Stop the Clock

In April 2011, I completed my final pack of birth control pills. I was ready and Sam had halfheartedly agreed that we could start trying for a baby (because his other option was likely that I'd start flushing the pills and stabbing holes in condoms...God bless the old me). He had just completed his first year of his three year doctoral program and we had celebrated our first anniversary. May 2011 would be our first month of possibility. You know how the story goes.

It's October 2018 now, a full seven and a half years later. The clock is stopping now. Have mercy, but there are a lot of weird, hard, mixed up feelings in this decision, but I'm sharing it because every other part of this journey has been open, honest, and vulnerable. It feels like this part probably should be too. I'm starting birth control again.

If you would have asked me even two years ago about birth control, I would have chuckled and offered some quip like "no need. I am my own birth control." And when you look at my track record, it seems all but certain. Even with IVF, I was given chances below 10%. So what are my chances of a regular, non-medicated cycle without timed intercourse? 1%? Less than 1%? The odds have always seemed so low. So very, very low.

I told myself years ago that I was done dictating my cycles. They could come or go as they wanted and I would just live life. If I had a 24 day cycle, so be it. If I had a 48 day cycle, I'd save some money on tampons. That was about my level of interest. And so with time, my dedication to even track my cycles fell to the wayside. I barely remember to even note when a cycle starts now.

I told God that I was done trying, asking, praying. I would just trust him. If he wanted a miracle, bring it. If he didn't, I was content with the miracles he has already allowed me to witness.

But things have changed. I no longer feel the same open arms feeling of surrender. Instead I feel an itchy, anxious fear that keeps me up at night and makes me second guess intimacy with my husband. And I don't want to live that way.

The reality is that our life is FULL with two kids...full in ways that are hard to explain. The boys are 16 months apart, basically as if I had gotten pregnant when Garrison was 6 months old. I know that as they grow up, the close proximity of their ages will likely be a blessing, but right now, we're in the thick of it. Two kids in full time daycare, medical bills out the wazoo, therapy appointments... it's just a lot.

And the truth is that I no longer want a biological child. That is CRAZY hard to admit as we have four embryos on ice in Florida right this very moment, but hiding behind my feelings won't change a thing. My kids have some hard, complex days ahead as they will begin to grasp and grapple with their adoption, their permanence in our family, their first families, and their relationship and role within our family. While I know a lot of blended families of biological and adopted children, it just doesn't feel like the right thing for our family at this moment. We will finish out our infertility treatments by seeing it through with the final four embryos from my IVF cycle in 2014, but after that, we're done. I have zero wish to ever crawl back on that crazy roller coaster. See you, bye.

Additionally, I think there's a solid chance that there is another kiddo for our family, but when I think about it, when I allow my heart to unwind and my mind to imagine, I feel deep within my soul that a future Greavu would join our family though international adoption, likely China. China changed some of their rules in the summer of 2017. One of the regulations now states that the youngest child in the home must be three years old (or older) before you can submit your dossier. We cross that line next June with Joel, and then the possibilities are wide open for us. But if I were to get pregnant, we'd be at least four years from bringing home another child from China. And I'll be honest, I'm not sure I could bribe Sam to go for four kids, and I'm not sure I'm the right mom for four. It feels like an either/or decision, and right now, my heart doesn't break for the possibility of a maybe baby with thick brown hair and green eyes, but it SHATTERS over the orphan on the other side of the world.

It felt reckless, even dangerous to have unprotected sex while we were in process with Joel. If we had gotten pregnant, we would have been obligated to report it to our agency, which would have very likely cost us our adoption of Joel. SCARY STUFF. My opinion might be different if the rules had never changed, if you could adopt while pregnant, or with infants in the home, but three years? Gosh, that's a long time. It feels like the nail in the coffin...and when those are the words that come to mind when I think about a surprise pregnancy, I know that my head and heart just aren't in it.

Am I 100% sure about this decision? Gosh no. Enneagram 6's rarely ever get the luxury of being 100% confident in any decision. We just learn to live and lean into the uncertainty. I turn 33 this month. The years are speeding by faster than ever. I'll receive the "advanced maternal age" tag in just two short years if I ever try to conceive again. I know that this decision may mean I'm eliminating my chances. And yes that's a little hard to wrap my mind around. Probably a little less hard knowing my chances are basically nill to start with though. It was going to take a miracle at 26. It'll still take a miracle at 35. I'm taking comfort in knowing that this isn't an irreversible procedure. It's a pill. I take it or I don't. If things change next month or six months from now, I can stop the pill and I'll be right back where I am...ridiculously infertile and unlikely to conceive.

But what about trusting God with our family? Didn't I say that? Gosh guys, I don't know. A lot of healing has happened over the last four years in my head and my heart and my relationship with God, but there's still a lot of doubt and fear when I think about God, particularly in relation to growing my family or fertility stuff. It's not good and it's not true and when the lies creep into my mind, I'm trying to push it back with the truth of who God is. But the reality is, sometimes I almost think it's more likely that God would heal my body, uterus, eggs, and whatever else is wrong in there now that I don't want a baby. Like I said, wonky, hard, messed up feelings still lurk at the bottom or it all. There's no magic wand to wave to unthink the lies you believe about yourself or God. I've been wrestling with a good bit of guilt about this decision, as if choosing to go on birth control means that I don't trust God. Maybe it does and maybe it doesn't, but I've finally come to place of semi-peace about the decision. If I was a normal, fertile woman with working ovaries and junk, and we didn't want to get pregnant, we'd pursue this option. Just because it is so much less likely for us doesn't seem like a valid reason to role the dice over and over again if it's not the outcome we're hoping for.

It was a good run. 7.5 years of not hearing the ding of my phone to remind me to stop and swallow a pill. I'll miss that. And I'm not looking forward to regular cycles. Ughhhh. Far too often. But I am looking forward to a little peace and the opportunity it brings for the future.

So, Why Adoption...Again?

Once upon a time, we made a plan. Sam and I said we'd adopt and then we'd return to Jacksonville, Florida for our remaining embryos. And yet, here we are, right smack in the middle of an international adoption. I'll be honest, I feel that tension. The reality of embryos sitting in a freezer in Florida with my name on them is a heavy burden...most days, that's exactly how it feels. But let me back up.

Adopting Garrison was quite possibly the single greatest, most defining event in my life. I feel like an entirely different person now. It feels accurate to divide my life in two, BG (before Garrison) and AG (after Garrison). Now part of that is certainly simply taking on the role of mother. That in and of itself changes every woman whether she expects it and welcomes it or not. Something simply shifts when you become a mom. But for me, it goes far beyond that. Adopting rocked my world on every level. It often feels as if it quite literally shattered my heart. For me, adoption was no longer about family building, instead it became about orphan care. I thought I cared about the orphan before, but now I think about the orphans on a daily basis and my heart breaks for the fatherless.

Another thing that changed for me after adopting was my desire to get pregnant and give birth. Some women adopt and still long for the experience of pregnancy and birth...it doesn't diminish their love for their children who were adopted, but it remains a desire for them. Others no longer carry that dream after adopting. I was 100% sure I'd be in the former camp. There was absolutely no way my desire to carry a child and give birth could ever go away...the desire was just too strong. And then a funny thing happen. I woke up one day and realized it was 100% gone. I say that and I think people thing I'm joking or just trying to be positive. Nope. Dead serious. In fact, I'd prefer NOT to ever get pregnant. For real. The only desire that remains for me is for healing. I still desire the answer to my prayers. I still desire for the Lord to reach down and heal me, not because I want to be pregnant or have a biological child, but because I'd love for that to be a part of my story. Does that make sense? Honestly, what I'd really love is to wake up one day with the knowledge that God had healed me and then I'd never test Him on it. "Cool. Thanks. I appreciate that. Now I'd like to not get pregnant, mmm-kay? Thanks." that's how I imagine our conversation would go.

And that my friends is a really interesting place to sit with four embryos in the freezer. In fact, it's a kind of yucky place to sit. I have these embryos that I feel responsible for, and yet, I don't really want to transfer them at this point. Yuck, right? I told you, it's not a good place to sit. We personally don't believe in discarding them or donating them to research and they are far, far too poor of quality to donate. The reality is that the odds are high that I will not get pregnant from the embryos. We know that and the doctors have agreed. We went down and spoke with the doctors at FIRM almost two years ago and they confirmed that the odds were low. Not non-existent, but low...I tend to lower the percentages of any Reproductive Endocrinologist a good twenty percent, so we're talking seriously low. So why won't I just transfer them and be done with it? Well, because it feels pretty gross to think about taking meds and stepping back on to the roller coaster all to hope that it doesn't  work. Ewww. It's not the same as just hoping the pregnancy test will be negative after unprotected sex, at least, it's not the same to me. It's hoping that the embryos don't survive. Ughh. That's tough. And until I can get my head in a place where I am open and receptive to a pregnancy, I don't feel good about opening that door again. Until I can say that I'm at least open to the idea of a pregnancy, I don't want to step anywhere near the roller coaster that is infertility treatments, let alone strap myself in.

So that's one part of it; I don't really want to be pregnant. The other part is that I desperately want to adopt again. Adoption is absolutely, without a doubt NOT the only way that we can care for orphans. In fact, I feel so very strongly that orphan care does not, cannot begin with adoption. Orphan care starts with orphan prevention. But, with that being said, I do believe in adoption. I believe that "God sets the lonely in families." I believe that believers are called to care for the orphan. And while I do not believe that it is the responsibility of the infertile couple to step torward for adoption, I do believe that infertility is a part of my story so that I would be directed towards the path of orphan care.

Over the last several years, I've followed several adoptive mamas on Instagram and as I thought and prayed and researched, I felt a strong desire to adopt from China, specifically from the waiting child list. We are overjoyed at the prospect of adopting a child with special needs into our home and we are thrilled to bring a child from China into our home and call them son or daughter. Truly, this is our plan A at this point and we could not be more excited for this opportunity!

With that said, we do still plan to return to Jacksonville following this adoption. I don't know what that looks like or how I can move from where I am today to a place of desiring a pregnancy without falling back into the crazy. I'm not sure exactly what steps I need to take to get my head on straight in terms of infertility treatments, pregnancy, biological children...all of that, but I know that I'm willing to take the steps to be ready and I know that we are committed to seeing that our embryos have the chance we promised them over three years ago. For now, we wait and pray that the Lord will bring us to and through the Chinese adoption experience. We are excited for the days, week, months, and even years ahead.

Another Child

It honestly feels weird to think about another child at this moment. Both because I am borderline overwhelmed with parenting the one and also because I am content. But I know I probably won't always be content. That's not a reflection on Garrison; I always wanted a big family. The itch for another child will return. I'm not sure when that typically happens. When do normal, fertile couples begin to think about trying again? Surely not at 5 months. But here's the thing. It took us almost four years to get Garrison. If we don't want Garrison to be starting kindergarten before a sibling arrives, it feels like we need to get started.

While in Jacksonville finalizing our adoption of Garrison, we stopped in at FIRM, the clinic where we did IVF. We have four (maybe three) embryos frozen there. We have decided that before we pursue any other family building opportunities, we will complete our frozen embryo transfers. In a lot of ways, these embryos feel like a weight. And that's totally not fair; I know. They are our children, long awaited for, fought for, prayed for, but it appears that it is very unlikely that we will ever meet them. The doctor confirmed that it is unlikely we will see a bring home baby out of this IVF cycle. And yet, we feel that we must give them a chance. 

When we completed our IVF cycle in January 2014, we paid to keep our embryos frozen for two years. At the time, it seemed like we would not need the full two years. We knew our embryos were lower grades and we figured that even if we got lucky, we'd try for a sibling within two years. But then the first transfer failed. And then the second. And then an entire year passed by. January 2016 will be here quickly. I know that as the months with Garrison just fly by. I feel as if I'm constantly sticking a round sticker on his onesie and exclaiming "another month went by so fast!" We have a few months to decide what to do, but the decision is (as always) complicated. 

We met with a different doctor for our consult as my doctor was out of the office and we were only in town the one day. This doctor was more of a straight shooter. He agreed that in light of our past transfers and the quality of our frozen embryos, the odds of success with any of our remaining embryos is low. He didn't really bat an eye at our request to transfer all four...that's always a really bad sign. He agreed that the Endometrial Function Test would be a good next step just to rule out any implantation issues. If something came up, he said we'd correct it and then his recommendation would be to transfer two. He agreed that our issue is very likely embryo quality (with a root cause in egg quality) but that if he had proof that there was a problem with my lining, he would be unable to say with certainty that our previous cycles failed because of embryo quality and transferring four would be riskier. However, his bet is that all is normal with my uterus and lining. That's my bet too, but I've never been one to turn down answers. 

And I guess this is where my ideas on family building and next steps are changing. I'm just not sure how much more money I'm willing to throw at my body. There are other ways to build a family, ways that I'm really open to and even excited about. I do believe that given all the money in the world there is likely a doctor out there with enough expertise to help me get pregnant with my own eggs and Sam's sperm. But we don't have all the money in the world, and if I'm being honest, there are other things I'd rather do with money (like pay off student loan debt) than throw darts at $30,000 a toss at a moving dart board with a shrinking bullseye. 

The doctor did mention and agree that this test for my lining (at $1,500) would be valuable information for later transfers, whether that's our embryos or donor embryos. And while IVF may be less and less glamorous to me, embryo adoption still holds a lot of appeal. So we have to decide if we want to do this test. It needs to be completed about 2 cycles before our transfer. We also have to decide if we want to attempt to transfer these embryos before the middle of January (when our payment runs out and we'd need to pay $500). To do the transfer without the test would cost approximately $2,500 including travel and medication. Adding in the test would bump that to about $4,000. That's a TON of money to come up with in 6 months, especially while paying for daycare at the cost of $10,000 a year. Which ultimately brings up the biggest  question: are we ready (and can we afford) another kid? Yes, the cycle is VERY unlikely to succeed, but I can't help feeling negligent if we don't calculate our ability to provide for another child if the cycle were to succeed. 

I have a feeling the answer is no. In fact, I know the answer is no. Daycare alone is almost $1,000 a month, and we don't have $1,000 margin in our budget each month. Will we ever? Absolutely. But in January, no probably not. The wisest thing to do would be to table the "another child" conversation and work diligently to pay off our student loans, start college funds, save for retirement, etc. But fear and doubt always wiggle back in from the depths of my mind when I think about postponing a second child. The doctor so kindly pointed out that "his recommendations would be different if we were having this conversation and I was still young." Gee, thanks. It's interesting that at 28 I was "so young and healthy" but at 29 I'm "no longer young." The clock is admittedly ticking (probably far faster for me as my egg quality already sucks) if we want to try IVF with my own eggs again. But even outside of IVF, I feel the clock ticking. Family building outside of the sheets takes time...lots and lots and lots of time. So do we table it, relishing in our current joy, and continuing to pay to have low quality embryos frozen? Or do we recognize (and maybe even embrace) our circumstances and the ways our family is likely to be built and begin the journey anew with the start of the new year by jumping with both feet back into the TTC game?

I have no answers. Time will tell. 

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Guys, can you go over to my sweet, sweet friend's blog and give her some love? She just miscarried again and is having a really rough time. My heart is absolutely broken for her. I know she'd appreciate some love and support during these hard days. She was ready (like really ready) to start her long-awaited cycle at CCRM only to discover she was pregnant...surprise. But now it's over and it's so hard to answer the big questions when what appears to be the greatest blessing ends in more despair.

Some Days are Hard

Some days are just hard. Today is one of those days. Today would have been the due date from our first IVF transfer. I already knew the date before we even got to the beta. I was in no way confident that our IVF cycle would work, we had had too many things go differently than planned during that cycle, but I still just needed to know, "if this works, when would we be due?" The date was engraved in my mind for the two week wait. And then for one, one billionth of a second I was pregnant. Again. Me. The girl who never gets pregnant. Somehow, despite all odds, it happened. A pitiful, little six yes, but it was still there. The date mattered. We knew how things would go before the phone call even ended. This would not be our take home baby. October 3, 2014 would not be our day. We wouldn't write it on the calendar, with hearts and stars and hope. We'd just tuck it away as a day to remember and reflect. A day to reminisce and mourn.

By the time I returned for another beta on that Monday in January it was over. It was most certainly over before it even began, but it was real. For one brief moment in time, two of our precious babies were placed inside of me. I'm pretty confident that only one implanted.... the numbers were just so low. But for a small window of time, we were connected, that baby and me. I was providing life and he/she was fighting for it. I'm not sure who failed whom... is my body to blame? Or did my sweet baby never have chance? Either way, our time together was important. That little bundle of a few hundred cells was half me and half my husband and all God-breathed.

Many will wonder where my hope for tomorrow is. Isn't adoption exciting? Aren't we hopeful that our baby is out there? Of course. But the hope for tomorrow doesn't negate the pain of today. We are thrilled about our adoption. We are nervous and excited and overwhelmed to start our home study. We are eager to get started so we can get finished, because the Lord knows this is not a fun process. But our joy and our anticipation for what tomorrow may bring doesn't change the fact that today hurts. Today was the day that life was supposed to enter the world, wailing and crying and furious over the traumatic entry. We had placed months upon months worth of money and hope and prayers into today. Today was the day that IVF was supposed to change our story.

Tears have been stinging my eyes since they opened this morning. I wanted those babies... both of those babies. They were fiercely and dearly loved. They were meant to be my miracle, my October babies, my last chance to sneak a baby in before my 29th birthday. They were 10,000 hopes and dreams and prayers all centered within those tiny bundles of life. But they are gone and we are here, and we have no answers as to why. So many questions still unanswered. Some days are just hard. Today is one of those days.

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I also wanted to give a brief update on the adoption. We met with our adoption consultant on Wednesday. Everything went really well. She said she thinks we'll do great, but I'm guessing she says that to everyone. We've got two tasks we're working on right now, and they both feel daunting. The first is our profile book. This is a physical book that will be mailed across the country to various agencies or attorneys so that they can present us to a birth mom. It's supposed to tell the birth mom about us and why we want to adopt... essentially a "pick us" type book. No pressure or anything. The second task is the home study. I completed the application for the home study last night.... not the home study, just the application. I didn't know the answers to half of the questions, so I'm feeling really positive about this process. But on we press and we cling to hope. We've been brought to today for a reason.

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And one last thing. Caroline over at In Due Time is about the sweetest thing ever... you all know that. She has a HUGE heart and has graciously offered to host an online Stella Dot party as a fundraiser for our adoption. How cool is that?!?! I'm going to attempt to invite everyone this weekend, but in the mean time, consider yourself invited. The party is open until October 31st, so if you're interested click this link. Only eleven weekends until Christmas!

Drops in the Bucket

This post has been sitting in my drafts for almost a year... seriously. I never got around to finishing it like I wanted and then it just sat sad and forgotten and grew dusty. But dusty blog posts are about as good as it gets around here these days. Kidding... except not really. Actually, I drug this old thing out because my friend Amie was discussing IVF and the price tag and it reminded me of this old thing. I decided to dust it off and post it in case anyone else out there is debating between saving for treatment, emptying out your savings, or swiping the credit card. I'll say what I said to her: absolutely zero guilt with whatever decision you make. IVF is EXPENSIVE and Sam and I are proof that it doesn't always work... you've got to find the solution for your family in your season of life that you can life with no matter the outcome of the procedure.

So after my Debt Free (sort of) post and the announcement that we're expecting to paying for IVF 100% out of pocket AND out of savings, I got several messages from people wondering how we did it. As I stated before, I am not the person you want to ask for money advice. We fail, and fail, and fail in terms of our finances. It is literally by God's grace that we were able to do this. It's kind of one of those "the stars aligned" type of deals. However, I do want to share what worked for us in case it helps someone else. Many couples pay for fertility treatments through various methods: parents, donors, grants, but for many the options are to save or take out a loan. Here's how we came to our decision and what we did about it:

First of all, let me just say that I'm honestly not emphasizing saving for IVF over taking out a loan. The saving thing sort of just happened. And by that I mean, we VERY intentionally saved, but we also never felt like a loan was an option until we were already close to the number we needed. Why? Well, we were first told to pursue IVF in November 2012 after three failed IUI cycles. The cost was quoted to us at $13,200 for one cycle (plus meds of course), but we were told our best bet was a refund program coming in at over $30,000. At the time, I was jobless and Sam was in physical therapy school... I really never thought too seriously about the potential to receive a medical loan. It seemed super unlikely, so I didn't look into it. Who would give two unemployed twenty somethings with zero assets a loan for 15-30K? What I was tempted to do was max out Sam's school loans (shh, don't tell the government), but he was so adverse to the idea that it led to the longest, ugliest fight of our marriage. I mean BIG people... I'm sort of surprised me moved past that one. With time, I forgot about loans... it wasn't worth it to continuously think about it and wish for it if we weren't going to do it. So again, we came to the decision to save not because we think a loan is a terrible idea, but because of our circumstances. If we had had the ability to take out the loan in December of 2012 AND if we'd both been on the same page, I'm pretty sure I'd have gone for it. So yeah, if you're leaning towards a loan or swiping the credit card, you're in good company here.

Another point to make is this: there are no shortcuts here. Saving takes time. It took us about fourteen months from the time we heard "IVF is next" until we were ready. Now, less than half of that time was spent actively saving for IVF, first we were unemployed and then we were paying off debt, but my point is just saving is a longer road, no matter what (unless of course you have wealthy in-laws or a heck of a savings account at your disposal). There were times when I felt so worried over the delay I was fighting off panic attacks and there were other times when I felt confident in our plan. It just takes time. Patience is a virtue, right? But if you've been told you are running out of time, I'd honestly recommend the loan. In fact, even Dave Ramsey, "Mr. No Debt, Ever," would. He said so here and here and here. So if I'm ever in this situation again (which we probably will be), at say 35 years old, I'm taking Dave's advice and getting the loan.

With that said, here's what we did.

• First, we transferred a portion ($2,500) of Sam's mutual fund into a CD so that we couldn't touch it. This was a starting place. I still didn't have a job, Sam was still in school, but it allowed me to feel like we had started. It wasn't necessarily the wisest financial decision, but it helped my anxiety while we waited to really get started. You've got to be able to live with yourself.
• Secondly, we got jobs (hopefully, you would be starting from this place). Once we both had jobs, we began to pay off our credit card debt. It made zero sense to me to save for one thing, while paying 10-18% interest on another. I'm proud of the decision, but I second guessed myself A LOT. If we'd held onto the debt, we could have saved the same amount significantly faster.
• Third thing was a budget. We are bad at budgets. You know those people who love them? Who track every dollar? We are not those people. We broke the budget monthly. But guilt is a powerful motivator and we needed something to keep us on track. If last month sucked, we could move on the 1st of each month... start fresh.

An important thing to note is that we were not perfect in anyway... we weren't even good. Our budget lacked a lot of "necessities". We sliced and diced until we were down to actual living expenses (i.e. bills). Our out to eat budget $40 for the month... and if you didn't buy it in the grocery store it came out of that amount, so this wasn't date night, this was Chick-fil-A. We went over EVERY MONTH in one place or another. There was no "new coffee pot" budget, not even an "OPK budget", so yeah as you can imagine, we went over a lot. It was not a sustainable, live the rest of your life budget by any means. This was for two reasons. One, our salaries, living situation, the whole thing was super new to us, we didn't know how much gas we would need or how much the power bill would be. We had to guess, and sometimes we went over (hello, Georgia summers). The second reason is this: I literally wanted to feel the pain every time I bought something that wasn't budgeted. I wanted to think to myself every. single. time. that I bought something outside of the budget, "this is less money for IVF". It's a bad budgeting system and not one that we have continued to use, but for our situation at the time, it worked.

An example: clothes. Even Dave Ramsey is an advocate of buying clothes. I figure if it's on Dave's list, it can be on mine too. Except when we created out budget, it was with NECESSITIES in mind. Are clothes a necessity? Yes, most certainly. But are new clothes a necessity in this season of life? Our answer was no. We had enough clothes to last six months or more, so there was absolutely no clothing budget. That is, until my husband ripped belt loops off his pants leaving giant holes... suddenly pants were more of a necessity. I waited for a sale, used coupons, and got the best deal I could, but as there was not a "clothes budget" it came out of the IVF fund.

Another important thing to note. We already knew before we signed a lease on our apartment that we were gearing up to live well below our means. It is always easier to make one decision that saves a big chunk of money, rather than a hundred small decisions. In my opinion, the single most significant thing we did was choose to rent a cheap place. Dave Ramsey recommends that you spend 25% or less of your monthly income on your rent or mortgage. Well we spent, 6.6% of our gross income and just under 10% of our bring home salary on housing. If we had been in a situation where we could not lower our rent or mortgage payment, it would have been very difficult to save as quickly as we did. The housing was a huge monthly savings for us and it has taught me that I never want to be house poor. Margin is always good.

And lastly, if budgeting, saving, or getting out of debt is difficult for you, I highly recommend an app (assuming you haven't ditched your smart phone in your saving frenzy). We used MINT... a free app (because $2 apps are not in the budget) that allows you to see exactly how much you have to spend at any given moment in a particular area. This was HUGE for us. It removes the "I didn't know" from the conversation (err argument). Our out to eat budget was forty dollars a month. So if we wanted to run to Dairy Queen for a blizzard, we checked the app. If $39.60 was staring us in the face on the 8th day of the month (which happened all too often), well then we had our answer. Forty cents does not pay for a blizzard. If we chose to go get the blizzard anyway, it was with the knowledge that we were blowing the budget, and even more importantly, that the extra three dollars was three dollars that was intended for IVF... ice cream starts to lose its appeal. With an app, there is no excuse; you can always know EXACTLY where you stand. And it removes a lot of math and data entry from my life. Praise the Lord.

So that's essentially it. I'm not a money guru by any stretch of the imagination, but with a lot of mistakes, we were able to pay for IVF out of pocket with zero insurance coverage! And we learned a lot in the process. Sam and I are far more money conscious now  than we ever were before. I am pro a debt-free life 97% of the time... clothes, food, furniture, pets... those things don't belong on credit cards in my opinion. But that 3% of the time... well that includes air conditioning units, because let's get real, I was not about to live through a Georgia summer without AC.... and so we have been using all of the knowledge we gained last year and doing the hard work all over again to get out of debt (again) and pay off all of the unforeseen  moving and new home expenses. That 3% also includes fertility disasters. No one grows up intending to need $30,000 to start a family, so don't blame yourself if you don't have the funds lying around. But do recognize that you are the master of your finances if you choose (either you're the master of your finances, or they'll be the master of you). One way or another, you're going to pay for it, either before the treatment or after, so either way, I encourage you to find places you can trim the fat. Save up faster, or pay it off earlier... you'll be glad you did. Some days, most days in fact, it will feel like you're hard work is only drops in a bucket, but persistence pays off. Your bucket will overflow eventually.

Hard Choices

For the sake of simplicity in this post, I'm dividing our next steps into two groups: group 1- we both (Sam and I) have a genetic relationship, and group 2- one and/or both of us do not have a genetic relationship with our child.

I'm currently struggling with our next steps. Unfortunately, I don't even really know what I want, which makes it particularly hard to agree (or disagree) with Sam about any of it. Every time I try to talk about any of the options, I start to cry. I'm feeling particularly vulnerable at the moment and all possible plans make me feel even more so. But I like to have plans, so I continue to think through them even if it's uncomfortable.

There are things that I like and don't like about each of the possible plans. I like that domestic infant adoption feels quick(ish)… it's certainly not a guarantee, but the possibility is there. I like that IVF gives me the potential to overcome infertility. I like that donor embryos is a cheap less expensive option. But with all the plans that fall into group 2 (donor egg, donor embryo, domestic and international adoption) I have a couple of things that I really don't like, a couple of things that I'm afraid of and can't seem to work through.

I've said several times before that adoption has always been a part of my family building plan. In my teens and early twenties, my dream was for 4-5 biological children first and then 1-2 adopted children, specifically via international adoption. To say I had a rose colored glasses view of adoption would be an understatement. I had never heard of adoption scams, or stealing infants from hospitals. I would never have dreamed that there was an underground rehoming network taking place in my own country. Adoption just seemed beautiful: it was all about rescue and redemption. I never thought I might need adoption in order to have a family, so it seemed almost ministerial rather than simply family building. 

My view of adoption has slowly changed. I'm honestly a little afraid of adoption. I'm afraid of getting in over my head, of unknowingly contributing to crime, of separating a child from his/her first family unnecessarily. In no way do I mean to say that adoption is bad. I have many, many friends who have or are currently adopting. I've seen adoption work. I've seen adoption be beautiful just like I imagined. But I've also heard things that make me nervous, things that seem to freeze my feet in place. 

My greatest fear with adoption seems to be spreading into all forms of family building that don't have a genetic connection, essentially all plans in group 2. My greatest fears center around the third party... the biological mother and/or father. Whether you want to admit it or not, adoption, donor embryo, and donor egg/sperm all have a third party involved. The fact that I would not have a genetic reflection in the face of my child isn't what I'm afraid of... looking at my child and not seeing high cheekbones or thick brown hair doesn't frighten me. What scares me is how the third party (or lack there of) might affect my child. How not knowing anything about his biological mom might forever leave a giant hole in his life. It seems to be a nonissue for some kids and a giant deal for others… I'm not sure if the difference is in the children or how they are raised.

In donor egg/sperm situations there is almost always no information available. In some instances, the couple receiving the eggs only knows height, weight, hair and eye color, and education level. Other than that, they simply know the donor passed whatever sort of preliminary tests required of donors. Unlike is most adoptions, even once the child turns 18, there is simply no additional information to provide the child… she will never know more about the woman who helped create her. The lack of information is typically to protect the donor from a child/children hunting for her years later. I don't think this eliminates donor eggs for us, but it's certainly something to think about, something to prepare for, something to process.

If the fear of raising a child who feels like a giant piece is missing from her life due to the lack of information frightens us, it seems that our next steps should be some form of open adoption or open embryo donation. But the moment I hear "open" an entire new set of fears arise.  I'm not sure if it makes me insecure or shallow but the idea of my child knowing and/or seeing his biological parents scares the dickens out of me. My dream of parenting never included a third party... the "adoption triad" as it's called. I understand why it's often the best situation for the child, but oh my heart. I'm not sure if I'm mature enough to handle that dynamic... I imagine I would forever be jealous of any connection my child might have with his/her biological parents. Meeting up at a park or inviting them to birthday parties scares me... and not simply because our parenting styles might be different or they might not be people I'd naturally choose for my child to hang out with. My biggest fear is that my child would prefer them over me. (insecure much?)

I can literally hear it ring in my ears, "you're not my mom." She might scream it as she turns, flouncing her hair, and slamming her bedroom door. The words probably came following a fight about boys or make-up. I'm pretty sure I said equally mean and hurtful things to my parents growing up, but that phrase might just rip my heart out if I ever hear it. It might be my biggest fear about losing the genetic connection with my kid(s). I certainly don't want to raise kids who feel incomplete, but I'm also afraid of allowing the biological parents into our lives. I'm afraid of how the third party would change my relationship with my child. It all just feels scary and foreign in ways I wasn't prepared to feel until group 2 was really right in front of me.

All of these thoughts have been swirling around ever since I wrote "Plans G-K". I had asked Sam several weeks ago to start thinking through our options so that we could discuss it soon. We finally talked about how we each feel about the different plans this past weekend. Essentially, I feel like we have six options (not including another FET or living child-free).

1. Expensive IVF: Somewhere with GOOD statistics like CCRM or maybe Advanced Fertility Centers of Chicago
2. Cheap(er) IVF: It would be $1000 less to go back to FIRM (which was already a fraction of the cost) for another round
3. Domestic Adoption
4. International Adoption
5. Donor Eggs
6. Donor Embryos

It should be shocking to no one that Sam and I didn't list our options in the same order. That would make things way too easy.

Sam's list: 3, 5, 6, 1, 4, 2
Amanda's list: 1, 5, 6, 3, 2, 4

Sam likes adoption for two things: he thinks it will be faster and that it's more of a sure thing.
I like IVF with CCRM (or other really good clinics) because it eliminates all of my above fears and allows me another shot at beating infertility (I'm not normally so competitive). International adoption is at the bottom of my list because, if this happens to be the only child we ever have, I don't want to miss having a baby. And I think repeating IVF at FIRM is at the bottom of both of our lists because of my poor response. It just seems dumb to repeat the same thing and hope for different results.

So how do we move forward from here? Obviously, we arm wrestle for it. I think the best move from here is to research each of our top options first. We might have a phone consult at CCRM and go to a few informational meetings at a couple adoption agencies. I've just finished reading Called to Adoption: A Christian's Guide to Answering the Call. I'm on the hunt for other good reads. I don't think we're in a desperate hurry to make up our minds… I'm in a desperate hurry to have a baby, but as all options cost a good chunk of change, it won't be any time soon. We've got time to research and talk and pray… hopefully our next steps will seem clearer to both of us with time. I do think I'll schedule a consult with Dr. Duffy at FIRM in the coming weeks to at least discuss the possibility of transferring all four remaining embryos. If he likes that idea, that may be our next step as it's certainly the cheapest and we'll have fully exhausted our options before moving forward.

Essentially, all of these are good options… there's no bad option here is it brings us a child of our own. But that doesn't mean choosing is easy… these are hard choices to make. These are decisions that I never in my wildest dreams thought we'd be making, not even when infertility was dumped on us. I'm still trying to wrap my mind around the reality of our life. There are moments when I just want to cry, tell God he's completely unfair, and refuse to give up any more than I already have. In those moments I just want a baby without stress or fear, without worry or heartache… I just want it to be simple. But simple it is not. I certainly don't believe the old saying that the Lord won't give us more than we can handle… I think the story of Job pretty clearly disputes that. But I do think wherever He leads me or allows my life to go, He'll see me through. He's allowed infertility to be a part of my life for one reason or another… I have to believe He'll see me to the other side, hard choices and all.

Courageous

I remember way back when I was just embarking on my first IUI thinking how much courage IVF must take. I was having mild panic attacks over the medications required for IUIs; I couldn't fathom doing IVF. In fact, I remember finding Amanda's blog right around the time she was embarking on IVF. I remember reading about the injections and thinking to myself that she was so incredibly brave. I also remember begging God to bring me a child before that point... my rationale was that He should know and understand that I am certainly not courageous, more like scared of my own shadow.

I've lived a bit since then though, and I have come to see things a little differently. I thought IVF was the most courageous decision because of the pain from the needles and medication, because of the risks for OHSS, etc. There's no doubt about it... that takes courage. I know because I'm staring down the barrel looking at IVF with big, wide eyes, so to speak. But the ultimate courage, the real bravery, I've come to believe is doing anything about my circumstance.

You see, it would be easiest to do nothing, to continue this life that we've been living for the last year, and simply let it be, to say this is the life we have and agree to be content. Sure, there's a very high chance I'd regret it later, but I still believe doing nothing is the easiest choice. We have a good life. It is by no means perfect, and I'm not fully satisfied, but most days I would score a good, solid 6-7. Some days totally blow, but even then I recognize that my "lowest" is really like a 4-5... there is a whole lot lower to go. And it is so scary to recognize that I could be signing myself up for my absolute darkest day. It would be easiest to avoid that kind of pain.

I once thought IVF, the procedure, the needles, the actual process was the bravest choice an infertile woman could make. Now I'm not so sure. IVF is certainly scary, but what's absolutely terrifying is the risk of pain, of heart wrenching, soul shredding, life changing pain. And that doesn't necessarily come from IVF, it comes from reaching, from stretching, from hoping for more.

When I think about the bravest women I know, I think of Aubrey. I can go ahead and admit without a shred of doubt that I would have given up on IVF long ago if my story looked like Aubrey's. She can correct me if I'm wrong, but I believe she just completed her sixth embryo transfer out in Colorado. Aubrey is the first one to tell you that the pain from a failed transfer is debilitating, and yet, she has  recognized the potential for pain, faced her fears, and chosen to move forward again, and again, and again. Crazy, crazy brave.

And like I said, it's not always IVF that requires bravery; adoption is incredibly daunting and the potential for heartache is huge! Every time I talked to Erika after she and Matt were chosen, I thought to myself, "she is so brave". There were no needles involved, no medications, but the risk for pain, for heartache, for absolute despair was definitely there. It took incredible amounts of courage to pursue adoption.

When I think about Holly and the depths of her sorrow after losing her perfectly healthy son, Jude, due to an infection that she could do nothing to prevent, I think I know what the absolute darkest days must look like. Holly is there; she is deep in the valley of the shadow of death. My lowest days don't seem so low right now. Another failed cycle doesn't seem that bad. It is definitely easiest to avoid that type of pain at all costs.

IVF looms in front of me like Mount Everest. It is both growing closer and more insurmountable at the same time. It is almost my turn. My turn to be courageous, to take a mighty risk, to see the chance for incredible, life altering pain, and choose to push through anyway. I could stay here, right where I am, recognizing that doing nothing has the greatest potential for long term regret, but the least potential for immediate pain, OR I can move forward. I can risk the pain of a botched IVF, of a failed transfer, of a (God, please no) miscarriage or failed pregnancy. The needles are definitely scary, but the real fear I still have to overcome is the potential for pain, the kind of pain that changes you, that etches your heart, and scars your mind. I am not courageous, but I'll get there.
 

Faith and Fertility Treatments (part 2)

So you're back for more, huh? Gray, deep, and murky waters haven't deterred you yet? Good for you. If you missed part 1, catch up here. I'd like to again preface this post by saying this: I am in no way an authority on this topic. Today's post will be almost entirely the decisions that we have made, that allow us to feel comfortable moving forward with IVF. The same may or may not be true for your family, and that's okay, because the deep end may be dark and murky, but there's a lot of grace out here too. I don't have to agree with you to love you. This is a chance to discuss these hard topics in a safe and open space. It is also an opportunity to explain how I've dealt with the unavoidable moments when pursuing treatments and my faith want to bump heads. Thanks for diving in with me.

Infertile friends, let me pause for one second and explain a little to the rest of the world. I was reminded recently that a huge portion of my readers are not "in the know," and terms like IVF still throw them for a loop. Bare with me. In vitro fertilization (IVF) is essentially the extraction of eggs (hopefully several) from a woman's body in the hopes that fertilization will take place outside of the woman's body. If fertilization takes place, embryos develop and they can, at some point, be returned to the woman's body. That's as bare bones, boiled down as I can make it. Now of course there are lots of variations. Sometimes the embryos go in after being frozen and thawed (frozen embryo transfer), sometimes the eggs are harvested from one woman, but returned to a different (donor egg and surrogacy), but essentially it all comes down to the attempt to fertilize an egg outside of a woman's body and then successfully return it to a woman's body.

For a lot of people, IVF seems too far. Like you're playing God. I get that, but hold on, let us explore the deep end a little more. Because the truth is that there are moral and ethical issues with other treatment methods as well. The initial hurdle most couples go through is oral medication. It seems innocent enough. The goal is to increase the chances of ovulation by providing an increase in hormone response. This also increases the chances for multiples though. I've heard many stories in which women become pregnant with three or four babies after one or two rounds of Clomid. Difficult decisions for sure.

If oral medication doesn't work, women are often encouraged to try intrauterine insemination (IUI). We've all heard of John and Kate Plus Eight. It's unlikely to happen, that's for sure, but there were supposedly only three or four follicles visible by ultrasound before their IUI, but low and behold, they became pregnant with seven babies, and eventually gave birth to six children. My point in all of this is simply that even the "lesser" procedures deserve a lot of thought. But even more important is an understanding that this is all gray. I don't think you can give a hard and fast rule on when to proceed and when to stop. Where one woman may be asked to cancel a cycle, another will be encouraged to continue. Take me for example: I was initially told my IUI cycles would be cancelled if I had more than three mature follicles because the chance of triplets was just too high. However, after three failed IUIs, we were encouraged to continue even when there were potentially five follicles. See what I mean? It's murky water.

However, it's not all that often that oral medications or IUIs cause serious ethical or moral dilemmas. The arguments and tough conversations really deal with IVF. Some would argue (like this author) that this is an incorrect way to think... IVF is safer and more ethical because the woman only becomes pregnant with one, maybe two children, 95% of the time. However, I agree that IVF is a big deal and it certainly deserves caution, wisdom, and a good deal of thought. The gun powder of the IVF dilemma is a part of a much broader debate: when does life begin?

Can we just pause for a moment and agree on one thing: the mystery of life it just that, a mystery. I don't think my reproductive endocrinologists all agree on this topic and they have witnessed embryos growing, multiplying, dwindling, failing. If they can't say beyond a shadow of a doubt, I'm not sure that any of us can say with 100% certainty. Even the  Christian Medical & Dental Association acknowledges a lot of confusion around the idea of conception. And for that reason, this is where we (my family) begin to use restraint. Since we don't know with 100% certainty, we have drawn the line as far back as possible. So we have decided that conception will be defined as the moment Sam's sperm enters into my eggs. From this moment on, I will consider these embryos my children.

We've never done IVF before. The assumption is that I will respond well and that we will be successful at creating embryos because I am young(ish) and I have good numbers. How successful? No one knows. If we fertilize ten eggs, we could get ten embryos or none. My immediate reaction to that news is both "fertilize them all, just in case" and "I don't want ten children" at the same time. So then the question becomes how many embryos should we attempt to make? Which brings us to my family's first non-negotiable: we will not discard living embryos. You see? I told you this was deep, dark, swirling water out here. Many people, fertile and infertile, disagree with that decision. But remember, I say all of this with grace. Here's why we've decided not to discard living embryos: I can't say which embryos will live or die, so I will give them all a chance. Therefore my options in terms of fertilizing eggs become: a- only fertilize as many eggs as I desire children (i.e. I want a max of 5 kids, fertilize 5 eggs), b- be willing to use every embryo, no matter how many children we have, or c- be willing to donate any left over embryos after our family is complete. Like I said, this is tough stuff. No matter the answer, the question deserves a lot of thought.

An added issue that will most likely arise due to our first non-negotiable is this: which embryos should we freeze? And should we freeze at all? I'd like to pause here and say that this is the territory in which I feel the least resolved. The next few months will be filled with a lot of research and a lot of prayer. That being said, questions arise like "at what point should we discard an embryo, if ever?" and "if freezing potentially damages the embryos, with a less than 100% thaw rate, should we freeze at all?" Tough questions. Lets tackle them one at a time.

At what point is an embryo essentially dead? I can't tell you how many hours I've spent thinking about this. Many of my doctors would encourage me to view it simply by numbers. If an embryo doesn't have the right number of cells on a certain day, it will surely stop growing they explain. My counter to that is this: as a believer, I recognize the existence of miracles. I believe Jesus called Lazarus from the dead after he had spent days in a reeking tomb, so I'm 100% confident he can give life where it seems that death reigns. So with that in mind, just because the embryo looks bad, I don't believe that the embryo is in fact a lost cause. Do I believe He will call my embryo back from its progression toward the grave? No, probably not, but that doesn't change the fact that He can. I won't put my mom in the ground until I'm 100% sure that she is gone (you're welcome, mom); in the same way, I don't want to throw my children in the trash until I'm 100% sure that they are gone. What does that mean? Like I said, I'm not sure yet, lots of prayer and research to come.

What about question number two: if freezing embryos potentially damages them, or lowers their chance at life, should I freeze? Have I mentioned before that these are sensitive topics? Yea, even my husband and I don't fully align on this one. He's a science guy. He has cut up people (dead people) and seen the inner workings of their bodies. I'm not a science girl, not at all. I've learned more science in the last two years dealing with infertility than I did in high school and college combined. The science world seems to take the stance that a good, vital, healthy embryo will survive the vitrification (freezing process) and the thaw. Embryos that don't survive wouldn't have gone on to be viable babies, or at least that's what I keep hearing. But I don't feel 100% confident in that right now. There's a lot of research left to do and a lot of soul left to search. My options are essentially, 1- freeze at day three or day five, hoping that the science world is right, 2- freeze at the pronuclear stage, because embryos at day one freeze and thaw better, or 3- freeze unfertilized eggs. Lots and lots left to decide.

Lastly, the question of how many to transfer will have to be answered. This is kind of a funny issue. I feel like everyone I talk to has an opinion on this. "You should transfer two," I hear that all the time. Some people feel very strongly about one, some people want us to insure success and encourage three. Let me go ahead and assure you, three is most certainly not on the table. Sam would die or heart failure if we saw three heart beats. My husband's fear of multiples makes this decision fairly easy for us, but it also leads me to my family's second non-negotiable: we will not use selective reduction. In case you aren't aware, selective reduction is the elimination of one or more babies while in utero. The goal, when done for non-medical reasons, is typically to give the remaining baby or babies a higher chance of success by lowering the risk for complications. We will not utilize this procedure. With that said, I can't imagine the fear associated with a pregnancy that could actually kill me... it would be an incredibly hard decision. Therefore, I want to limit the chance that I would ever have to make that decision. For our first embryo transfer, we will be putting back, at max, two embryos. If one or more of those decide to implant, and potentially split, heaven help us... literally.

I bring all of these tough topics up, not to stir up controversy or to make anyone feel defensive; that's not my intent at all. My soul purpose here is to say that these are lofty, weighty decisions. They deserve thought. All too often, doctors ask patients to make decisions in a split second. I, personally, want to have thought through as many possible scenarios so that I am prepared when unexpected circumstances arise. It is easy to allow fear of the unknown to sway our decisions. Add in the pressures from the financial costs and it is easy to get swept along in the current of the doctor's recommendations. Despite the fact that IVF is a huge financial undertaking for my family, I never want our finances to cause us to make decisions we will later regret. The temptation for us will be to get the most for our money, but there are ethical questions to be answered before we create twenty embryos. That's why my family is trying to answer the tough questions now. My faith guides many of these decisions, but regardless of faith, regardless of your beliefs, these are mighty large questions for all of us.

But the truth is this: the fact that there are ethical concerns surrounding fertility treatments doesn't automatically mean that we shouldn't pursue treatment. It simply means that we should do our research, move forward with our eyes wide open, and take the time to answer the hard questions. Whether you're aware of it or not, adoption has important ethical concerns too. Just because there is a potential to do more harm than good, doesn't mean we should stop adopting. The same is true for IVF and other fertility treatments.

Thanks for diving in with me. The water may be murky, but the shore is reachable: I pray those of us that feel lost at sea all find the shore with our faith and family intact... and a miracle to boot. My original intent for this series was to encourage other women of faith. I know that I have often wondered if my faith precludes me from treatment, and I'd like to offer my opinion that no, it doesn't. There is a path in which you can seek treatment for your miracle, bring-home baby and maintain your beliefs. Is it necessarily my path? Do you have to agree with me on each issue? No, not at all. Navigating the dark waters of faith and fertility treatments just takes time, thought, prayer, and a lot of soul searching. But if nothing else, I hope this series encourages thought and discussion amongst everyone. I encourage comments and dialogue, but let us all remember to offer grace and love before accusation and condemnation.

Faith and Fertility Treatments (part 1)

Let me preface this post by saying I am in no way an authority on this topic. I can't tell you how many hours over the last few years I've spent thinking, reading, searching for answers. The bottom line is this: the following two part series (yep, series) includes the conclusions that I have come to. They are what works for my family and the way we plan to move forward. If your family chooses or has chosen a different path or a different view, I may disagree, but I don't hold that against you. This is a highly sensitive subject, so let us agree to step into the deep end and tread these waters with a whole lot of grace.

I am a Christian. And I am infertile. For some reason, these two things seem to bump into each other a lot. From day one infertility beat up on my faith. I remember wondering if I was being punished, if I was unfit in the Lord's eyes for motherhood... I asked a lot of questions in those early days. The hardest issue for me to grapple with was prayer and faith in terms of infertility. Ultimately the question came down to this: should we seek treatment or should we simply pray about it? Initially, I wondered if choosing treatment meant that I didn't believe in prayer, believe in the power of prayer. At the time I first made my decision, only two people in my world knew about my infertility. My dilemma wasn't due to feeling judged or persecuted for my decision... no one knew I was making it. As I'm now about to embark on IVF, you can ascertain where I eventually came down on that decision.

But it wasn't a one time thing... I've had to ask myself at each and every step along the way if I should continue down this path. When I initially chose treatment, I was putting my toe in, per se, to see if the water was warm. We were just choosing an oral medication (clomid) to increase the chances of ovulation, but it seemed monumental at the time. And then the next decision was upon us: do we stop here, or do we move forward? It's one of the reasons I'm often thankful for our financial situation; it made us stop, made us pause long enough to think. If you had asked me 10 years ago how I felt about IVF, I'd have told you no way, not for me, I don't want to play God. So am I letting my circumstances change my morals, or was I simply an uninformed, opinionated, seemingly fertile teenager? Ultimately, I believe it is the latter. But I still believe some of the same things I did as a teenager. I've just learned that this is a really, really murky world. There is no black and white here; if you're looking for that, turn and run away, because if you really dive in you'll see that it's gray... gray, gray, gray.

I've also been forced to question my decision to pursue treatment over and over again because of the questions and comments I have received along the way. I have often felt judged for "not having enough faith". People tell me stories all the time about their sister, mother, cousin, best friend, etc. who couldn't have children but they prayed or they went to a healing service and then they became pregnant. I'm never sure exactly what I should to do with those conversations. While I'm thrilled for their sister, mother cousin, etc, I never know if this is a thinly veiled remark on my faith (or lack there of). Are they sharing simply to share God's power and encourage me on my way, or to suggest that if I prayed harder, I wouldn't need IVF? I never know. Am I being overly sensitive? Possibly. This is a sensitive subject. But it often feels as if the group of women who choose not to pursue treatment for whatever reason are championed more... like those pursuing treatments are cheating in some way.

So let me tell you what I've come to believe is true: I can do IVF 100 times with the best doctors in the wold, but if the Lord doesn't breathe life, no amount of science will bring me a baby. So why then does the Lord seem to breathe life only for those embryos to fail? Why then does He breathe life and allow miscarriage? Why then does He bless a woman who does not want a child and will eventually choose abortion? I do not know; I am not God. But I really, really believe that the Lord will either bless our journey through fertility treatments with a baby, or He won't, and the outcome has nothing to do with the fact that we chose treatment. His ways are higher than my ways. I do not feel confident that we will leave IVF with a baby. Why? Because God has not promised me a baby. Not via IVF, or adoption, or by any other means. And I don't believe that I can extrapolate God's promise to Sarah or Hannah from the Bible onto my life and my circumstances. And so I embark on IVF with no confidence in our success, but full confidence that my God loves me and is for me.

Choosing treatment, in my opinion, doesn't negate my faith or diminish it, no more than is true for a person seeking a lung transplant for Cystic Fibrosis or a patient seeking chemotherapy for breast cancer. In addition, the fact that I chose treatment does not mean that I decided not to pray over our circumstances. I don't believe that this is an either/or scenario. I'm choosing treatment and I'm on my knees at the same time, asking for blessings, asking for peace, asking for provision. So to those who would look at an infertile couple pursuing treatments and judge, I would simply ask you this: if you were diagnosed with a treatable disease today, not a deadly one, just a life changing one, would you do as your doctor recommends, or would you say no thank you and turn to prayer? If the latter is your answer, good for you; I suppose you can judge those of us pursuing treatment. But if your answer is the former, I would caution you to approach these circumstances with as much grace as you can muster.

Like I said, it's murky water out here in the deep end. If you dive in, you won't know what's up and what's down. This is tough stuff that requires a lot of pondering, questioning, asking, and listening. There are moral and ethical decisions tied up in fertility treatments whether you are a Christian or not, whether you acknowledge them or not. So stay tuned for part 2 of Faith and Fertility Treatments.

Can I Get a Little Service?

Has customer service died? I know there are a few pockets within civilization that are staking their claim, not budging an inch, forcing you to enjoy your experience. Chick-fil-A for example... you're required to enjoy your visit. They will "my pleasure" you until you cave, smile, and enjoy your visit. Apparently the medical field, particularly the infertility world, has forgotten about customer service... at least in my little corner of the world.

Sam and I have decided to see what else is out there. I guess I should pause here and say that we are still moving ahead with IVF. My last post was a little confusing and I caused many of you to worry we were jumping ship. We're not. Full steam half steam ahead. We haven't made the decision to leave RBA, but their falling success rates plus the high costs have made us question our current path. We're looking closely at what Atlanta offers and also thinking about the surrounding states. Basically, our criteria at this point is: Beat RBA. We really, really love our doctor at RBA, so if we're going to leave a good, working relationship, it's going to be for something better. To us, better means lower cost and higher success rates, but it doesn't mean I'm going to sacrifice quality of care, at least not much.

But seriously, I feel like just about every fertility clinic could take a lesson in customer service. Is there a Chick-fil-A boot camp? My friend Em recently wrote a post that stirred up all kinds of interest about what makes a good patient. I'm here to admit that I'm an excellent patient when it comes to some things and a terrible patient when it comes to others. I'm EXCELLENT at keeping records. My notebook has tabs, it has charts, it has notes… I find blood work results faster than my doctor can flip through my chart. But I'm the first to admit that I'm a needy patient. Even outside of fertility treatments, I need to be reassured that my doctor checked everything. But I'm honest… I shoot straight with my doctor's. I tell them right away that I'm complicated. But if I'm about to pay you EIGHTY GAZILLION dollars for a procedure with approximately a 40% chance of success, I expect a little customer service, you know? Show me another profession that can treat me like crap and still expect payment!

How about some examples? One office has a "lovely" system in which 90% of the time, no one answers the phone. They simply ask you to leave a message. Now this office wins some MAJOR points for their low cost, and by low cost, I mean half of RBA... so I'm trying my darnedest to give them the benefit of the doubt. I left a message last Wednesday... I never heard anything. Granted, it was a holiday weekend, so I waited until later on Monday to lose my cool. I called again. Holy freak out, I got a person! But that person A- attempted to make me do a "new patient" consultation, even though I did one less than a year ago, and B- said they'd have to call me back to set up an appointment and NEVER DID. I'm trying my best to keep cool, and recognize that's it is a small staff, a busy office, and they could save me $8,000, BUT if this is the kind of service I should expect as a patient, NO THANK YOU. I'm needy, thank you very much. What if I was bleeding? What if I was confused about the six million medications? What if I had a reaction? Someone has to ANSWER THE PHONE or CALL ME BACK! It is totally possible that I could receive a personal email or phone number once I start cycling… maybe there is a secret number… but you'd think they'd treat me well enough to get my business in the first place!

Office number two, was mostly polite, and easy to deal with. Most of my frustrations were probably due to dealing with office number one only moments before. But still, I'm not a fan of hoops. I'm not a dog... I don't do tricks. Apparently the initial receptionist couldn't assist me... I had to speak with the new patient consultant. But the first lady told me to request a "Second Opinion" consultation, as it's FREE. New Patient Lady wasn't in (of course), so I left a message. She called me back to inform me that I can't do a "Second Opinion" consult if I know I'm coming for IVF... whatever lady. She then informs me that they can't file the consult to insurance if the consultation takes place over the phone. So I can either drive eight hours one way, to get my insurance to pay for it, or pay full price from the comfort of my home. Awesome. It's also interesting to note that I know for a fact that CCRM files phone consults with insurance... so this is a policy, not a law, just so we are clear lady. And in accordance with my "I don't do tricks" rule... schedule my stinking appointment without requiring my complete medical record be in front of you. I (the Queen of Medical Records), do solemnly swear to have them to you well before the appointment.

Are you still reading? Troopers, I tell you, troopers. Well, for your reading pleasure I present crappy service item number three. This actually came from my clinic, so boo to that. I've been pretty pleased for the most part with the office staff. They call when they say they will, they answer the phone, they offer me well wishes and hugs for good luck... so this was a little out of character. I called to request my medical records. I knew there would be extra steps... privacy laws and all that jazz. What I wasn't expecting was for the receptionist to FREAK OUT over the request. She wanted to know if I was leaving the practice, if I was seeking a second opinion, if I was quitting treatment. I tried to calm her down (though it is a possibility) by explaining that I'm the Queen of Medical Records... you see, to keep my title as such, and to maintain my "good patient qualities" I need this for The Notebook. She then explained that there are fees and such, and wouldn't I rather wait until I was "finished with treatment" so I could get the records all at once for free? Well, yes, I would... but you see, I'm not finished with treatment, and I may never be. I laughed and explained that treatment isn't ending any time soon, that I understand that I have to pay a fee for MY OWN records, and that yes, I'd still like them. She then said this, "I hope you aren't in a hurry; we're way behind on this. It'll probably be a few weeks!". I'm guessing that was her way of gauging my reaction; if I flipped out, I obviously needed them for something other than my personal enjoyment. So I played it cool. But I wanted to say, "no, no problem, I'll drive down and make a copy myself". Geez!

Basically, I'm frustrated. If I was about to buy a car, I could expect excellent customer service... they would woo me for that kind of money. But it appears to me, that fertility clinics assume that I am desperate for them, and that they can treat me as such. Well listen up, I'm desperate for a baby, not for you. There are about a zillion clinics out there... someone will meet my demands and do so with a smile and maybe even a "my pleasure".

End rant.

The Truth About IVF

So I know you've all been waiting with bated breath to learn about the IVF clinics across America. Before we get to that, I'll just say this: the more I learn, the more I'm frustrated and discouraged about this whole process. We hear things like "40% chance of success", but let me tell you, the reality of the situation is that not all clinics have odds like that. There are a LOT of clinics with 20% success rates of bringing home a baby. And then, there are clinics with 70% success rates. Not all IVF was created equal, I guess. And then there is the price difference. Let's not even get into the issue that some states have insurance policies requiring practically FREE IVF, no, let's just talk about the difference in price for out-of-pocket expenses: The lowest I found was under $7000. But I found several clinics in various states offering IVF with ICSI for under $10,000. And then there's the other extreme. There's the clinics that cost $14,000 and up... literally twice what others charge. Some places require lots of additional testing before they will accept you as a potential IVF candidate... all of that adds up. I know what you're thinking: "you get what you pay for". That's what I assumed too, but that doesn't seem to be an accurate assumption across the board. Resolve's website gives one explanation for the variations in cost stating, "in areas with few infertility clinics, prices, on average, are higher". I guess I can see that... supply and demand, right? It also appears to me that big cities, wealthy areas (like Atlanta) cost more. Except when that big city (like Boston) is in a state (like Massachusetts) that mandates infertility coverage. In those areas, prices appear to be more moderate. So let's take a look at that chart again, but this time with some numbers filled in. 

IVF prices include ICSI and any additional required fees.
*** No prices available ***

For those of you who picked a clinic, do you still feel that way? Those who responded to me all picked CCRM for their shockingly high live birth rate. But as you can see, that extra chance of success comes with a hefty price tag. The truth is that IVF alone is not all that outrageous at CCRM... really no more than clinics here in Georgia. It's the ODWU (One Day Work Up) that complicates things. They charge $4,500 for testing, regardless of whether you've had that tested before. Yikes! But it obviously works. Their odds were the highest I found, so the additional cost seems to make sense. I will say that regardless of the location, it appears that there is NEVER a sticker price... CCRM lists one set of prices on their website, but my dear friend Aubrey (who has her retrieval TOMORROW) has a different price list. We were driving ourselves crazy trying to find the discrepancies! I say this to assure you... we will pay more than we innitially agree to. There will be an extra test, ultrasound blood draw or medication that was not listed in the IVF consult... and we'll pay it because, what the hell, what's $200 more dollars in the face of a bazillion?

So yea, CCRM is expensive and efficient. Essentially for every $1000 you spend, you increase your chances by 3.2% (like how I do math? super real and mathy... my Calculus teacher would die.) But let's compare that to say, my clinic, RBA. $14,700 for a fresh IVF with ICSI. 2011 SART data puts them at a 34.8% chance of bringing home a baby. With that price and those odds, for every $1000 you spend, you increase your chances by just over 2%. RBA is one of the most expensive clinics I found, and yet, in my opinion their numbers simply don't justify the expense. But when I look deeper, I'm even more confused. The live birth rate took a nasty plunge in 2011. When I chose RBA, these latest numbers weren't available, but now I've got to ask what went wrong? Here's the live birth rate over the last several years: 

2011- 34.8, 2010- 40.5, 2009- 41.4, 2008-40.7, 2007- 44.3

In five years, the chances of any one cycle of IVF yielding a live birth dropped by almost 10%. The only rationale I can supply is that they have become much more cautious and serious about the number of embryos they put back. I get the feeling I'd have a pretty big fight on my hands if I wanted to do two embryos. 

Essentially, I have no point here. So yea, thanks for reading all my insights and special math skills. I'm just suggesting that this kind of sucks. No, it super sucks. Where you live (or where you are able and willing to travel to) totally dicates how much you will pay and what your chances are. We're not talking about a percentage point or two or a couple hundred bucks, we're talking double the odds and literally twice or three times the cost. There are HUGE differences from state to state and clinic to clinic in regards to IVF. No easy decisions here.

Petri Picking

Not to be confused with picking peaches, no, no… petri picking is the selection of whose well guided, super smart, extra costly hands will handle the petri dish that our future maybe baby will spend its first three to five days of life in. Now that we have confirmed that our original decision of IVF is the right one for us, we have to move on to the VERY difficult decision of selecting a clinic.

"Don't we have a clinic?" you ask. Yes, yes we do. And we love it: we love our doctor, we love our nurse, we love the facilities, we even love the surgery center (who likes surgery centers?). What we don't love is the price tag. I don't have concrete numbers yet, but I've heard $14,500 tossed around as the cost of one IVF procedure including ICSI. Add in the cost of meds and well, we're sitting at $16-18,000… for a chance at a baby. Gag.

A reader very sweetly reminded me after reading this post, that there are cheaper options out there. Ironically, my husband brought up the same thing. So now I'm forced to reckon with the fact that there are less expensive options… my doctor's sunny disposition may or may not be worth $10,000. So we've returned to the drawing board so to say. We're looking at EVERYTHING… cost, results, patient care, location, etc. There is a lot that goes into this decision, particularly when there is NO INSURANCE. No insurance means that every clinic is open to us… that's a lot of fertility clinics. We are of course looking very closely at what our state has to offer because, let's face it, it's convenient. When you're talking about 10-20 appointments, the distance between point A and B starts to matter more. But it's not the ultimate decision making factor. Many women seek treatment outside of their area. My friend Aubrey lives in Boston, but she is in Colorado right now for treatment. Others even look outside of the US for cheaper "vacation IVF" options.

The confusing, frustrating, overwhelming thing about this decision is the fact that every clinic is so different. Some offer discounts for prepaying for multiple cycles, some offer "low cost" options, some have statistics well above the national average, and some, well, suck. To demonstrate some of the differences, I've put together a handy little chart for your viewing pleasure. Three of the clinics are in Georgia… I've also added in some clinics from other states for comparison. It's a blind chart at this point. I want unbiased opinions simply on the statistics available (from SART). Afterwards, I'll disclose the names and prices associated with each clinic. And just for clarification, this is using my age group: under 35… the data is obviously very different in each age group.

Various Fertility Clinics SART Data- Bottom Row is National Average

What do you think? If you had to choose a clinic from this list, which one would it be? Why? What is the most important criteria to you? Do the numbers matter most or do you give higher value to the quality of care? Does it all come down to the money?

I'll be back to fill in the blanks to see if that changes any minds and to give you an idea of what our next steps will be in this process soon.

Eeny, Meeny, Miny, Moe

So now that we've all gotten the EXTREMELY hard decision of what to do about the end of Google Reader (which I never used) behind us, lets talk about making tough decisions… because sometimes eeny, meeny, miny, moe isn't the best decision making strategy (who knew?).

The husband and I have chatted about our next steps... probably a bit more than he really wanted to. But he was a trooper and we thought through as many possible "what if's" as we could come up with. So where do we go from here? Which of the options are we going with? Before we get to that, you'll need a little background information to understand our choices.

Way back when, some eons ago, when I was super amped up on Clomid, I attempted to make my husband think through all possible outcomes (i.e. what if Clomid doesn't work? whatever will we do?). I found this quiz that was designed to help couples ascertain what it is about a child that they believe will make them happy. The goal of the quiz is to help couples recognize that they may be looking for different things out of a child and/or fertility treatments. And yes, I did make him take the quiz. And yes, I did lie and say it was "just a few questions" rather than SEVENTY statements requiring a rating of zero to five. The quiz was moderately helpful, but more so was the conversation it facilitated. Sam and I are one of those couples who are looking for different things from fertility treatments.

For Sam, statements like number ten "I want a baby so my genes will be immortal" scored around a four or five. This indicates that a genetic connection to his child/children is very important to him. After discussing it further, we discovered that this statement is really true in regards to one child. He is completely fine with adoption, but it is important to him that he pass on his genetic traits to at least one child.

For me, genetics isn't so important. You may remember from this post, that I actually did not want to pass on my DNA when I was younger. For whatever reason, the idea of not seeing my green eyes, or high cheek bones reflected in my child's face is not, and never has been, a big deal to me. But for me, the desire, the reason I've gone through fertility treatments is because I want to carry a child. Pregnancy is a life experience that I've desired since I was very, very young. I want to feel a baby grow inside of me, I want to feel the kicks and punches, I want to hear the thrum, thump of the heartbeat, I want to experience birth, I want to feel a baby skin to skin just moments after birth, and I want to nurse my child.

So as you can see, we kind of come at this from two different places. We are both open to adoption. Adoption is part of our family building plan. But we both have a reason, though different, for wanting "our child". Now granted, we could both be made "happy" and fulfill our dreams by utilizing Sam's sperm, donor eggs, and my uterus... but I honestly don't know that we will ever get to that point. If we discover that I am in fact a "genetic dead end"or that my eggs are of such poor quality that our chances become pathetic even through IVF, well, then we would have to have a serious heart to heart. My ultimate desire is for a family, in whatever way, shape, or form it comes to me. I'm not sure that the pregnancy and birth experience is reason enough for us to spend $30-40,000 on IVF with donor eggs. Particularly if we didn't learn that donor eggs were needed until after we already spent $18,000 on IVF with my own eggs. It would simply take us sooooo long to come up with that kind of money, sacrificing the pregnancy and birth experience wouldn't seem that awful in light of knowing I could have a family more quickly via other means.

So where does this leave us? How do we make our dreams come true give our dreams a chance? For now, the plan hasn't changed all that much. We are still planning to pursue IVF. I say planning because we do have some hard questions that we want answers to before we move forward. But IVF makes the most sense for us as a next step. And here's why: adoption might bring us a baby faster, but we would still be turning to IVF later, when my body is older, when my eggs are older, when our chances are slowly but surely getting worse. As we don't currently know status of my eggs, it seems like a significant risk to place IVF on the back burner. Adoption is available for years to come... IVF may not be. So the plan is ONE IVF: meaning one fresh cycle, if we fail, we will systematically move through any embryos that we might have left over. If we make it all the way through IVF and any FET's that the fresh cycle yielded, we will move on to adoption. Once we have created our family, we may revisit IVF if that desire still exists. And if at any point we decide to begin the adoption process, we will move ahead with that, even if that is before we've completed the IVF part. What we will not do is leave embryos on ice... we will utilize all of our embryos until we fail at each and every one, or we successfully bring home a baby, even if that means that adoption and IVF bump into each other and we have multiple babies enter our family all at once.

So there you have it: the plan. I'm sure to those of you who are not going through infertility, it seems crazy lengthy with lots and lots of extras... but if anything this journey has taught us to dream big, but to plan for the unexpected. We try to think though each and every possible outcome so we don't find ourselves shocked or overwhelmed by this crazy ride. Our next steps include deciding once and for all where we are going to cycle (more info on this soon), and selecting a payment method. So kudos to us... we have eliminated options 1 and 5 from the lengthy list. But we still have LOTS of decisions to make and LOTS of information to gather. So look out for more news on our decision making process!

Genetic Dead End

Have you ever wondered if you might be a genetic dead end?

Before we go any further, I want to pause. Please read this with an open mind and an un-sensitive heart... I know that for many of you, this might actually be something you have thought about A LOT... Please take this post for what it is: the thoughts being mulled around in my head as we look ahead and look behind. Also, if you're considering or are using donor eggs due to DOR or POF, I understand that this might be a super sensitive subject. But honestly, I'm not really even thinking along those lines... this is more to do with bad genetic code than poor egg quality/quantity.

Okay, so with the disclaimer out of the way... lets embark on a little trip, Magic School Bus style, if you will, into the dark, deep reaches of my mind. Ready, go.

I'm beginning to wonder (umm, maybe wonder more) if our IUI's fail us because of something dark and ominous... bad genes. Hang in there with me for a minute. We've had four "textbook" IUI's. Sure, there have been things that I've pointed at and said, "that... that could have been better", but ultimately, our doctors have loved my response to medication, we've always had "big, beautiful" follicle(s), I've always had a lining within the clinic requirements, we've always had a post wash count over the recommended amount, it's always been "perfect" and yet, not one BFP. Not one. So as I sit here with a very empty uterus and a trash can filled with pregnancy tests with one ugly line, I have to wonder "what has gone wrong?"... and "is it fixable?"

I'll tell you now that this isn't coming from dark place of "woe is me" or depression over the failed IUI. I'm still doing pretty well... I'm just thinking. I feel like this is all good stuff to think through before we officially hand over a check for a car, a down payment on a house, $18,000. So the way I see it, we could have a few options for what has gone wrong (you can let me know if I've left something off): poor egg quality, poor fertilization, bad DNA. Sure I know there are other things... but I feel like the surgery proved that there is nothing preventing implantation, that my tubes are open, that my uterus is normal... the little things are getting checked off... we're zeroing in on some game changers (and game enders).

For some strange reason, the diagnosis of infertility was actually not the first time I thought of this. I was a weird kid... I remember telling my mom in middle school that I thought I'd adopt because I wouldn't want a child to have my genes... I'm sure she thought I was the strangest twelve year old alive. Who thinks of that stuff? But as a middle schooler, I had become convinced that my family was way more messed up than other's... addiction is RAMPANT in my family, I saw all of this awfulness, equated it with the gene pool, and decided I didn't want to put a child through that... at twelve years old. As I've aged I've learned that genes don't determine everything... I'm not an alcoholic, a drug addict, etc. There is a component of choice in all of this (thank God, or I'd be doomed). But I do find it strange and a little ironic that I wanted my DNA contribution to end some fifteen years ago.

Was my wish granted? My thoughts on where we go from here are too long and convoluted at this point... that's another post entirely. But as we talk, make plans, peer into the future, I can't help but wonder if this is all for naught. What if Sam or I are balanced translocation carriers, what if the combination of our DNA yields death every time? What if he or I are meant to be genetic dead ends? Something to think about... We could get all the way to and through IVF only to learn that our DNA is just not compatible... that we cannot support life. I've asked about tests for karyotyping and such before, but I've always been assured that it is only needed if you suffer from reoccurring miscarriages or if IFV fails multiple times. Am I strange for wanting to know now, rather than later?

Have you ever wondered about this sort of thing? Was I the strangest kid in the world? Would you do all you could to find out this type of information before IVF?

I'll be back at a later date to discuss our next steps and "the plan".