Birthday pleasantry-

Today has been so laid back. I cleaned. I played with my son. I bathed him, fed him, cuddled him, and chased him around the sitting room. Sometimes there is so much perfection in simplicity. I spent so many years waiting for a birthday like this. We've had a ton of firsts this week- first hair cut, he started walking across the room, he figured out how to climb on stuff (god help us), and we stopped formula during the day.

Yesterday I got very little sleep. V decided he would rather stay up all night than rest (a result of weaning I think), and I was just exhausted. I ate 5 breakfasts- waffles, cereal, more waffles, french toast, and finally eggs over easy. I was in carb heaven. For whatever reason, when I'm sleep deprived I just eat and eat and eat. The only non-breakfast food I ate yesterday was some manicotti with zucchini wraps to replace the shells. I did get my jog in though (after a cat nap).

The scale was still nice to me today despite all that... I don't know how, but it was: 174 lbs- 5 more to go until I'm "overweight." I'll probably pay for all that tomorrow though... or in the coming weeks. I'm sure the birthday cake isn't going to help haha.

Mmm, CAKE.

We aren't really celebrating my birthday until this weekend. I have a free meal coming my way from one of my favorite restaurants (BD's Mong.olian BBQ) that I look forward to every year. What can I say? Free food calls to me. Plus, being a picky eater, this restaurant just gets me. Pick your own ingredients from the buffet, even spices/sauces, have them grill it in front of you? It's great. Anyway, we'll go out to eat, maybe window shop (Although we'll probably get something for V, because I seem to do that everywhere we go). The one thing I hate about having a winter birthday is the limited places I can go- I'd love to go to my favorite park or the zoo, but it's going to be frigid this weekend. I've had 28 years of experience with this though, so I think I'll survive! ha

Oh, and today we finally got word about A's request for a raise to compensate for the insurance increase- it was approved. THANK GOODNESS! That is such a HUGE relief. Things are starting to look a little better about this new insurance now, although the increased co-pays still frustrate me... but, no sense dwelling on it right now.

It's been a pretty wonderful birthday so far. I'm going to make homemade pizza later, and we'll probably watch a movie, V will tear up the sitting room again, and by the end of the night I'll settle in to cuddle him to sleep. That's my favorite part of the day: reading him his favorite book and snuggling until he passes out for the night. It's our time. When he gets older and starts sleeping on his own, I am going to miss that so much.

Answers and planning-

We heard back about a few things.

First of all- no infertility coverage. But no surprise there.

Lovenox... I've been freaking out about this. If it was still a tier 4 we would have to pay $250-375 a month for it, wheras our old policy it was $100-150 a month. In other words, if it was still a tier 4 we would be looking at Heparin or putting off TTC... possibly indefinitely. They told us that it is a level 3 though (thank goodness) so the generic would be $70 a month- if what they've told us is correct. We will need to recheck this, and I want it in writing, but it looks like it will be cheaper under this new policy.

PIO injections however will be going from $10 to $40 for a months worth. Still, it could be worse.

We still have NO idea what our premium is going to be... it's supposed to come out of our next paycheck, and we still don't know how much we're going to be out next month. To me, that's just unprofessional. I'm sorry, but we need a little more advanced warning than mere days to rework our entire budget. The only possible bright side here is that DH had asked for a raise to compensate for the increased premium- and they haven't outright turned it down. So there's still hope that we might be able to get that to offset the costs. I'm not too hopeful, because I know how these people work, but it's something.

Our fertility clinic used to code things so that we could get coverage, like ultrasounds were for PCOS (which let's be honest, isn't an outright lie. Coding is a tricky thing.). They no longer do that, so absolutely everything is coded as infertility. No coverage whatsoever. We paid out of pocket for the blood work recently, and we'll be paying all out of pocket again. This isn't new to us, I had to do this with my first OB and my first RE. Still, it was nice to have a little help while it lasted. I'll always be grateful for that.

So, I need to call next week and figure out how much my TSH draw will be (that's coming up on the 7th) and we'll need to figure out about when to schedule our next consult with our new RE. I'm still hoping we'll get in with Dr. M, but we'll see how that plays out.

As of right now, it looks like we'll still be moving forward. I'm still having issues with my birth control pills and this new brand isn't any better. Part of me wishes I could just stop the damn things now, because this bleeding every other week is getting old. I still have about 1 week left after this pack, and then we have 4 weeks of a brand new pack. These ones don't have a week of inactive pills, it steps the hormones down so there are only two actual inactive pills, and this has me both confused and concerned. I don't know how beneficial these will be for hormone regulation with their wonky hormone ratios.

I just don't know.

I have started to consider things to put in motion when we start TTC. While the odds of us conceiving quickly are pretty low, I don't want to move forward without planning for it. My old RE, Dr. J, seemed to think getting another SCH may very well be inevitable. She said that she hopes that if we do, next time it will be smaller, but I am at pretty high risk for it. Yay me. I won't be able to stay on strict bed rest this time around though (not with V running around), but I can plan for restricted activities and plot ways of making things easier for is. I'm thinking freezer meals, both for the oven and the crockpot. I've never really done much in that way, so if anyone has advice or websites, hit me up in the comment section. I just remember how bad things were last time- as much as I love my husband, that really didn't go so well. While he did try to cook for me using my recipes, it was almost always a disaster. Bless his heart for trying though! We bought way too much fast food last time, and we can neither afford that physically or financially this time.

I've only told my online friends from my support groups, readers of this blog, and my best friend about our plans. My husband's boss might know now though, given his inquiries about insurance issues. Otherwise, I still plan to keep things under wraps this time. Granted we did that last time too- we didn't start talking about it until after the first miscarriage. I really don't want anyone's opinion, or criticisms, or expectations though (they really do think I'm not infertile anymore, like I have a magical combination/cure, which is crazy-pants.) If it works, we'll talk openly about all the planning and everything, but I'd rather not deal with people this time around.

It sounds like I'm not really planning for the more obvious result- not getting pregnant or carrying to term. But honestly, there isn't much to plan for there. I grieve. I learn to cope. I keep trying, whether it's biologically or through adoption. We'll enter the new year with a new resolve, and do what we can. Taking the hits as they come and rolling with the punches.

Part of me feels like this year is a training session, you know? A re-entry into the world I spent immersed in for so long. I've slowly started frequenting the infertility forums. I've looked back in my notes, my blog, remembered where we came from. I've slowly been allowing myself to picture us doing this. I've made baby steps back into the clinic. We've started the process, and we're taking it one day at a time. I guess I don't really expect much from this year, other than a reawakening. I want to enter this slowly, like infertility is an old friend that I've lost contact with. I've never forgotten what we've been through, how cruel she can be, but I've let myself gloss over some aspects. It's those aspects that I think will pack the most punch though.

Ch-ch-changes-

A's work is still in the middle of it's... whatever they have going on. They're either going to dissolve, or merge, or something. I know that one option has been taken off the table- the buyout. That option would have favored us considerably and made everything in our life considerably easier.

Our insurance is set to change, and we've found out that this new "better" insurance is much worse. Our co-pay for ER visits is going up by $100, and all other co-pays and prescriptions will be going up by $5. I can't find anything "better" about this insurance, to be honest. Some of the benefits are the same as our previous company/policy, but everything else... no. We're waiting to find out more about the specifics in our coverage (they're mailing us a booklet) but we're pretty much guaranteed that we still won't have infertility coverage, and I'm in the dark about whether I'll get coverage for Lovenox. I'm going to have to call them if A won't... because I need to know this up front.

Bottom line is this: they expect us to pay more each month for an infinitely sub-par policy.

A's boss can't understand why he's so pissed about this.

I know I should be thankful that we have coverage at all. We've lived below the poverty guidelines before, we've lived without insurance, and it's tough out there. I think the thing that pisses me off the most about this is the way A's work just keeps walking. all. over. him. They take him for granted, they aren't paying him what he's worth, and they've done this knowing that he needed this job and why he's stayed here. He stayed for the job security, for the insurance, and because (even though he has 6 years experience in the field) most other companies want a college degree for what he does- and A doesn't have that.

And let's be honest, the timing sucks. The all mighty freakin' awful timing of this. The fact that they want to shake things up after we've already spent MONTHS planning to try for a second child. I've already had blood tests and started medications, and NOW they want to throw this at us. No warning, just, "Hey, we're changing your insurance in less than a month," and, "We're also going to take more out of your paycheck while we're at it. You don't have a problem with that, right? We don't give a fuck if you do anyway. Eh."

They still haven't told us how much more we'll be paying a month. Just, "Oh, well you were paying 10% a month on the last policy, but you'll be paying 30% for this new policy." WTF does that even mean? 30% OF WHAT TOTAL?!

I'd hate to have to push TTC back until March (or next year), but I am starting to wonder if that would be better. A doesn't want to wait though- he's still going to have a job, and we'll still have insurance, and he still has baby fever. I don't like all the unknowns though. I'm a much more reserved and pessimistic (or realistic) person. He's always been puppies and rainbows, while I'm storm clouds and Armageddon. Which, at times is good because I like to think we balance each other out: I keep him grounded while he stops me from drowning in my depression. In this instance though, I worry that his optimism might be blinding him.

I don't know. Maybe it's just my "This shit's getting too real," mentality kicking in, and I've realized that I have 5.5wks left of BCP and we might actually have to enter this quagmire again. And part of me doesn't want to. Part of me would rather cherish another year free of injections and possible bed rest and blood tests, and just enjoy being healthy and taking my son to the zoo. Okay, so most of me wants that. But I really want another child too.

I just... I want another child like all my SILs got another child. Sex. Uneventful pregnancy. BAM. Baby! No bed rest. No injections. No bleeding excessively. No sobbing uncontrollably at the movies or screaming from the bathroom. Pregnancy, the dream society tells us it should be.

I want to be normal.

But that's something that as much as I try, as much as I wish it, I'll never be.

January 2013 Weigh In-

This month I could have done better. I also could have done a lot worse. I let my cravings and the holidays get the best of me. There were two weeks where I didn't even bother tracking my calories because of holiday sweets and cake. Still, I did manage to stay on top of my exercise, and I did lose weight. It was a bit of tug and pull though, I'd lost, then regained, then lost again.

We've also been battling a seasonal bug that swept through the house. Trying to keep up with everything while sick has been difficult, but I've done my best. I made sure to meet my weekly exercise goals each week although, again, my diet has been hit and miss.

I weighed in this morning at 175.8 lbs, down from 179.6lbs last month. So I've lost about 3.8 lbs this month. I lost another inch off my waist, and an inch off my hips. So, progress!

Since March 17, 2012:
Weight lost: 51.2 lbs

Inches off hips: 11.5

Inches off waist: 11.5

Total weight lost since January 2011: 74.2 lb

I'm still on Metformin, and I've recently restarted my Thyroid medication as well. I'm going to try and focus more on my diet, since I think that's the biggest obstacle for me these days. I'm also thinking of switching out some of my walking for light aerobics with an exercise ball.

Since I started losing weight, I've seen a huge improvement in my PCOS symptoms. I don't know how much that's the increased Metformin dose though, and how much is the weight loss. At my biggest weight (250 lbs) I was on 1,500mg Metformin daily, and my symptoms were awful.  I was getting an incredible amount of skin tags, and getting dark skin patches all over. Once I increased my dose to 2,000mg (and switched to ER), all those issues started to clear up. Here in the past year, I haven't had any noticeable issues with them at all. I think the Metformin has made a huge difference, but I think the weight loss has helped as well. I still have issues with a lot of my other surface PCOS symptoms, but those two issues were by far the most prominent.

Anyway, I'm still making progress and that's awesome. I just need to stick to my guns a little better and continue to reaffirm my resolve.

Results are in-

Honestly, they look pretty good to me. My AMH was 2, and from what I see online that's great. Prolactin was a little lower than normal, at 4.6 (should be 4.8 to 23.3 according to the lab report). My DHEA-S and Testosterone were great; they've went down a whole lot! In 2009 my DHEA-S was 370 and now it's 284.9 (should be 98.8-340). My Testosterone was 93 in 2009, and now it's 30 (should be 8-48). There were some crossed lines of communication between my fertility clinic and my primary doctor's office, but I got that all sorted out and got my TSH results where they needed to go. They were 4.99, and I've already restarted Synthroid- I get my levels retested February 7th.

I'm really surprised (in a good way) by how much my testosterone went down. I don't know exactly why it did- between the higher dose of Metformin, the ovarian drilling, and the weight loss, possibly the use of birth control pills? I think there are a lot of possible contributing factors. The fact that I'm on birth control pills when this was tested does make me worry that the results may be skewed. My DHEA-S level is lower too though, so it might not matter much, as we were testing those levels to determine if I'd need to use Dexamethasone on future Clomid/Femara cycles. I don't think birth control pills reduce DHEA-S, but I could be mistaken?

Today was my REs last day, so I don't know who will call me about the results. I still haven't scheduled a consult with a new RE either. I'm trying to wait until we get a few other things figured out. We found out last week that our health insurance (through A's work) is changing next month, and we won't know more about that until the 21st. On top of that there are some changes going on with his employer that make me nervous. All this was sprung on us after we've already begun planning and prepping for all this, so it has me very frustrated. He'll have a job- we're not worried about that- but there are a lot of unknowns with his benefits and situation just the same. I just wish we knew what was going to happen.

Waiting on results-

Technology has made it easier for me to access my records. The lab I used lets you access results online immediately, and they'll send me an email to let me know when they're in. Technology can be wonderful sometimes. At the same time, I find myself anxious for the results and checking back for them. I've never had my AMH (anti-mullerian hormone) tested before so I'm curious where I stand. I'm not too worried about my other results- the testosterone and DHEA-S only matter as far as if I'll use Dexamethasone again with Clomid (should we go there). The prolactin, well, it was normal in the past. I know it can change, but I'm not too worried about it (hopefully that won't be my famous last words).

I did call my PCP's office and ask about my TSH levels from a few weeks ago. Back in July it was 2.53, and in December it went back up to 4.99. My PCP considers anything under 5 as normal, so I'm borderline normal for everyday purposes. My RE said she likes it to be closer to 1 when TTC/pregnant, but that she would definitely want it under 2.5 before I start TTC. I fully expect to be put back on Synthroid, but they haven't called me about starting. I'm starting to wonder if they got the results back from my PCP (they were supposed to fax them). The only reason I'm anxious about this is that I would need to start my dose and get it re-checked in a month... and if we're planning on TTC at the end of February, I'd need to start it soon. If I don't hear back from them tomorrow, I'll probably give them a call in the afternoon (or wait until Thursday).

I feel like I might be obsessing a little already, but this is sort of important. Elevated TSH levels might not make a huge difference, but they could make issues with ovulation and increase my risk of miscarriage. And I already have an increased risk of miscarriage, so I really don't want to take any chances.

I'm still taking all my medications, still working on weight loss, and I started a new BCP in the meantime (fingers crossed that I won't have breakthrough bleeding with this one). The new BCP is weird. It's not a normal tri-phasic; it has 2 pills at one dose, 5 at another, 17 at another, 2 at another, and then 2 inactive pills. Hopefully it won't mess up my prep-work for regulating my body.

I'm still struck by how much effort goes into preparing to TTC. I mean, something could come up and we might get waylaid, but here we are trying our damnedest to prepare as best we can. When we first started trying, way back in the day, it was so exciting and simple. Now it's just... eh. And definitely not simple. Things are just so different. Entering this knowing exactly what kind of hornet's nest we may be entering is both a good thing and a bad thing. On one hand, at least I know what to expect. We're prepared, we know what we need to do, we're much more grounded, and we can start things off on the right foot. One the other hand, we know what to expect. I know how hard things can be, how difficult, and how expensive (I mean seriously, we're still 2 months away from trying and we've already racked up over $400 in expenses).

Just a lot to process. Hopefully those results will come back before the end of the week to give us a better idea of where we're going. I should know more about the Synthroid by then too.

Until then, just more waiting.

A final visit-

Entering the waiting room was weird. You know, it's been nearly 2 years since we had that last IUI. The staff has undergone changes. They had receptionist I don't remember. Nurses who didn't know me by face or name. Our one nurse, Lin, was still there. She chatted and asked about V as she led us back to the consult room. The same room we had our last consult, where we decided to give it all one last go.

A lot has changed in the clinic. But a lot has stayed the same. We waited for Dr. J to come back, and while it felt like a long wait, it probably wasn't nearly as long as I imagined. She looked exactly the same, and we fell into our normal chit chat habits. We covered any changes since last visit and talked over courses of action. I got her to give me her sincere recommendation for one of her colleagues, and why she felt that way. She felt that Dr. M would be the best to handle my situation and complications, to go over everything with me, and talk to me like I need (she knows me so well). We covered all bases, and that was it... good bye.

I didn't cry, we didn't shake hands, it still doesn't feel like she's leaving. I know she is though- by this time next week she'll be gone. We'll be shifted along to the next RE, and business will go on as usual. I can only hope that the next hands that guide us will be as caring and competent.

She ordered some blood work: AMA, Prolactin, testosterone, DHEA-S, and my primary doctor should be faxing them my TSH levels from last month. We discussed her recommendations for trying, and settled on a course of action we felt comfortable with: We'll be trying on our own for a month or two, I'll chart BBT/OPKs and after ovulation start progesterone supplements. If I get a positive pregnancy test, we'll test progesterone levels and start PIO if needed. I'll also immediately begin Lovenox injections. If my TSH is elevated, I'll be starting Synthroid well in advance to get that under control. Otherwise, I'm already on all the medications they'd like for my situation: Prenatal, Vitamin D, extra Folic Acid, low dose aspirin, and Metformin. If that first cycle (or two) off BCP doesn't do it, I wanted to give Clomid another try.

All that's left really, is to meet with my new RE. I guess I'll schedule a consult for February if possible.

I'm already dealing with the financial wrap up. It's been such a lovely year, not having to worry about all that. We paid our co-pay of $50 for the consult, but as I know insurance won't cover it I'm sure at least $150 will be bounced back to us. The blood work will be $226 (insurance doesn't cover infertility, so I called the lab and got an estimate- they have a small discount for self-pay). So roughly $426 racked up already, and we're not even TTC yet.

I know that everyone has to put thought into trying for another baby, that it's not always easy, but I get really envious sometimes. I get envious that they don't have to put so much money into everything. That they don't have to worry about every little thing. When we first started trying, it was easy. We thew out the protection, and that was that! Then nothing happened. And we started adding to what was required of us as the years went on and our medical folder grew. So yes, I plan to be more laid back this time, but I can't be laid back like my sister in laws were. For me, laid back means being able to step back when I need to. Not being as aggressive. It doesn't mean I can just let nature take it's course... because that will not end well. And I hate that.

Anyway, it feels good to have a rough plan, to know what we need to do. I'm still not very optimistic, but we're doing the best that we can.