Huh?

Is that an actual question?

After the ectopic pregnancy was, as they call it, “resolved”, they scheduled us for a follow up appointment with our fertility specialist.  We went in not knowing exactly what to expect, but eager to find out our next steps to parenthood and making a plan.  I’m a big fan of plans. And, not a fan, when things do not go as planned.  So, needless to say this whole experience is not really working out for me. Haha.

Of course the appointment began with the well timed head tilt/how are you doing question which both together leads me to start balling every time.  What is with that look?  It just says “Awwww, you’re pitiful.” and automatically makes tears appear in my face where they have not been for a while now.  Especially when I go in there pretty optimistic and determined to make it through one appointment without casually sobbing in her office.  There’s something about that 45 degree angle head tilt that just messes with you.

*Side note.  Do you think she does that to every patient?  I mean, she is an infertility specialist.  So she only deals with sad trying-to-be-moms every day.  Is your head on a constant gangsta lean of pity all the time?  Or is it just because my scenario is particularly pitiful?  Or do you have a bet going of how many tears you can garner in one day?  Just curious.*

Anyway.  The appointment itself went fine.  Asking how I have been feeling since I got the go ahead to go back to my normal routine after the treatment.  Adding back in all of my vitamins, and an additional 800 mg of folic acid to build back up my reserve. Eating normal foods again, and not having to restrict myself to basically anything with no nutritional value.  Which is fun for a few days, but after essentially living on donuts and french fries for a couple of weeks you genuinely want to order salad three meals in a row.

Then we started talking about next steps.  We were kind of mentally doing IVF already.  Since our initial pre-op appointment for IVF was scheduled for March 3rd, we had determine before the ectopic that this was our best option at this point.  For those of you who are a little more novice regarding the wonderful world of fertility treatment here are some definitions for common treatment options for fertility issues:

Clomid: Clomid is a medication you can take to help you ovulate; to treat either not ovulating at all, ovulating too early or too late, or just irregularly.  It is often prescribed for women who have been diagnosed with Polycystic Ovary Syndrome (PCOS) which causes hormonal imbalances and can lead to difficulty getting pregnant on your own.

IUI: Intrauterine insemination is when you insert sperm into the uterus to increase the number of sperm that make their way into the fallopian tubs and subsequently increase the likelihood of fertilization.

IVF: In vitro fertilization is the process of extracting eggs, retrieving sperm, and manually fertilizing the eggs, then inserting the embryo back into the uterus.

While we discussed all possible options we ruled out Clomid and IUI based on our personal circumstances and history.  We knew I wasn’t having issues ovulating, nor were we having issues having eggs be fertilized based on our previous pregnancies, our issue was maintaining.  So, Clomid wasn’t necessarily going to help, but could lead to multiples based on the hormone increases, and multiples by nature are risky.  And since I was already deemed high risk, it didn’t seem like the best route.  IUI wasn’t going to help us since we had been able to fertilize eggs at least three times before February and therefore, and based on our tests we didn’t have sperm count or motility issues.

Based on that, IVF was the option we decided made the most sense to us.  With that, we also opted into Preimplantation Genetic Screening or PGS as part of the process.  PGS is when they take a tiny sample of cells from the embryos created during IVF to test their health.  Chromosomal abnormalities lead to about 60% of miscarriages.  (By the way 15% of known pregnancies and up to half of all pregnancies end during the first trimester.  It is so much more common than most people realize, but certainly does not make it suck any less.)  Since we have had the barrage of tests and have been determined to be “healthy” people with no known cause for infertility, our doctor feels pretty confident the losses were based on the embryos being abnormal.  Ectopic pregnancy, not included because that was a whole different animal. But PGS will ultimately allow us to implant an embryo that we know is healthy, and has no abnormalities which would likely lead to miscarriage.  This doesn’t mean miscarriage is not possible, it always is, but we believe doing the PGS is the best shot of a successful pregnancy for us.

Of course, this isn’t covered by insurance, unless it is determined that you or your partner carry specific genes they want to test for, which we don’t.  They typically won’t cover it.  We’ve already submitted it and had it denied.  And even after one of my infamous strongly worded letters of appeal, was still denied.  So we have to shell out between $2500 and $5000 for the testing.  It is based on the number of embryos they test.  They charge you for the average (7-8) at $3300 and give you money back if you have fewer to test, or (YAY! lol), bill you afterwards if you have more.

~Note:  I am BEYOND lucky that I am (A) employed and that (B) the insurance coverage at my employer is great, and that (C) the vast majority of any medical costs for ART (Assistive Reproductive Technologies) are covered. So, while I know many women and couples who have had to essentially take out a mortgage to do IVF, we are very grateful for what is covered by our insurance and privileged to be in that position.  While shelling out maybe up to $5000 for the testing is certainly a financial hardship, and something we have basically decided we will “find a way” to figure out, we know that in the scheme of costs associated with this shitty thing called infertility, ours is really nothing to complain about.  And being in a position where we can somehow cover the costs outside of what is handled by insurance is certainly a lucky one.  It’s nice to find the *luck* in a dark situation.

So, anyway, we made all these determinations in January after all of our tests were concluded. And in February were giving it our “last shot” of getting pregnant before we introduced science into the equation.  So, after the mess that we went through during that pregnancy, our plan was mostly just reinforced.

But, that was what made it upsetting when the doctor said “while having a miscarriage doesn’t technically make you more likely to have another one (I knew that part), having an ectopic pregnancy does make you more likely to have another ectopic (I knew that part too), and there is no research to prove that using IVF actually reduces your risk for an ectopic (WHAT. Didn’t know that part.)

I was pretty shocked to hear that.  To me, we were taking the guessing game out of it. No worry about when you’re ovulating, will the sperm get to the right place, will it travel in the right direction, etc., etc. We are just taking the healthy embryo and putting it exactly in the place it is suppose to be, problem solved right?  Nope.  Apparently not.  Theoretically it should reduce the risk, but there is no research showing that. So, after we legit signed our lives away on pages and pages of paperwork, similar to a mortgage which makes sense based on how much this all costs, the doctor just says casually , “So, do you wanna keep your tube?”

And it was like a 1980s DJ record scratch (yeah, kids, back in the day DJs actually used records to play music, look it up). Anyway, I was really caught off guard by the question itself, but also the casual nature.  As if she was asking me if I liked watching TV. Like, would you like to rip out one of your medically necessary for pregnancy body parts?  The doctor actually apologized for how it came out.  But when she explained it, I did understand the question.

My ectopic pregnancy was discovered in the ovary, so I never considered there being an issue with my tube.  But, what she explained was that most ectopic pregnancies happen in the tube and often because of tube related issues.  So, even though it looks like mine ended up attaching in the ovary, it was likely caused by the tube.  She described the tube as having tons of tiny little hairs that should be pointing the embryo in the right direction, but if there is a section that is pointing in the wrong direction then that could cause ectopic pregnancies in the future.  Or if there is an scar tissue from the last one, that could have the same result.

Causes of an Ectopic Pregnancy:

• An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked.
• Scar tissue from a previous infection or a surgical procedure on the tube may also impede the egg’s movement.
• Previous surgery in the pelvic area or on the tubes can cause adhesions.
• Abnormal growths or a birth defect can result in an abnormality in the tube’s shape.

So, I am actually going in this week to have a test which is described as totally comfortable and not painful at all (LIES).  They will put a little camera in there and take a look around to determine the health of the tube.  The idea of removing it is absolutely terrifying to me.  It would be a real surgery with real recovery time.  But also the idea of just not having one of my baby making parts feels awful.  Technically you can still conceive in the future naturally (in theory) with only one tube.  But is, for obvious reasons, less likely.  If I am being honest with myself, once we do IVF once successfully (because I am thinking positively here people!) we would likely do it again for a second pregnancy-If we have enough healthy embryos to do so.  So, the tube wouldn’t necessarily be a required component, lol.  But STILL.  If I can avoid a major surgery I would like to.  But, having gone through an ectopic pregnancy already, I know the shittiness of that journey and if that can be avoided that would be great too.  Actually removing the tube removes the majority of the risk of an ectopic during IVF or a what they call a spontaneous pregnancy. But I definitely don’t want to do that without knowing whether that would be necessary or not.

So, I am getting the scan done this week.  Taking lots of antibiotics to preemptively ward off any infection and hoping that she takes a look up in all my business and sees no reason to do any surgery.  I’d appreciate all the fingers crossed for that result.  In my head, if it is not absolutely required, I would likely want to give the IVF a shot once before any surgery.  But we will let the results of the test determine how we proceed, and hope for good, none-slice-and-dice results so that we can proceed with the IVF cycle starting in May as planned.

We have crossed the threshold in this blog from talking in the past tense mostly about things that happened in the recent or somewhat distant past, to discussing the present tense.  That is actually a little scary, to be honest, but here goes nothing!

Also, apologies for my delinquency in posting this past week.  There is this thing in higher education we call Maprilay.  It is the absolute insanity of events, work hours, and obligationss covering the end of March, April, and beginning of May which results in the months merging into one big blur of work and not really anything else!  And it got the best of me this week. But we are coming up on the conclusion of this mad time period in my profession, because: