Two Surgeries & Some medication 2009, part 2


Stepping into real time for a moment:  Wednesday morning, on the twelfth day of the twelfth month of 2012, I am going in for my twelfth egg retrieval.  That’s got to be good luck, right?  Here’s to creating some beautiful embryos and then freezing them; all previous IVFs we have put what are called ‘freshies’ back in. They’ve always been grade A, and yet the embryos either didn’t attach to my uterus or I had a chemical pregnancy.  I suspect that this is because of the altered state my body is in directly after the stimulation, no surprise considering what my body and I go through. Freezing is something we haven’t tried yet, and I suspect THAT will be the trick.  Here’s to lucky number twelve!

And now for Two Surgeries & Some Medication 2009, part 2

I often think of the movie “Requiem for a Dream” when I think of the ritual of taking of drugs, and the actual reaction of my body to drugs. As already mentioned, I am sober for many years, as somewhere along the way I developed an allergic reaction, to put it mildly, to what started out as recreational drug taking. And so it’s a highly sensitive thing for me, to put drugs in my body that I know are going to change me.

But let me give this some perspective:  a pre menopausal woman who is healthy ovulates an egg every month.  When going through fertility efforts, the goal is to force exponentially more follicles into growing into eggs before forcing them to ovulate. Force is likely a violent word, and while I’ve begun to look at the drugs as my friends, I am highly cognizant that I am forcing my body to do something unnatural.

I was warned of the side effects of Follistim, which include weight gain, irritability, night sweats, and insomnia.

The ritual of taking these drugs carries qualities that if someone isn’t already OCD, she may become addicted because of the repetitive qualities of the actual act:

Open the Follistim Pen, put in the cartridge, consult the ledger to be reminded which side of the belly the drug went into yesterday, deduct prescribed amount from the size of the cartridge (which comes in 300, 600, 900 plus some undetermined amount of overflow).

Disinfect my abdomen on either right or left side, depending which side it went into yesterday, making sure to have disinfected the top of the cartridge upon putting into the pen-like device.

Twist knob to control how much the dose is; for AI it vacillates between 150 and 225 (I would later learn that the dosage goes up as the prescription increases for IVF efforts).

Apply needle, and then first twist off big needle cap then remove the smaller one.

Squeeze fat of abdomen slightly and put the needle in.

Press on the dosage amount, which releases the fluid into the body. Keep fat of body squeezed and once the inserting is done, keep needle in for around 5 seconds.

I of course keep it in for 10, because the drugs are so intense that everything seems to me like it’s in fast forward and keeping the needle in for 10 seconds will counteract the fear that I’m counting way too fast.

Once dosage is in, I carefully would remove the pen and needle, and now take large needle cap and twist on before pulling off the actual needle.  Put into the disposal needle kit.

If you’re lazy and have beautifully manicured nails that could get chipped by opening the disposable container that the pharmacy has provided, perhaps you throw the needles in the trash – like I, on occasion, did and do.

Then it’s time to calculate today’s dosage in the calendar, and make note of which side ‘took’ the shot.  Then back to the produce section of the refrigerator the Follistim cartridge and medicine and case goes, as it a perishable medication.

The actual FEELING the drug gives is pretty gnarly.  On one occasion, I described the feeling moments later as if I could hear a dog barking 3 miles away; my shoulders tense up and raise immediately.  I feel the medicine rushing through me, and course through my blood stream.  I have to actually remind myself to breathe.

I was already an insomniac, I theorized some residual effect of my earlier drugs years, and now I experienced increased restless sleeping.  I would sweat profusely after only minimal exertion.  My already overweight body would get extremely bloated.  And yet I was highly optimistic, and incredibly determined.

Once Dr. T believed the follicles were ready, I had two; he prescribed an HCG shot ($52.94), which triggers the follicles-now-turned-into-eggs into ovulation.  I had done this on previous AIs as well so was somewhat familiar.  The shot had to be given to me by Craig in my butt, at an exact time determined by Dr. T.  The reason for the exact time is that within 36 – 41 hours this medication will force the eggs to drop, and the doctor had to make sure the sperm could get to those eggs before that window closes; the procedures would be scheduled accordingly.

I would have to remove the exact portion of saline water from its bottle, drop it into the vial with the powder, and then swirl around gently until everything was mixed.  Instructions were very specific that this medication could not be shaken, so of course I was hyper paranoid that any wrong activity would stop the medication from working and thereby disrupt the mission I was on.  Once all of it was mixed, I would pull all of the medication out into the 3cc syringe, switch that needle with the 25.5 needle, pull my pajamas down, and tell Craig exactly where to shoot it: at a 90 degree angle – after he had disinfected the area with an alcohol swab.  (I had gone into the doctor for the previous HCG injections.)

He was so nervous the first time, which I thought was funny, as by this time I had undergone 2 surgeries in that year alone and for that past week daily shots; my belly had bruises all over it; for me, it was just another necessary step, and I didn’t have time to flinch.   Even when blood came out after he removed the needle and swabbed the area, I pulled up my PJs nonchalantly, with a sense of real accomplishment at having done the next step, as prescribed.

This cycle’s AI #1 and AI #2 followed, with Craig producing his specimen at home, and then him rushing from our home in Venice to the doctor’s office in West LA, where he would drop me off with the sperm in a brown paper bag that also held any necessary consent forms, before he would then proceed to work in our shared vehicle. I would turn the specimen in at the pre-designated appointment time, usually around 7:30 AM so that Craig wouldn’t miss any work, which meant I was typically the first patient and on a few occasions arrived before any of the staff.

I would wait for 1-hour for the sperm to be cleaned to get the best swimmers, and then be guided into the doctor’s office at which point the doctor would ~ like in all other AI appointments I’d had by this time ~ confirm that the sperm was Craig’s therefore mine by checking name and birthdate, and then insert it into my vagina with a catheter.  Once complete, I would wait 20 minutes often with my knees to my chest to invite those beautiful little sperm to find my egg, before I checked out at the front desk (approximately $560 for the sperm cleaning and the Artificial Insemination at this office), and then walk over 3 long blocks to the bus stop which included walking under a freeway overpass, which was always pretty gross, and then take 2 buses home.

And the day of my 2nd AI, we would have sex, too, and then that night, begin inserting a medication called Progesterone into me vaginally, that was meant to decrease chance of miscarriage.

20 days later, unfortunately my period arrived.  I was sad and of course highly disappointed, but simply picked up the phone and made an appointment with Dr. T for Day 3, once again.  We went straight into another cycle, which meant approximately another $1,000 in medication, since I had some left over, plus of course the costs for the doctor visits, the sperm cleaning, and the bus fare.

A complete week of Follistim at 150 a day, followed by 2 AIs and sex on both days, and I started the Progesterone again, this time one day early.

It had been 20 days since the last day of my last period, and I had a little blood spotting when I wiped.  I guess I thought it might be my period, but it didn’t actually come that day.

Or the next day.

So on July 9th, 2009, I took a pregnancy test that came up positive.

Over the moon.  Through the roof.  Elated.  Happy.  Grateful.  Thrilled.  I was beside myself with happiness, and scheduled an official blood test with Dr. T’s office the next morning.  And low and behold, a total of 12 AIs, at least 10 tries of sex timed to ovulation, 2 surgeries, countless ultra sounds and doctor visits, and almost $15,000 later, I was pregnant.

And we could not have been happier.

Two Surgeries & Some medication, 2009 part 1



In January of ’09 Craig and I were told to get to the hospital in Santa Monica at around 5 am; it was cold and dark; Dr. B was to perform a surgery in which he went in through my belly button to remove the cyst, since the birth control hadn’t made it go away this last time.

I remember the doctor came into the tiny hospital room and that he was dressed impeccably well for that early in the morning, and that he smelled good.  Yes, I am the type of woman who forms a (harmless) crush on her OBGYN.

He asked whether the nurse had marked me for the surgery yet, and when I answered no, a little confusedly since I didn’t understand the question, with no ceremony at all he lifted up my gown – under which of course I was naked – and with a black felt pen circled the area on my skin over the right ovary.  I mean, I know he’d seen my vagina before, and that within an hour he would have me under drugs with only a napkin sized paper blanket over ‘it’ – to give the illusion of privacy, but at this stage I was still very guarded when it came to my privacy and sexuality.

Funny, I think if I were writing this before everything I’ve gone through, which would of course be impossible, I’d have written ‘my privates’ instead of vagina.

The next time I remember seeing him (I guess the anesthesia worked its wonders), he went over the notes of the procedure, to let me know that the cyst had been successfully removed, and to alert me that I had what’s called Endometriosis, a condition in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other regions of the body, causing pain, irregular bleeding, and possible infertility.

Infertility, a word so very vulgar, it might as well be 4-letters to a person who wants to be a parent.

He also mentioned something that he’d seen in my uterus, of which he’d taken a biopsy, which later came back negative.  However, at that time, he did not see either of these findings as deterrents, and so we moved forward with another AI.

By this time I had spoken to enough people about fertility efforts.  I had many friends who had babies, and one friend in particular who had struggled severely with fertility, but was by now mom to 3 little boys, and with 1-surgery behind me, I decided to take their collective recommendations and seek Acupuncture with an LA-based specialist.  On the consultation he checked my body fat and pulse and recommended that I stay away from sugar as much as possible (harder for me to actually do than to quit serious drugs, it turns out), drink special teas that I would have to boil daily in a special clay pot, and come in for weekly treatment.  I was willing to do anything, and even though I had lost my well-paid position at the end of 2008 – due to the collapsed economy, I increased the fertility budget and did as he suggested.

My first consultation with the Dr. including the teas was $337, plus the clay pot at $30.  Between appointments with the head doctor ($162), the plan was for me to see a member of his staff (for $107), and also buy more tea ($32).

And once again, after AI, natural sex, coupled with herbs and acupuncture, I got my period that March.

I sat crying in Dr. B’s office very confused and upset as to why I wasn’t pregnant yet.  He suggested I see a different doctor, who called me that evening and introduced himself simply as David, and I made an appointment for us see him.

The very next morning, Craig and I went for a consultation with Dr. T at his West LA clinic.  Instead of what I considered the standard protocol in which a nurse comes to get the patients and guide them into the fancy doctor’s office, I recall he came out to the waiting room to meet us wearing scrubs and invited us in.  I was surprised when he sat down opposite us at his big oak desk, as I had presumed he was the nurse (as had Craig).  I immediately liked him.

He gave us a kind of 101 course on how a woman gets pregnant.  He flipped through images on a computer to demonstrate the different stages, while a screensaver behind him flipped through images from his own life, including pictures of his child.  He asked us at one point if we were of Ashkenazi descent, and I told him my Jewish father was from Vienna, Austria, and that Craig was Catholic.

Craig didn’t understand the term and with furrowed brows asked him to repeat the question, which made me laugh.  Actually, the only reason I immediately understand was because I had a friend whose pregnancy tragically had to be terminated around 20 weeks because she and her husband both carried the gene that comes from Ashkenazi Jews that causes a disease called Tay Sachs.  (Later, she and her then husband would adopt three children from two different countries.)

Then we discussed next steps, which included an ultra sound on day 3 of my next period.  “I’ll see you on day 3,” has become the most uttered phrase during this process.  Apparently on day 3 the ultra sound shows necessary details of the uterine lining and allows clearer visibility of the ovaries where the follicles are developing.  In addition, the blood levels of Estrogen and woman’s Follicle Stimulating Hormones (FSH) are best tested on day 3.

The consultation with Dr. T was $315.

I returned on day 3 for a saline induced ultra sound with him, and he immediately saw something that he said was possibly obstructing my ability to get pregnant.  He suspected it was a fibroid in my uterus, but wouldn’t know for sure until he removed it.  He introduced the situation as this: He could either go in vaginally and try to remove it, a process which would require a few hours in a nearby hospital and several days of recovery, or he could cut me open to ensure that he could definitely get to the suspected fibroid, which would necessitate about a month of physical recovery before we could even try again. We agreed that doing the lesser invasive procedure would be the smartest.  I imagine I took a deep breath and then scheduled the procedure for late April.

In the meantime, I returned to the Acupuncturist to get more tea and a treatment and told the doctor that there was a possible fibroid in my uterus, and then he proceeded to practice what I perceived as a sort of voodoo over that area of my body.  And it really bugged me; that I told him such basic info before he acted as if he knew exactly where it was and exactly how to treat it.  He said he would ‘loosen it up so that it would come out easily during surgery’, and then and there, I became incensed about this particular guy’s approach to acupuncture.  I was embarking on a scientific journey and wanted pictures and graphs and statistics to guide the way, not a hunch that somebody had. I purchased the tea that early April and took it as prescribed that next week, but never returned to his office for another treatment or more tea.

On the day of the Hysteroscopy (the inspection of the uterine cavity by endoscopy through cervix, not to be confused with the Hysterosalpingogram x ray test in ’08) it was time for another IV, my 2nd that year, and I remember the nurse fumbled around to find my vein.  I showed her where the nurse found my vein during my January surgery, but still – there was painful poking and prodding and she had to send another nurse in.  I think it was a guy; I don’t remember, as I was too involved in the socks that they had provided with those treads on them; what a great invention these little hospital booties are.  Do you know the ones?  I have quite a collection of them now….

(As I looked up the exact definition of Hysteroscopy, it struck me when it said ‘through cervix’, that this surgery could have been the reason that my cervix was later weakened, deemed ‘incompetent’, the scientific reason for my baby’s premature birth and death. And upon telling this to my husband just now, 3 years after the fact, he said, “What do you want to do, sue him?”  He was serious.  Not knowing whether we’d have a case, I think, if only that would change anything….)

I don’t remember going under but I do remember waking up to Dr. T telling me that he had removed a HUGE fibroid from my uterus during the surgery, that he couldn’t believe he had successfully done it vaginally, and that IT was the reason I hadn’t gotten pregnant thus far.  I was certainly enjoying the left over drug effect; as a sober woman at this time for over 3-years, I had grown pretty excited when I knew I was going under again and looked forward to taking the pain pills – as prescribed of course.

But the words he uttered broke through loud and clear: the obstacle getting in the way of me being pregnant had been removed!!!

I called Craig and let him know; he was thrilled! And then my friend Claire picked me up from the Santa Monica Surgical Center, after which she took me to fill my prescriptions – since Craig was at work – and then drop me off at home.  I was lucky to have a friend who could help us by picking me up; my medical appointments had turned into a full time job, and we needed Craig to keep his as we continued our efforts.

I began to look forward to my next period with great excitement and anticipation, as on Day 1 I would make arrangements to visit Dr. T on Day 3 and have him check me out, meaning have him do an ultra sound and look carefully at my ovaries and uterus and take blood to make sure my levels were where they were supposed to be, before we took our next steps.  In late May I saw Dr. T, who confirmed my uterus was clean and ready for next steps.

He said that he was going to put me on Follistim, a highly aggressive follicle stimulant, much more advanced and aggressive than the earlier used Clomid, with the purpose of creating more possible eggs that would then be fertilized by Craig’s sperm.

That medication alone cost $1,249.71!  It was only sold at special fertility pharmacies, and me, with Craig at work across town in our shared car, had to figure out a way to get the medication. In addition, the medication had to be kept refrigerated or it would go bad.  Fortunately, as mentioned, I was a producer and quickly formed a solution as to which two buses I needed to take from West LA to Westwood, and then home, with my medication being kept safe and cold in a medical, portable cooler-type bag.

The medication was to be taken every day for around a week, with periodic visits scheduled to monitor the growth of these follicles, before we would do the trigger shot to release the ovaries.

To be continued…