Last week I promised the gravy and never quite got around to it because my family came down with Ebola and I was too busy with Hazmat Fun Week to write. So finally, here are the fine print details on last week’s clinic consult and all of the cycling news that has happened since then.
Sorry, right number
The 2.5 hour drive to the clinic was pleasant. We had a wonderful time chatting about any and everything under the sun. We made it to the psychiatrist’s office just a few minutes late, thanks to the office being given the same building number as a restaurant about a half mile away. We knew we were in the wrong place when we pulled up at Big Boy’s Burger Barn. A call to the office and instructions from the receptionist to "just keep driving and look to the right" got us to the correct location.
I’m not crazy, but the midget who lives in my right ear is
The psychologist was very sweet and specializes in infertility marriage counseling, among other things. She explained that first she would spend some time talking with Mia and Urs, then with me and Frank, then with the four of us together. While she was in session with Mia and Urs, she had me complete a 200-question personality inventory. By the tenth question, it was apparent to my mostly unpsychologically-trained eye that it was mostly geared to reveal any tendencies towards alcoholism, drug abuse, and suicidal thoughts. Probably also some paranoid schizophrenia just for good measure. I couldn’t help but laugh at some of the weirder questions, though: I sometimes get junk mail that I wished I never received. My favorite sport to watch on TV is the high dive. I sometimes hear voices that other people don’t. Everyone is out to get me. I had to rate how much each statement did or did not apply to me. The voices in my head were telling me to bubble in VERY TRUE for all of the statements that pertained to alcoholism, but I promised them a few sniffs of cocaine and a fifth of vodka if they would just shut up and let me finish the darned questionnaire. But seriously – it seemed like the test was easily decodable, therefore easy to lie on and make yourself appear to be St. Theresa, if you so desired. Everything went smoothly with the whole psychological consult, and we were all found to be sane, or at least the same type of crazy. The doc said she would type a formal report to send to the clinic, but would call immediately to let the RE know that we were psychologically sound and prepared mentally and emotionally as individuals and as a collective group for the surrogacy journey.
Lost in Translation
I’ll refer to our RE as Dr. Sleepy; his lively, animated personality is anything but sleepy, but his real name falls in the same vein of all things related to deep, deep slumber. After a brief intake and chart review with the nurse, the four of us were ushered into Dr. Sleepy’s office. He started with a brief introduction of himself, then launched into a sudden sermon about how difficult we have been. Literally. I think we were all immediately put-off, but the more I listened, I got the feeling that he came across much harsher than was his original intent. I honestly don’t think he intended to be harsh, at all. Given his uncertainty with Mia and Urs’ English language capabilities, I believe that he oversimplified what he was trying to communicate and unintentionally rubbed us all the wrong way. The gist of what he was trying to say is that we are a unique case because 1.) this is a surrogacy, 2.) the language difference, and 3.) the time zone difference between the clinic and Mia & Urs throws wrenches in scheduling phone calls. He just wanted to establish from the start that email communication between M&U and the clinic has been more successful than phone communication, so we should mostly rely on email in effort to help avoid some things being lost in translation. I was actually impressed with his desire to smooth out communication kinks and get everyone on the same page.
If I had to choose one word to describe the RE, thorough would be the one. After Thou Shalt Email was established, Dr. Sleepy explained that he always starts his consults by explaining how babies are normally made and how babies are made via IVF. In our case, he would also explain how babies are made via gestational surrogacy. Given our subfertile and infertile histories and the fact that I’ve gone through IVF twice and Mia four times, this was definitely unnecessary information. We humored him and all leaned into listen intently as he whipped out three or four Xeroxed diagrams which featured various angles of the male and female reproductive systems.
I quickly felt myself developing a dangerous case of the giggles. Dr. Sleepy went all ESPN football coach on us when he took out his pen and began marking the diagrams as he talked-
In a normal conception, this is what happens: HERE are the ovaries (big X’s). Normally, a woman of prime childbearing age produces 6-8 follicles per cycle on each ovary (6-8 written under one ovary). HERE are the fallopian tubes (oval, oval). Of those 6-8 follicles, one will grow better than the rest and we call that the lead follicle (big circle on one ovary). That follicle ovulates and an egg is swept into the fallopian tube. When sperm (scribbled oval with a tail) is introduced into the body through the cervix (pointed out with the pen), they travel up through the uterus (squiggly line upwards), one will meet with the egg in the tube (X on the tube) and will be fertilized. Then the fertilized egg will continue traveling into the uterus and will burrow itself deep into the endometrial lining (scribblescribblescribble).
And so on. He was so enthused and so precise with his explanations and scribbles that I couldn’t help but imagine him jumping up and shouting "TOUCHDOOOWWWWN!!!!" I had to bite down on the inside of my jaw to keep from laughing.
After we learned about how HOLY MOSES! people really can get pregnant without a doctor’s involvement, he spent some time talking with Mia and Urs about their fertility history, losses, and relevant diagnoses. This part was also a tad frustrating, because Mia and Urs had spent the better part of December translating Mia’s 4-inch thick medical files and had faxed them to the clinic early January so that he would have the chance to review them before our consult. It was apparent that Dr. Sleepy had spent little time reviewing the records. He quickly explained that though some translations were there, it was still difficult to get an overall feel for the heart of the issues and he knew he would be more effective with Mia and Urs there in person to help him gain a better understanding. I was also impressed with his efficiency – Mia and Urs hand-walked him through the major relevant details and pointed out the related documents in her file. Dr. Sleepy made quick work of it and was able to quickly come to the conclusion that he agreed with their previous doctor’s diagnosis of immunological problems.
He also threw in the nugget that he didn’t necessarily agree with their former RE’s assessment that those problems were unfixable and that Mia would never be able to carry her own pregnancy. He quickly dismissed that and said that given the history, he did agree that surrogacy was probably what would guarantee the greatest chance of success. Urs had him back up to the point of "I believe I could get you pregnant." I was glad that he did because if it were me, I would want to know what Dr. Sleepy thought he could do differently than the old doctors. Sleepy explained that he would have added Lovenox and some other tweaks to Mia’s protocol. Mia & Urs explained that they had tried that with IVFs 3 and 4. Dr. Sleepy said there are other techniques he could do that probably hadn’t been done, but after the mention of the unsuccessful Lovenox treatment, Mia and Urs didn’t need to understandably didn’t want to hear any more. Besides, it’s not just a matter of getting pregnant, it’s a matter of staying pregnant.
Finally Dr. Sleepy said folded his hands, grinned with those brilliantly Zoomed-white teeth and said, "So when did you guys want to get started?" In perfect unison, the four of us said, "Now." Earlier he had made mention of Mia doing a Clomid Challenge Test, which had my guts in a bit of a twist because that would have pushed us back at least one cycle. Thankfully, he immediately said, "Great! So let’s just skip the Clomid Challenge and do Day 3 blood work, instead. Your cycle should start in the next 1-2 days, is that correct? Wonderful! You can have your Day 3 blood work and ultrasound done while you are still here and we can definitely get you guys started right away and transfer around the end of March. How does that sound?" Why, it sounds quite nice, Mister Doctor Sir. Thankyouverymuch.
Dildocams for Everyone!
After our Go Team Go! huddle, we broke off into two exam rooms – Mia and Urs in one and Frank and me in another. Dr. Sleepy took a count of Mia’s resting follicles (5-7 each ovary, good for 37 years old), then came to do my saline sonogram. Usually exams don’t bother me too much, but Dr. Sleepy seemed a little rough in the nether regions. Stretch, stretch, stretch Your cervix is set far back! To the nurse: I’ll need the larger speculum (read- MY! What a big vagina you have!). I could have died. Finally he got all the cranks and gears set in their appropriate places, blew me up with the saline, and pointed out on the ultrasound screen that my uterus is free of polyps and other implantation-thwarting growths and my ovaries look great for having PCOS.
We had another post-fiddle huddle with Dr. Sleepy and then met with Cari, our WONDERFUL nurse coordinator. We got some tentative dates for cycling and the transfer and also began to make arrangements for ordering the meds. Later a nurse took a thousand vials of blood from Mia, Urs, and me for our FDA-required infectious disease screening. Then we sat down with the financial coordinator, and that was sticker shock at its finest. Approximate dollar figures of course had been previously discussed, but understandably it was a bit heart-stopping for Mia & Urs to see it all spelled out in black and white.
It had been a long day; from the start of the psych consult to then, we had been going non-stop for 7 hours with barely 30 minutes of rest. We were all tired and hungry, and the build up rehashing their troubled past added to the financial cardiac arrest took a bit of a toll on Mia. We finally left the clinic, and in the parking lot Mia had a bit of a well-deserved moment. Tears borne from a blend of frustration, gratefulness, anxiety, and hope sprung from Mia’s eyes and she just fell into Urs’ arms. He was so caring, and it was apparent that he is her strength, the glue that holds the parts of her infertility-fractured heart together. He muttered something in her ear, and within moments she was smiling and laughing again. We all hugged and took a collective cleansing breath.
We made our way to the beach and took a refreshing nighttime stroll, and by the time we were finished, we were all laughing again. Earlier the psychiatrist had recommended a fabulous little local restaurant and we decided to stop there for a leisurely dinner. It was the perfect ending to an exhausting day and we spent our time chatting excitedly about their return in March.
The Game Plan
Since Mia and Urs left on the 6th, we have managed to get a lot of the particulars squared away. Now there’s not too much else left to do other than take care of a few details and wait for March. I start Lupron in five (5!!!!) days and Mia will start a week later. I take my last BCP on the 24th (thank God) and my period is expected to start about 4 days later. Assuming that it does (and Mia’s also shows up as expected), transfer will be either on the 23rd or the 25th of March.
Mia and Urs have already booked their tickets. They will both fly directly into the clinic’s city so that Mia will not have to make the 2.5 hour drive between here and there every 1-3 days. Mia will arrive March 6 and Urs, who has to come later for work reasons, will follow on March 18. Mia and Urs have booked a beach front 2 bedroom/2 bathroom condo for the month. Mia’s first appointment is March 7 and she will tentatively start Follistim that day. After that, she will not have to be seen again until the 12th, so she will drive here and stay with us March 7-11 (yay!). I’ll drive up to spend the next weekend with her, then a few days later Urs will arrive. Frank and I will drive up the night before transfer. Frank will come home after the transfer, but I will stay in the condo with Mia and Urs to complete my 48 hours of bed rest with them. Then we’ll all come back here and try very hard not to obsess over every twinge in my body.
It has not escaped my attention that because they are staying until the 30th, Mia and Urs might still be here
if when (positive thoughts, and all that) I get two pink lines. If the approximated dates work out, I will be 5dp5dt the day they leave. With Baby M, I had ghost lines by the evening of 3dp5dt, faint-but-definitely-there lines by 4dp5dt, and a positive digital and a beta of 24 on the morning of 5dp5dt. I am a sick, sick puppy and I already have a stash of over 40 pregnancy tests. How I would love to be able to send Mia and Urs home with a plastic baggie of positive tests. A little gross, considering they will have been dipped in pee, but wow – what great souvenirs those would make.