have to wait until at least CD 42 or 45 before testing...I know I could test...but I'm so pragmatic I don't want to waste them! Haha.

Day 12: Ultrasound Day

After finally going back to my OBGYN after about a 6 month break from fertility medications, taking a course of Clomid and estrogen supplements, today is the day. Today I will have an ultrasound to see if Clomid worked and if it's viable to trigger ovulation.

The biggest things I struggle with is the probability. Even if the Clomid stimulated follicles to mature and the estrogen supplements helped to thicken the uterine lining, that doesn't guarantee anything.

It's definitely a journey of both science and faith.

Which makes it really difficult to see all the people who it "just happens" for. Because really, there are a whole lot of people out there who it doesn't just "happen" for. 

And I know that by comparing myself to other women, I'm only going to drive myself bananas. It's something that I struggle with on the daily and every time I see an announcement, I feel like it's another dig of what I haven't been able to do yet.

I also know that I need to stay faithful. To believe that it is possible. To know that we can become parents someday.

It's truly like fighting an enemy daily to tell him to shut up and go away. 

The doubt. 

The fear.

The negative, fatalistic thinking.

I have to be positive and go in with the best attitude.

In the last six months, I have lost 15lbs (which I'm hoping helps with the PCOS symptoms) and I'm exercising 5 days a week and eating a generally clean diet. It's hard to know what else I could be doing more of or better at, without making crazy drastic changes (what else is there left to do?)

All in all, I'm excited to go back to the doctor's office today to at least see what's next and what lies ahead. I want to be positive even if the outcome isn't what I'm hoping for. That's the hardest part, and yet the key....

Thoughts on the journey

In the last seven days, three women I know have announced their pregnancies. In the last two weeks, at least 4-5 Facebook friends have given birth.

So here's the tough thing. I don't know anything about their stories and how they got pregnant. Was it easy? Was it difficult? Did it require any medication or help?

One friend announced her pregnancy on Facebook, and for whatever emotional reason, it felt like a jab to my stomach. Which, when I think about it, is stupid, because it's not like she's expecting to spite me. It's not all about me.

But when you're going through infertility, not knowing if you'll ever be able to have your own child that you desire so much, every single pregnancy announcement feels like a reminder of what you have been unable to do for yourself.

As an overachiever in life (I was very competitive when it came to academics, at least in high school), and being able to get good grades and ace exams and the sort, it just feels sort of like a cruel joke that this is so difficult.

Then again, I was never good at sports. I was never good at running. And while I suppose that I could have practiced to my hearts content and improved my running, I still would not be an Olympic contender.

It's weird all the thoughts you have.

Will I ever be a mother? How will it happen? When will it happen?

And for now, we really would like to explore becoming parents naturally.

Adoption is awesome and it a whole other conversation for another time. It's definitely a consideration, but it's not at the forefront of the agenda at this time.

What no one tells you about infertility

Infertility was never a challenge I expected to face.

It's probably the hardest obstacle I've ever come in contact with in my life so far.

I feel like I'm fighting against time and resources. 

I feel like I'm on the craziest emotional roller coaster I could ever board, and I hate crazy roller coasters. 

It's both physically and emotionally draining. 

And, while you're feeling ALL THE FEELS, every other woman around you will be pregnant, just announcing her pregnancy, or have just given birth. IT'S CRAZY.

You will feel like you're the only one.

You will feel like there's something wrong with you because if all these other women can get a bun in their oven, why can't you?

And then there are the couples who made an "oops" baby. "Oops we got pregnant by accident" or "We didn't mean to get pregnant". It can be good or bad, hopefully good for the sake of the child.

My message to those people: There are no "oops" babies. Pregnancy is 100% preventable. Your "oops" is merely your laziness and irresponsibility. But now you have a HUGE responsibility to take care of, and you better do it right...your child deserves that.

You feel like you can't share about your struggles because you don't want to be a Debbie-Downer. 

People ask you if you want to have kids.

People ask you when you're going to have kids.

And how do you honestly answer that question?

Usually the "we're trying" answer suffices.

Sometimes, that opens up a whole other can of worms that presents itself with all kinds of unwarranted and quite frankly, unwanted advice.

"Just relax and it will happen"

"You'll get pregnant at the right time"

"Don't think about it so much"

or

"Why don't you just adopt?"

Okay, so for the record, that last statement is not any more comforting that the previous ones. Actually, that's probably a way more insensitive thing to say because first, perhaps the couple has looked into it, second, maybe they have decided it's not for them right now, and third, if you knew what it took to adopt....it's not just a "JUST" adopt sort of situation.

Adopting a human is way more involved and complicated than adopting a pet. I imagine that it involved a whole new emotional roller coaster track from infertility treatments...similar...parallel.

Infertility can be one of the loneliest roads you'll ever walk. 

It feels like no one truly understands unless they have been through it too.

But perhaps that's the amazing part.

The more I talk to other women about getting pregnant and what it's like, the more I find others who did have a hard time here and there. While it doesn't make up for my own empty womb, it does help to know that I am not alone in this.

Infertility affects 1 in 8 women. 12.5% of the population!

One of the hardest parts of going through infertility is that there is no magic turnkey solution. It works for some and not for others. And as you go through this grueling physical journey, you're faced with an emotional battle you never saw coming. The decisions. The finances. The risks. The outcomes.

Just know that you're not on this journey alone. 

My best advice if you're going through infertility: 

Find someone to talk to; whether that's a friend who is also going through infertility, a counselor, or just someone you're close to that you trust. 

Talk to your spouse or partner.

Find other things to focus on so that you're not dwelling on how you're not pregnant yet. Whether that's a project or new job or new business, or whatever it is, I think it's super helpful to have something else to devote your attention to. 

Pray.

Meditate.

Exercise and eat right. If anything, this is just a good idea for your health and fitness. 

You Are Not Alone

I never imagined that infertility would be a part of my life.

You typically imagine your life after high school and college to go a little something like this. Find a job, meet your future husband, get married, buy a house, have kids, enjoy life, and have the cycle repeat.

I didn't think that it would be so hard to not have kids yet in this time of our lives. I remember at the beginning of our marriage, we were conscious that we didn't want to start a family right away. Having spent most of our dating relationship long-distance, we wanted to be able to be together and it be just us for a while.

Once we decided that we were ready and would start trying, we had no idea what lay ahead of us.

Why is the infertility journey such a lonely one?

I think it's because no one really talks about it openly. There's a stigma to infertility. Like you are broken and incomplete. And in this age of social media, where everyone shares their best food forward all the time, openly sharing about infertility is one of the hardest things ever.

I believe that's why there is a strong infertility blogging community. There's something about just writing about your experience that someone may or may not see that is freeing. You can get all your thoughts and share your experiences and struggles, with a whole lot less fear of judgment.

Because the last thing that people going through infertility want is your pity. That is not a helpful reaction. At least it is not for me. I want nothing more than to be able to start our family. While you may be looking for the words to say to comfort a friend who is on this journey of infertility, telling them to "relax" or that it'll "just happen when it's supposed to" or to try old wives tale remedy XYZ is not the thing to say.

We know all those things. We've Googled. We've researched to our hearts content. We're on the constant search for anything and everything that might give us a fighting chance to get pregnant. And let's not even start thinking about how to stay pregnant.

I read a stat that 1 in 8 couples are going through infertility. That's 12.5% of the population! That's crazy. But in a way it's also comforting.

I know that one of the main emotions I have felt during this time in our lives is feeling like we're the only ones. Thanks to Facebook, it's easy to see EVERYONE ELSE who is pregnant, just gave birth, or are expecting their next kid. And all we want is to join that club.

Baby shower invitations feel like jabs to the stomach (though they are not, of course). The baby aisles at Target are adorable and heart wrenching. Gender reveals are so sweet, but you can't help but roll your eyes. You have to smile when you're around pregnant ladies even though you don't want to, AT ALL. It's not their fault. It's not, but when it's the one thing you want most, you can't help it.

A couple of things have helped me during this journey:

Sarah's Laughter Devotionals: I was randomly searching through the devotionals section of the Bible App and I looked up infertility, not expecting to find anything. I was pleasantly surprised to actually find two different devotionals for those needing encouragement during this time. My favorite of the two is Sarah's Laughter. You can also go to their website and sign up for daily encouraging emails which I really enjoy receiving. They always arrive at the right time.

Infertility Blogs: I don't remember when I first started to look for infertility blogs. I think it was around the time that I had been diagnosed with PCOS. I was looking for other people and their experiences with PCOS. That's when I found Chelsea's blog. And then I found Lisa's blog. Check out the list on Lisa's blog for other infertility bloggers.

Focusing on other things: This has been huge for me. I remember when we first realized that we were not going to have an easy time getting pregnant. I focused on it. I obsessed over it. I tried to find every cure, remedy, oil, magic, etc to help us get closer to our goal. But that's what's tricky about infertility. You can do all those things and still have no results. Instead, I decided to focus on my business (I'm a photographer) and on getting fit.

Getting fit: At the beginning of this year, I decided once and for all that I was going to get healthy and fit. Dealing with PCOS makes that a little bit more complicated, but I was not going to let that deter me. In February I joined a challenge group my friend was hosting and it made all the difference to have that kind of accountability in the group. It was great! I decided that I wanted to help others get fit too and became Beachbody Coach. Working on getting fit, while it doesn't make any promises of becoming a parent any time soon, will at least get me closer to my goal, feeling healthier, and happier in the midst of this lonely journey.

What can you do?

If you have a friend or family member who is going through infertility, reach out to them. Don't try to offer suggestions per se, but be there for them. Go out and grab lunch. Go to the movies. Go get a pedicure. Spend quality time with them to show that you care. Pray for them. Pray with them. Offer to let them vent to you, we all just want someone who will listen (to give our spouses a break!).

Be empathetic, not sympathetic. Please don't pity us. You may not understand what it's like, but that's okay. This journey is a unique one that only people who have been through it or are in it truly understand.

Infertility has truly been one of the craziest emotional roller coasters that I have ever been on. It makes me feel crazy. It makes me feel lost. I wish that there was a path carved out with clear directions on which way to go. Do we try more medication? Do we try for an IUI? Do we start saving for IVF? Do we hope that with lifestyle changes we're healthy enough for it to happen naturally? These are the questions constantly running through my head. (Not to mention the biological clock ticking away....)

If you are in the trenches of infertility, know that you are not alone.