Making Milk

So - yesterday was my appointment with the Lactation Consultant, and it went pretty darn well, she was pleased that we had a lot of time to work with - and careful to warn me that it's a lot of effort if the adoption doesn't go through.  She has her own modified version of the Newman-Goldfarb protocol, which is the protocol I'll be following.  I thought I'd share it here.  A - because it's important info to have out there, and B - so I don't forget it either.

I will be using domperidone (she prefers not to use Reglan, and it's contraindicated for me anyway) because I'm okay with ordering it online, and not freaked out by the slightly behind the government's back way of doing things.  She does say that the dom should be actually approved sometime next year.

So - Here's the plan:

1. When we are about 12-13 weeks out from the due date, I start taking Yaz continuously.
2. At 2-3 weeks before the due date, I start adding the dom.  
1. Starting dosage for the dom is 2 tablets three times a day - continue at that dose for 5-7 days
2. Continuing dosage of the dom is 3 tablets 3 times a day (can go slightly higher - max is 4 tabs 3 times a day)
3. When we go to the higher dose of dom, we stop the Yaz, and start pumping and hand expression 8 times a day (and one of those will be in the middle of the night, if not 2).

I apparently respond much better to hand expression than I do to the pump.  With hand expression I can get drips right now, but the pump did nothing for me.  I know that the drips aren't usual for most people, but I've been a bit of a drip for like 8 years, so I guess I'm used to it.  I can hand express as I feel like it between now and when pumping begins.

The reason  that it's not a firm timeline is that some of it will depend on if it looks like she'd going to be here a bit early.  The lactation consultant also said that I should be prepared for the consultants at the other hospital - where she will be born - to be less than helpful.  She would like the birthmom to express colostrum to be spoonfed for the first couple of feedings - and for me to suckle as well.  I know that after that she plans to pump for a little while to give us some breast milk.

Finally - she very much says that I need to rent a hospital grade pump, so I'm going to have to figure out which one that needs to be.  The Symphony one from the Hospital is $80 a month, and insurance won't help out until after the baby is here, there's another one I was looking at that is $45 for the first month, and then $25 a month after that, but she wanted to make sure that it was one she felt would work well.  I'll probably hear from her next week sometime.

In a bit of awesome news - my authorization letter for the Lactation consultant arrived in the mail last night - I'm approved for 15 visits in the next year, so we shouldn't have a problem on that end.  I'll likely be able to go right away after she comes home.

That's the plan. 

Dollars and $ense of family building

Click on the picture to see the
other responses

This was started over at Write Mind Open Heart, and it's a conversation that we all need to be aware of.  The added costs of family building when it comes to Infertility and Adoption are not a laughing manner, and neither is how we will explain these things to our children and how they will feel about them.Some of these questions I have to answer from a hypothetical perspective, because I don't know all of my answers or my journey yet.  I thought that this would be an appropriate opening post for my National Infertility Awareness Week Blogging.

Consider your now or future children as adults, and consider the fact that you had to spend money to either conceive them or make them part of your family. What effect do you think the latter will have on the former one day? What, do you think, your grown children might feel about the funds it took to create your family?

I hope that they're not bothered by it, and I hope to instill the belief that we loved them and wanted them so much that we went all out in the attempt to be their parents. 

How did/would you handle it if your child asks you, “Mom, how much did I cost?” How would you answer at age 7? At age 18?

I would be honest, but try to couch it in terms that make sense to them given their age.  And try to remind them that we didn't go out to the store and buy them, we went to the doctor and paid him to help us.  So, to a 7 year old, it might be along the lines of an awful lot, and maybe a dollar figure, but something to make it real and to a child on the cusp of adulthood - I'd probably compare it to the amount it costs to buy a new car.

When calculating the costs of your family building, what do you include? The direct costs are easy (such as RE fees for a cycle or homestudy fees), but what about fees that didn’t directly lead to your child’s existence in your life, such as cycles that didn’t work, adoption outreach avenues that didn’t work, failed adoptions, avenues that were explored (and that cost something) but not pursued, etc.?

So far I'm including all of the costs.  Medications, supplements, testing, marital counseling, cycles that didn't work, everything.  Why, because that is the cost of us building our family.  It's not just the cost of a single cycle, because we should learn from the failed ones and hopefully make the next try better.  On the other hand - I'm not counting the costs of snacks at support group meetings, or the cost f gas to drive around....  or - even - the cost of ice cream.

If two children in a family “cost” different amounts, should that have any significance?

No.  Because it's not a measure of a child, it's the measure of the amount of help that we needed to bring that child into our family.

To what extent have finances determined the family-building decisions you have made? How have you able to balance financial considerations against other factors such as medical, ethical, emotional…?

Finances have played a big role.  We really didn't want to go deeper into debt to start our family.  So we spent a year of instituting austerity measures at home to help us pay more out of pocket for our treatments.  We chose to participate in a type of shared risk plan because we knew that we couldn't afford to try again if the first attempt failed, at least not soon after, and we wanted to make sure that we would have a good chance at a family.  In many cases, We put some of our emotional heath on the back burner to our financial health, waiting put strains on our marriage, and strains on our emotions that we weren't really prepared for.  Mostly because although I'm the one who wanted to save first, I'm also the one who was impatient.

Has institutional and governmental support for certain family-building paths impacted your choices? For example, ART being covered by insurance, tax deductions for adoption expenses, etc.

No treatments were covered by our insurance, and there is nothing in our state that required that they do so.  The only way that the outside entities affected our decisions is that they made family building harder for us.

Have you considered having ART treatments abroad, either due to lower cost or due to certain methods being unavailable or illegal in your own country? In your decision-making, how did you balance the financial savings against issues like the unknowns of the country, perhaps not speaking the language, and medical practices that may differ from those of your home country? If you did travel abroad for treatments, what was your experience? Would you do it again?

Right now, I'm not comfortable with it.  Probably because I haven't traveled that much myself, and because I couldn't conceive of a way for us to go out of country for ART and keep our jobs.  Will I consider it in the future - I hope I don't have to, and I think that it's farther than Jakobe is willing to go.

Insurance Sucks!

 And Yeah, we knew that already.

Today has been spent fighting my way through prescription coverage hoops to try and get them to pay for anything - starting with my second pack of BCPs.

Last month, when I first filled my order for BCPs, they had a problem filling it, an told me that they thought that I might have difficulty when it came to filling the second one - because they're continuous and skipping the sugar pills.  So, last month, I called my insurance and was assured that there would be no problems, all the pharmacy had to do was call the phone number that popped up on their screen, and it would be approved.  Fast forward to yesterday, when it was denied for being refilled too soon.  I just paid cash, and said I'd deal with it today.  

This morning - I called my insurance, and had them figure out what the problem was, called the pharmacy and had them call the insurance, and finally got it all worked out - I can go pick up a refund on my way home tonight.

Then the Walgreen's specialty pharmacy called - Their system showed that my coverage was cancelled last month - and that I no longer had prescription coverage.  So again with the back and forth and calling the insurance (and Yes, I know that I don't have any coverage for fertility meds - but the pharmacy still wanted to try...) who said that I showed up that way because I didn't have fertility coverage - Not sure why they just didn't deny it.  Which in the end is what happened about half an hour later.  

So now - I'm waiting to see if I can get a paper scrip for my antibiotics (because if I take it to a local pharmacy, it should get covered) and my injectable meds have been ordered and should be delivered Friday.

Finally:  Welcome to everyone visiting from ICLW.  I'm happy to have you, and I'm looking forward to a great week.  As you can tell Jakobe and I are very very close to embarking on our first (and hopefully successful) IVF cycle.  We're excited, scared and all of those other emotions you care to imagine all rolled up into one.  This week will also include our injections class, and the delivery of our meds.  So look forward to the "Money Shot" on Friday or Saturday.

Post-it Tuesday: I'd like to say more...

Thanks Suzy for revealing the option of Post-it Tuesday to me.  I'm feeling guilty for not keeping up... but I'm still here.  Here are a few things I've been thinking about.

And the Verdict is...

IVF with ICSI.

If we want to have biological children - that's our only option.  Dr. R thinks that we're very good candidates.  Given my age, and my FSH values the last time they were tested, he thinks our chances are about 60% if we did one cycle and a better than 90% chance if we did 3.  ( doing the binomial probability thing bears this out).  Our chances without IVF:  "As close to 0 as you can get without actually being 0."

He looked at Jakobe's SA and said that the volume really didn't matter, because everything else sucked. He described the motility as "every so often - one of them twitches."  I guess we've got twitchy sperm.  So - Jakobe wants karyotyping because Dr. R brought up the possibility of mosaic Klinefelter's syndrome. He doesn't think that it's likely - but Jakobe wants to be sure.  Thankfully - it looks like most of the screening tests are covered under insurance.  They don't have an infertility code attached at all - including the karyotyping.  So - Insurance should cover it.

I did my CD3 blood work again today - so we'll see what it looks like this year.  While we were there - He did a basic exam - determined what size catheter to use on my cervix, and got some good shots of my ovaries and uterus with the ultrasound machine.  I don't have any idea what look was on Jakobe's face during the actual exam - but he thought that the ultrasound was pretty damn cool.  I really just felt uncomfortable.  Exams during my period are a lot more painful for me than usual - so it was even further on the "not fun" side of things than usual.

The plan: We don't have one.  The cost figures didn't even start to sink in for Jakobe until we were sitting there in the office.   It didn't really matter that I had told him how much I thought it would be - it wasn't real for him until he saw it in black and white on the piece of paper there.  It's making him very hesitant.

We talked a bit at lunch after the appointment, he feels like I've already made up my mind.  In a way I have - I know that I want to do.  I also Know that what we do has more to do with what we both want, and what we can both accept.  I don't get to make these decisions on my own.  We're a partnership, and we have to make them together.

It turns out that Dr. R does have a shared risk program.  It's a 3 cycle package (no refunds) where you pay for slightly less than 2 cycles upfront - and you can have 3 fresh cycles. It doesn't include the cost of anesthesia, medications or ICSI, which we would pay for at the time of each cycle - but I think that if we go ahead with IVF - the 3 cycle option is what we'll do.

I'm thinking that now may really be the time for us to take advantage of the EAP (Employee Assistance Program) and maybe a see a counselor.  Hopefully there is someone in our area who has some experience helping people to make decisions like this.

For now - we'll keep thinking, and trying to figure out what we're going to do.  And - maybe I'll have a good cry.

Working on patience

It seems like the one constant in this IF journey is the need to be patient.  Every cycle – if you’re trying, you wait to ovulate, and then you end up waiting to test, or waiting for AF to show.  Then there’s all the other waiting.  You make an appointment with the doctor, and wait for the appointment, you wait for your HSG, and then you wait for the results.  You wait (and abstain) for a SA, and then – even if you get the results quickly, you wait for someone to tell you that it’s not as bad as it looks…  but it is.  Then you wait to see another doctor.

Can you tell we’ve been doing a lot of waiting?  Right now I’m waiting for our appointment to see the RE next week.  I can’t help but hope that it won’t be as bad as we think it will be.  With our luck, it will be.  We got the clinic’s estimate of our insurance coverage in the mail on Tuesday and just as I thought.  No coverage for me (Payment is due at the time of service), and for Jakobe, testing only.  I’m pretty sure that means that they’ll pay for the SAs from here on out.  It will help, just a little.

In the meanwhile, we wait.

Something Different

I made it through the rest of the day Friday.  I did spend some time in bed, curled up with Jakobe, and crying while he held me.  It helped.  I'm working on being okay with crying in front of him, not because I feel like I shouldn't be having these feelings, more out of concern that I'll make him feel worse.  He's already decided that he's 100% responsible, and that it's all his fault - I can't convince him otherwise, and I wish that I could.  Or at least I could convince him that blame doesn't really matter, we're in the same situation no matter who's at fault. BUT - He says that my sucking it up makes him feel worse than the crying, so I'm giving it a try.

Friday evening I got to indulge in one of my favorite hobbies - experimenting with food. The Menu was:

• Lamb Meatballs with Cilantro Raita
• Pear Compote with cheeses (Swiss, Gouda, and Mascarpone) on
• Homemade Rye Crackers

This was the first time I had made crackers, and I discovered that they're pretty easy to make. (I'm going to try and take a picture tonight of the little bit that's left. If I do, I'll add it to this post.)  They do take some time, and I was glad that I made and divided the dough on Thursday night - it meant I actually had time for my mini-breakdown.  I'm including the recipe for the crackers at the end of this post - all the guys said that they were awesome.

I was going to write a step by step walk-through of my weekend, but I started to bore myself - so you definitely don't want to hear about it.  I was in a fog, and even took a nap in the car because I didn't want to sit home alone and stew, but didn't want to do anything either.  I'm hoping that this daze is short-lived, but it's still hanging around.  I don't feel like eating - which might be good, I started Weight Watchers again last week, and I've lost 2.5 pounds, so maybe a little lack of appetite is a good thing.

I made an appointment with the only RE within about 300 miles this morning.  Bad news #1: the initial consult is in my name - so we have to pay cash.  Bad News #2: the earliest available appointment is June 21st, so we're back to waiting again.  Good News #1:  when they re-do Jakobe's SA, they'll submit it to his insurance, and it should be covered.  Anyway, making that phone call seems to have used up my whole day's allotment of motivation, and forward motion, I'd like to go back to bed now.

We've got company again tonight, so I'm on the hook for more cooking, as well as smiling and having a good time.  Can I have a clone?  Maybe someone could make a Stepford me that I can take out of the closet and turn on when I'm not in the mood? No, we'll then I guess I'll fake it 'til I make it.

Olive Oil Rye Crackers

2 c all purpose flour

1 c dark rye flour

1 t  salt (I used fine sea salt)

1 c warm water

1/3 c extra virgin olive oil

Mix together all of the dry ingredients, and then using a mixer with a dough hook on medium or medium low speed, add the water and olive oil.  Let it knead for 5-10 minutes.  Mine was a little extra moist, so I added a little bit of flour half way through the kneading process (2-3 T).  Once you have a nice dough, split it up into 12 equal balls, and then let them sit for a while (at least 30 minutes)  This is the point where I put them into the fridge to wait until Friday, so if you refrigerate the dough for later, let it sit out for 30 minutes to an hour to return to room temp. 

15 minutes before you're ready to bake your crackers, put a pizza stone in your oven and preheat it to 450.

Take one of the dough balls and roll it out to your desired thickness - I made mine pretty thin, poke all over with a fork, and then transfer to the hot pizza stone.  Keep an eye on it, but let it bake until golden - about 5-10 minutes - while you roll out the next one.  Remove the finished cracker from the oven, and let it cool on a wire rack.  Repeat for all of the crackers.  When they're done, you can break them up into pieces for serving.

Variations:  you can top these cracker with whatever you want, and you can also cut them into shapes before baking (I think you'd have to make them quite a bit thicker than I did to do the shapes...)  If you don't have a pizza stone, you can use a cookie sheet - they'll take a bit longer to bake.  And if you don't have a mixer with a dough hook - I'm sorry, you get to knead by hand - therapeutic, but it gives you very tired arms.

No Change

It's funny, because I don't really have much of an update, but at the same time I feel guilty for not writing anything new.  Beginning in January, I promised that I would post at least once a week, and I thought it was going to be hard.  Instead, I've found that it has been incredibly good for me.  Having an outlet for all of my feelings, and knowing that someone is probably out there who understands helps me make it through the rough days.  Knowing that maybe my struggles will help someone else helps too.

Also, I signed up for International Comment Leaving Week (IComLeavWe or ICLW) and I feel like I need to do some sort of an introduction, so I guess that these needs coincide.  

Our Current News:  

• We're still waiting.  
• We're still not sure exactly what/how were going to tell Jakobe's parents about our infertility.  I just know that hearing "You know, if you and Jakobe decide never to have children, we'll love you anyway." again is going to result in me saying something I will regret, and/or making a scene.
• I double checked with our benefits person yesterday and verified that none of our 8 options for health insurance plans have *any* infertility coverage at all.  
• My head nearly exploded earlier this week when two of the people who were supposed to be in the office while we were at the urologist appointment decided to take that day off, meaning that we have almost no coverage if something goes wrong.  As bad as I feel about leaving one person to manage everything the morning of the 30th, I put my request in first, and if my two bosses think it's okay to take the day off and leave the office almost empty for half the day, then that's their call, not mine.  My personal life has to come before work sometimes.

And a welcome to ICLW visitors:

{Stepping up to the podium}

Thank you for stopping by.  I'm Jenni, and my husband and I are infertile.  I have endometriosis, which may or may not be impairing our ability to reproduce because my husband has crappy sperm so we've never really tested it.  I have always wanted children, in fact my initial plan was to get married at 19, and have 4 kids by about age 27.  That unrealistic plan was completely blown out of the water by that fact that I didn't even meet my husband until I was 27, and got married at 29.  

We spent most of the first year TTC hoping that we'd have good luck and assuming it was my fault that we weren't successful.  I had most of the testing right as we started, so the next step was a repeat laparoscopy for me.  I thought we should make sure that we had taken care of any possible issues on his side before I had surgery, and to our shock all of the news on his side was bad.  

Now I don't get a laparoscopy right away, which you might think of as a good thing, but I'm one of the lucky ones for whom endometriosis is not a silent problem, instead it's more of a screaming, tearing, ball of pain in my abdomen for a couple of days a month, and a gnawing, dull pain the rest of the time.

We're waiting to go see a urologist, and find out if there's a possibility that his crap sperm is caused by retrograde ejaculation (a complication of diabetes) or possibly some sort of ejaculatory duct obstruction, or even something we haven't thought of yet.  If so, maybe there's something we can do.  If not, we feel like we're most likely looking at IVF.

{stepping away, and finding my seat}

Good News!!!

Okay - I wrote this post once already, and then I lost it.  GRR!

I finally got Jakobe's login information for his health insurance web portal.  I say finally because I've been wanting to do it for a long time, but hadn't yet acted on that desire, and not because Jakobe was holding out on me.  In any case, I logged in today to check his Infertility coverage - just to double check my belief that he didn't have any, and discovered that I was wrong.  This is what I found:

Infertility Services

Diagnosis and Treatment of underlying medical condition covered (e.g. endometriosis). 

Other examples in my book would also include: ejaculatory duct obstruction, retrograde ejaculation, other things I can't think of, but I'm sure are out there....  I'm pretty certain that this means that our upcoming urology appointments and follow up appointments will be covered under his insurance.  I expect we can probably get coverage for SAs needed as part of the diagnosis or treatment of the "Underlying condition" whatever that is.  This is a good thing, and it changes the picture for us somewhat.  It certainly may open up some options that we may not have been able to explore before.