Friday, August 10, 2012

The Question I Didn't Ask

I've struggled with how to write this post. It's more personal than most of the things that I write about here but Peanut told me the other night that someone else might benefit from what I've learned, so here goes.

We've been struggling to have a baby.

I'm 31, and we've been married two years. We turned our lives upside down last year to put ourselves in a position where we felt we could start a family - we moved across the country, we bought a sensible sedan, we bought a house. Everything fell into place - except that when we started trying to conceive, it didn't seem to be working. I began charting my temperatures in the fall using the Taking Charge of Your Fertility method, and it was evident right away that something was, indeed, wrong.

I was lucky to have my doctor take me seriously after failing to conceive for only 6 months - usually at my age, they make you wait a full year. But I showed her my charts and she did some tests and determined that I have polycystic ovarian syndrome - PCOS. I actually skipped that chapter in Taking Charge of Your Fertility, because I lack every other defining symptom: I'm not overweight, I don't have acne or excess hair growth, thinning hair, sleep apnea, insulin resistance. I simply...don't ovulate. Which, you know, is kind of important to that whole babymaking process.

The doctor recommended medication, which devastated me. I had a vision of a natural, medication-free birth outside of a hospital and I sort of felt like I wouldn't "deserve" that if I couldn't even get pregnant without intervention (not to mention that it may not even be available to me if I wind up having a high-risk pregnancy - which now seems more likely than ever). I hinted at this back in March when I was first diagnosed, but after doing a lot of thinking I agreed to try the medication.

According to my charts, it hasn't made much of a difference. When I started, my doctor told me to try it for four or five months and if I didn't notice an improvement (in cycle length, in temperature consistency, in achieved pregnancy) to make an appointment with her colleague at the in-office infertility clinic.

Which I did. When I called to make that appointment, she said fairly offhandedly "Does your insurance cover this?" I said I thought so - after all, they covered the first medication and all the tests I'd had up till now (I mean, theoretically - this is a high deductible insurance plan, so so far this year, they haven't covered anything - but everything I've paid out of pocket has been applied to the deductible which means it's "covered"). She advised me to double check, so two weeks ago I did.

And.

The health insurance that I so carefully researched last September/October, knowing that I would be attempting pregnancy this year, does not cover infertility treatment of any kind. The medication I'm currently on skated by because it is more commonly used to treat something else, but the second medication - the one that's more "sure fire" to produce pregnancy - would not be covered at all. Nor would any more intensive procedures, like IUI or IVF - procedures that frequently cost in the many thousands of dollars for each round.

It's a simple matter of a question I didn't ask, because I didn't think it would apply to me. And here are some other questions I didn't think to ask at the beginning of the process:
* How long are we willing to keep trying to get pregnant?
* What about medication that causes really bad side effects to me and/or increases our risk of multiples?
* Which invasive and/or higher-risk procedures are we willing to try - especially now that we will have to pay for them entirely out of pocket?
* Would we go into debt to have a baby?
* How much do we tell other people about what we're dealing with? How do we handle the subtle pressure that friends and family might be putting on us if we decide to keep it quiet?
* How do we handle the strain this is putting on our relationship, or the emotional effects it's having on me? (After all, I'm the one that's "broken".)
* How do we handle learning of pregnancies in our friends and family?
* What do we do about health insurance now? Should we switch again at the next open enrollment session? CAN we, or is this now a pre-existing condition that won't ever be covered by anyone?

The reason I write this post is that my answers to these questions might have been quite different last summer, before I'd invested a year of hoping, dreaming, and unpleasant side effects into the pursuit of starting a family. I should not have been so cavalier as to assume that infertility would never happen to me, especially as the rate of incidence of PCOS and other hormonal imbalances is drastically increasing among my generation*.

The question you don't think to ask can affect almost any situation in which your finances are involved. Having a baby is perhaps one of the most emotionally fraught situations, but think about things as simple as "What's your return policy?" or "How does this apply to me?" or "Is that the best you can do?". One thing I have learned from this is to now always, always ask the question that seems silly to ask - especially if I initially brush it off with "oh, that'll never happen to me."

Note: I will probably not write much more about our infertility experience, even as it relates to our finances. Even an anonymous blog is not totally private, and we have been keeping our situation very quiet in real life. If you have specific questions, please feel free to email me, but not to worry - this blog isn't going to turn into an infertility or a mommy blog at any point!



* I have my own theories as to why this is, namely, hormones in our food, plastics that leach BPA, and rampant hormonal birth control use. It would seem to follow that confusing our bodies' natural hormonal signals can't help but affect the way they function longterm. But that's a topic for a totally different blog! (And, probably, a team of research scientists.)

16 comments:

  1. Oh gosh, I can't imagine how hard this has been for you guys. I assumed that I would get pregnant on the first or second cycle and that did NOT happen. It seemed like it happened for everyone else, so why not for us? My problem was different than yours--I have a VERY short luteal phase for some unknown reason the doctors can't figure out. I decided to try some "natural" remedies (herbs, teas, eating foods high in vitamins that promote fertility) before I did medication, and it did help. I was prepared to start acupuncture for fertility (it was expensive, but cheaper than the medical tests they wanted to start running on me) the next month but then I happened to get pregnant.

    Your theory is probably similar to mine...I completely agree with what you're saying. I have a good friend who has PCOS and like you, the only symptom she had was that she doesn't ovulate. I will NEVER get back on hormonal birth control again....I think that made my situation worse.

    Good luck....I hope positive news comes your way soon.

    ReplyDelete
    Replies
    1. I do wonder about all the hormone disrupters in plastics and the use of them in animals, and I have been steering clear for about five years (since I was 25 and became pregnant with my first daughter). Canned food is absolutely banned from my home.

      I don't know about birth control pills though. I started them at age 15 to help my horrible periods and took them every single day until I was 25 and I became pregnant immediately with my daughter. Perhaps they effect everyone differently?

      Delete
  2. Oh ... *hugs*

    I don't have any answers for you except huge empathies again. I'm already "broken," so much so that I don't even know if we can or dare try, as I've mentioned and it's ... tough. Especially as I wasn't the one who hugely wanted children in the first place so I actually feel a little bit of guilt over being the one holding up the show in more than one way! I want the choice, though, really I do.

    Yet, somehow despite my own feelings of brokenness, I don't feel like a huge hypocrite in saying (I know, if you do feel that way, you can't help it to some degree) you really shouldn't look at it as you being broken. You're not, it's just ... a thing. My fingers and toes are crossed for you.

    **hugs**

    ReplyDelete
  3. Even though this is not something I ever struggled with (I have two beautiful daughters), I still appreciate you posting this. Sometimes I can get caught up in life and take my blessings (and I mean, all the blessings, kids, husband, parents, friends, house, career, health) for granted. Just reading this makes me realize how blessed I am and it gives me compassion for others.

    My best friend struggled to get pregnant while I was pregnant with my first and it was hard for me, but she handled it like a champ and was so supportive and loving towards me. If it ever bothered her, she never let on. Thankfully she got pregnant with her first (she used a fertility drug, not sure which one) about two months before I conceived my second.

    Bless you and I'm hoping your experience the joy of pregnancy soon.

    ReplyDelete
  4. Oh my, that's got to be rough. I'm so sorry.

    In all seriousness, if so-called Obamacare is enacted, won't insurance companies NOT be allowed to look at pre-existing conditions? Has that kicked in or is that more of a 2014 thing?

    I certainly hope you're not struggling at that point, but I do have a tiny bit of hope that THAT barrier won't be a problem in the future (while you're still young and can benefit). I suppose your other option may be to get on a medical plan through work, even if it's more expensive (assuming one of you has that option) - I don't think they can exclude you if it's an employer plan.

    I hope you can take notes and fill us in later on, when it's a less painful subject.

    ReplyDelete
  5. Thanks so much for sharing, and I'm sorry to hear that it's been a difficult path for you. I don't know that I want to have children, but I fear that I will struggle getting pregnant if I do (some infertility conditions have a hereditary component to them, and that doesn't bode well for me). I certainly have never thought to ask such questions, but I certainly will if we ever do start to consider children. I hope y'all find a way or some luck.

    ReplyDelete
  6. My sister and I both have PCOS (minus most of the telltale symptoms, just like you mentioned). Hormone regulation has been a serious problem for both of us, and while I didn't have any trouble getting pregnant with my son, my sister and her husband struggled for years. Once she finally did get pregnant, she was able to conceive a second time with no problems. I won't annoy you with a bunch of platitudes about the right time or the right medicine - I will just say that I'm crossing my fingers for you both.

    I know this was probably very difficult for you to share but I'm glad that you did. Hugs to you!

    ReplyDelete
  7. I'm really sorry LMM. You and Always the Planner seem to be going through similar difficulties at the same time. I know that while right now I don't think I would be devastated if I later found out I couldn't conceive, I can imagine how that might change in reality a few years down the track. Hugs to you and Peanut.

    ReplyDelete
  8. I'm so sorry :( I can't imagine how this would feel. I have never tried to have children but it's always been in my plan to have a family and I couldn't imagine what it would feel like if I couldn't.

    ReplyDelete
  9. I think it was very brave of you to write about your struggles. Although I write anonymously a lot of my good friends read my blog and I struggle to write about things like this. Some things are private and painful and you simply aren't ready to share them with people around you (even your loved ones). So kudos to you for opening your heart to your readers. I wish you the best of luck! It took us almost a year to conceive and although I don't have PCOS I can totally relate to your struggles. Just wanted you to know that you are not alone!

    ReplyDelete
  10. This comment has been removed by the author.

    ReplyDelete
  11. Good on you for writing this post, though I understand that you likely won't say much more after this. I'm experiencing my own sub-fertility (a term I much prefer over infertility) right now (for a different reason), and it's always nice to hear other womens' perspectives. While I completely understand the reasons so many couples decide to keep mum about their experiences, I also wholeheartedly believe that EVERYONE would be better served if people discussed this sort of thing more openly and honestly.

    I got pregnant at last summer at age 33 in the very first month after my husband and I stopped preventing - something that shocked the pants right off me, actually. Unfortunately, that pregnancy did not end well and I underwent a D&C in the early fall, then started trying to conceive again in December. But month after month...nothing has happened. Like you, I chart my temps, monitor cervical fluid, time sex, etc, etc, and know that I ovulate beautifully, and yet...nothing. My doctor humored me and ran some tests after our 7th unsuccessful month and it turns out I'm dealing with Diminished Ovarian Reserve.

    While my OB and the RE I saw subsequently both assure me that it IS possible that I could get pregnant on my own, they recommended that I try a fertility drug, but after lots of thought and talk with my husband, we've decided to hold off for now. It's what my gut tells me to do, though I of course reserve the right to change my mind.

    Like you (and MOST women in America), my insurance does not cover infertility treatments. It covers diagnostic testing and will cover the treatment of the underlying cause of infertility, but no advanced reproductive technologies. In my case, there is no treatment for the underlying cause.

    All that said, here is a little piece of hope for you: My very best friend has struggled with PCOS for her entire adult life. She almost never ovulates naturally and never experiences a period. On two different occasions, she's used multiple rounds of ART in an effort to achieve pregnancy, and never once has succeeded. However, several months after both of these instances (over 5 years apart), she went on to conceive naturally and now has 2 sons.

    I wish you the very best of luck - PCOS is no joke, but there are many, many, MANY stories of success out there and I hope you'll be adding your name to the list soon. :)

    ReplyDelete
  12. I am so sorry. I'm going through the same thing (and I'm 31 too). I don't have PCOS, all they have been able to tell me is that I have high FSH levels.

    It is hard keeping it between just you and your husband. It is hard to tell someone. I ended up telling my mom when the drugs I was on made me crazy emotional.

    It is hard to know how long to try, we haven't quite put a date on when we will look into adoption, but it is an option we will take if we have too. We are just not willing to give up yet.

    My only advice is to be as open as possible with your husband. I feel like the broken one too and we had to work out a way of talking and dealing with everything. I still feel like crying every other day (and often do) but I have to accept that it is okay to be sad. We have slowly told more people and I finally came clean on the blog recently and honestly it has helped. Though many people don't know and I don't want them to know either.

    I have my third transfer the end of the month (hopefully). If it doesn't work I'm going to go to a Naturopath and taking a break from the drug induced IVF world. You may want to see if that is covered in your insurance. I'm doing acupuncture right now and it is helping me de-stress.

    Good luck and feel free to email me alwaystheplanner@gmail.com if you ever want to talk about it.

    ReplyDelete
  13. big hugs..

    i'm sorry your insurance flaked on you.. please dont beat up yourself thinking you shoudl have researched htis or done that.. you have no way of knowing this would be in pipeline. the bottom line is we can only make decisions based on what we currently know at the time.

    if you are looking at natural rememdies, books by susan weed and rosemary gladstar can be really helpful. Esp. the first author.

    Goodluck!

    ReplyDelete
  14. So sorry to hear this, LMM. I often thought while reading your blog that all signs seemed to be pointing toward you and Peanut starting a family, and I'm so sorry to hear about your struggles. I hope that whatever options(s) you and Peanut choose, that it ends up being the right thing for both of you. I have many friends who have struggled with infertility and have taken many different roads--there's no right way for all couples.

    Alotta Lettuce--glad to see you posting somewhere, although I miss your blog terribly! I am so sorry to hear that you are still hurting, too.

    Bonnie

    ReplyDelete
  15. I'm so sorry to hear about this! I've had your post open on my browser for days and days wondering what I could possibly say. Just know that I'm here for you if you need anything, even just to chat...I want things to work out beautifully for you and Peanut.

    ReplyDelete

Thanks for commenting!