#failing

I don't tweet, or twitter, or tweeter, or twit. (And no, I don't know how to conjugate this new pastime correctly.) But I'm fairly certain that #failing lets everyone know that myself, a place, or a thing has gone horribly wrong. Now what you are supposed to do with the information from there, I have no idea. But essentially, this particular hashtag could describe my life. Yep, I'm failing at life.

Now of course there is the super obvious ways I'm failing: failing at conception, failing at pregnancy, failing at motherdom, etc. But this goes WAY beyond that. Do you ever think about all the things you should be doing? Do you get overwhelmed? I do. I've never understood how I could possibly be even mediocre at everything, let alone excellent. Take for example the grocery store. Seems simple. Buy food. Take it home. Cook, eat, repeat. But man, oh man, it's SO MUCH MORE COMPLICATED. See, I know, for instance, that I'm supposed to eat healthy... organic fruits and veggies, hormone free milk, free range chicken, grass-fed beef, etc. But there's another whole side to the grocery store and that's called the budget. The current budget barely supports chicken, let alone chicken for SIX DOLLARS PER POUND. The budget does not have room for organic everything. I'm not saying that I don't understand why organic is more expensive, (just ask Erika, she's dealing with the world's largest worms) I'm saying I can't double the grocery budget to allow for all of this stuff AND save for IVF at the same time (well, I guess I could, but I'd also be forty by the time we got there). You see what I mean? Something has got to give! Either the budget's happy with all the processed goodness that coupons can buy or the body is happy with all the healthy quinoa, tofu, and organic eggplant available. It can't be both.

Let's look at another example, shall we? So yea, we should all exercise. Mm, hmm.Yep. We all agree. Apparently we should exercise for 30 minutes FIVE days a week. Blaghh! I'll skip the eight hundred reasons I haven't exercised lately (rain, more rain, 100% humidity, no gym membership) and be real honest... I'm lucky if I get the dishes washed. Actually, my husband is lucky if I get the dishes washed. Between work, the other work, researching IVF like it's a full time job, and just regular boring old life, I'm normally "done" for the day at about 8pm at which point I can decide to A- go exercise, B- go wash dishes, C- do a load of laundry, or D- say to hell with it all. I pick D a lot. There's a pile of laundry on my couch that's been there since Monday (shhh... don't tell my mom).

I'm not really trying to gripe about my life... life is really great these days. I'm just struggling with the idea of sucking at adult life. I was really, really good at pre-adult life. My mom may argue, but I'm pretty sure I ROCKED as a baby. And I'm confident I excelled at childhood. My teachers loved me, I loved school, I was awesome at everything (except sports, but hey, nobody's perfect). I was pretty awesome at college too. I wasn't stellar at the extracurricular part of it... no sororities, no clubs, no stereotypical college stories to reminisce over later in life, but academically- nailed it, athletic participation via spectatorship- yep, all over that, finding the love of my life-check. It's this whole grown up thing that I'm not sure I'm cut out for. Balancing the checkbook, sticking to the budget, cleaning house, laundry, preparing meals... I'm failing at that stuff. Adult life seems to be all about restriction and worrying about everything. Got to get rid of all plastics because of BPA, got to get rid of all non-stick cookwear because Teflon might make me more infertile, got to recycle and buy green cleaning products because we've got to save the earth, got to use crazy expensive/less effective health and beauty products because of all those chemicals, etc. Adult life is all about cholesterol, and BMI; 8 hours of sleep, and staying active; saving for retirement, and paying off debt. #failing at all of the above

And you know what the kicker is... I don't even have any kids. I'm fully aware that my mom friends are infinitely more busy and tired than I am. And why wouldn't they be? They have an additional mouth to feed out of the same budget because no one gives raises for expanding your family. And they have to worry about sleep schedules, BPA free bottles, organic baby food, and cloth diapers. They've got to deal with carpool, and daycare, homework and reading logs. I'm failing at my small, little, unfit for Twitter life, and yet, I'm hoping it gets a whole lot worse. 

Anybody #winning at life these days?

Rain, Rain, Go Away

I'm interrupting your previously scheduled slate of monotonous details about my uninhabited uterus and what we plan to do about to bring you breaking news:

It's Raining in Georgia

I've been really careful over the last few days months of rain in good ol' Athens not to complain... I mean it's rain, it's not the end of the world. And I'd rather have rain than be in jeopardy of losing my house from terrible fires like in Arizona and Colorado. Or poor Texas who has been in the worst drought since the Dust Bowl for what seems like forever now. But it's come to a point that I simply can't take the rain... and I LOVE rainy days. L-O-V-E them. There is nothing better than an afternoon nap during a good rain storm (well, yes, there is something better... it's called snow, but Georgia doesn't know what that is). But really, enough is enough.

I'm fairly certain that it has rained every day for the last month, maybe longer. If by chance we managed to escape the day without rain, I'm fully confident it rained that night. It's rained when the Weather Channel says there's currently a 0% chance of rain. My backyard looks like the Okefenokee Swamp moved in. Literally. And with the swamp comes swamp like characteristics like MOSQUITOES. Poor Sam, mosquitoes love him. Even Sterling's getting bitten. It's to the point that my floor is just wet and muddy at all times... our very own slip and slide. So fun. It's time for the rain to end... at least for a day or two. The ground is fully saturated. If I could pipe this stuff out west, I would, but as I can't, I'm just asking for the rain clouds to share the wealth, you know?

 Let me show you some evidence of this weather phenomenon. First up, my yard. We live in a little duplex and the owner promised to cut the grass... score! As we don't currently have a lawn mower (it died in Augusta), this was great news. Sam was never too on top of grass cutting, so I'm cool with the once every two weeks status quo... unless two weeks of grass growth leaves me with a JUNGLE! Seriously, it's insane! There are some paving stones that make a sort of walkway from the door to the driveway... I can't currently find them. Every morning and afternoon I have to wade through this green grassland in heels, dress pants, etc. It's not pretty. And because you don't believe me, I've included a photo of the madness. The car in the right corner is my 4-Runner... grass is getting dangerously high. We may have to off road it before too long right up to the front door.

The Jungle: I estimate some areas to be well over a foot in the backyard

And last night Athens experienced the storm of the century. Unfortunately, I was driving in it and I was far more concerned about surviving the white water rapids coming down Broad Street straight at me to take too many photos, but I assure you it was intense. Cars were swerving left and right... anything other than SUV's and trucks were seriously in jeopardy of flooding. I kept remembering that there's some rule like "don't cross moving water of more than 5 inches" or something like that... hahaha. At the bottom of the hills, with water rushing in from both directions, the water was cresting the bottom of car doors. In some places it seriously looked like rivers... with rapids. Add in cars and trucks creating some massive wake, well you get the idea. I did manage to snap a picture at a red light of a waterfall. Athens doesn't really have any waterfalls, until now.

Athens' newest attraction:
Who knew you could go rafting down Broad Street?

So yea, breaking news. The forecast calls for rain every day until the world ends. I've also decided that this may be (in part) my fault. You know how your period will start as soon as you leave the house wearing white pants with no tampons in sight? Yea, well, it will rain, A LOT, as soon as I set foot outside with my TOMS on. And you guys, I love my TOMS. They are the ballerina style, so I feel like I can get away with them at work, but canvas shoes do not do well in the rain. I have to park about a ten minute walk away from my office... needless to say they are pretty damp by the time I find shelter. I'm starting to worry that they may disintegrate… or rot. Sad day. So yea, it's raining in Georgia… again.

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.

Is It Worth It?

Tonight, after spending way too long doing simple addition, subtraction, and long division for the setup of a new monthly budget, I'm struck by this question: is IVF worth it? I know what you're thinking, "didn't we just go through this? didn't I just decide that we are moving ahead with IVF?". Yes, and yes to both of those. And honestly, this has less to do with the dollar signs (though I did swallow frequently to keep the vomit down) and more to do with my broken heart.

One thing about this "community" that I've become a part of via the internet and this little ol' blog is a real, genuine level of care and concern for the people who find themselves stuck in the same boat as us.  My heart literally breaks when one of the girls that I've come to know and love comes to another bump in the road, experiences another failure, loses another child, etc. I can't count the number of times I've read a post from a fellow infertile to find real tears streaming down my face. It sucks to go through this. It is literally the worst thing that I've ever had to deal with, but it's incredibly difficult to watch others that I love go through it as well. Some days, I'm so, so thankful for the company, thankful for the friendship, thankful for the support, but most days, I'm begging the Lord to let my friend off this roller coaster. I've never met more deserving women of the name "mom" than I have through my blog.

I've said this before, but I'll say it again. When I first heard the diagnosis of unexplained infertility, I never, ever dreamed we would need IVF. We just weren't that broken. Sure, I talked about the what if's… I wanted to make sure my husband knew that I was ready to go the distance if the need arose, but I didn't believe it would. Not for us. However, I, like so many people, believed that if the need did arise, it would work, because IVF always works. The thought that IVF might fail was inconceivable. And then I did my research… 40%… 40% chance of success for any one IVF transfer. Which means that there is a 60% chance that IVF will fail (at best). 

We get crazy excited about 40% odds because our odds have been so incredibly crappy before, but really, IVF only gives most couples twice the odds of a normal young couple (for one month)… for the price of a car. I remember hearing that within three cycles (IVF or FET) 80% of couples will succeed. Those are better odds. Sure, three cycles could cost upwards of $30,000, but 80% is pretty decent odds. So I settled back in my belief that IVF works for almost everyone. And those that it doesn't, surely it's women in their late forties, or men who had vasectomies, or some other crazy story… it's not regular, beautiful, healthy, vibrant young couples. But over the past couple of years, I've learned that all too often it is the beautiful, the young, the vibrant, the healthy couples who fail over and over again.

I remember telling my doctor my fears of failing at IVF. I was trying my darnedest to convince him to do further testing like karyotyping and natural killer cells… pull out the big guns now. He didn't bite. He asked where I was getting my information. I told him my friends. "You know that many people who need IVF?" he questioned. I explained that I blogged and by opening my little corner of the world up and telling my story I had come across countless women with stories of IVF failing. He shrugged off my concern. His words, not mine: "women on message boards are the most severe cases". I didn't take the time to explain the difference between a blog and a message board, nor to explain that his rationale meant that I must be a severe case. He's wrong, but I do get where he's coming from. His thought is that the women who turn to "message boards" have been at it longer… therefore, it's safe to assume that more of them will have failed.

Regardless of whether my friends suffer more losses and failures because they are the "severe" cases or not, my friends are hurting. It sucks. Today, one of my favorite ladies, Aubrey, got some really awful news. She just finished her fresh IVF retrieval from CCRM, arguably the best IVF clinic in the country, only to hear that only two of her eggs fertilized. I literally do not know what I would do if I received that phone call. But Aubrey is so strong (she's from Boston after all)… within moments of hearing the news, she made the decision to go again. Aubrey has been down this road before. She's been kicked when she's been down more times than anyone deserves. CCRM isn't her first choice, it's her "last" choice, it's her last hope of conceiving and carrying a child of her and her husband's making. She's thirty years old… thirty, not forty-five. This was her fifth egg retrieval… not her first rodeo. She has not been one of the 80%, and my heart breaks for her. Tears literally streamed down my face as I read her blog today.

The saddest part is that Aubrey is one of many. She is not alone in her feelings of failure… this is something nearly every woman dealing with infertility faces, but I think it's different after an IVF failure. IVF is supposed to work. Another friend is gearing up for her sixth transfer after she completes some additional tests. How can this be? She is a young, beautiful, smart dentist… this shouldn't be this hard. She has endured so much in this journey already, but she's not giving up. And then there's my friend, Suzanne; her story is particularly touching. Suzanne is also headed to CCRM in the coming months for a donor egg cycle. She recently had a crushing blow when her long awaited IVF cycle at her "local" clinic yielded only two eggs, neither of which survived long enough to be transferred.  Talk about a tough blow. Suzanne is so loving, tender-hearted, and caring, yet she is also tenacious… she deserves her miracle.

And there are so many others. Literally too many to list. My blog roll is FULL of stories that regularly bring me to tears. I'm not surprised any longer when IVF fails one of my friends, but I am still broken-hearted. My frustration and anger on their account is white hot some days. They have sacrificed so much to be mothers… and they are asking for one. None of them believe they will go on to have a large family… they are giving everything they've got to bring home a miracle. And in the midst of my fury, my frustration, my sadness, my mourning, I question "why do I think we will be any different?". And obviously, on some level, I do believe that. For whatever reason, I am clinging to the belief that IVF will work for us, or I wouldn't go down this road. But why do I think our situation will turn out any differently? Hear me when I say this, I desperately want a child, but I do not deserve one any more than Aubrey, or Nikki, or Suzanne, or Kimberly, or Emily. IVF is not an easy choice. It's a long, stressful, expensive journey that brings a chance of a bring home baby. The question "is it worth it?" has to be answered (sometimes again and again) long before the outcome is known. 

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!