I heart Dr. Receptive

Last week I had another appointment with Dr. Receptive to see what he thought about my day 19 bloodwork results and also to ask him about getting more bloodwork done while I waited for my mid-May RE appointment. Once again, I walked out of that appointment feeling good.

Dr. Receptive said he was glad to see all the numbers within normal range even though the bloodwork was done later in my cycle. He said that he was glad to see that my FSH levels were not “screaming at the top of their lungs” and were just “quietly talking.” Most of what he tried to tell me, I was already familiar with, but you have got to love a doctor who tries to explain things to you so you can understand it. (And with such anthropomorphism! I love it!) And he did it without being condescending. I think the other thing about him is that, unlike my experience with the doctor who told me about my high FSH results, both times I have talked to him he gave me the sense that all hope is not lost. It wasn’t in anything he said explicitly (“Don’t worry, everything will be ok”). He is somehow comforting without being unrealistic. He certainly has a gentle compassion about him and he is definitely a doctor who is open to patients doing their own research. In fact, he complimented me on the fact that I was trying to learn about POF and being proactive in dealing with it.

I told him about my appointment in May and my idea to get my day 3 FSH retested as well as progesterone testing done before my RE appointment because it was highly likely the RE would ask for those again. He had no problem writing up the lab requests for it and he asked me questions again about insurance coverage and made sure to put in my possible diagnosis of POF to ensure the greatest chance my tests would be covered. He asked if I was aware I could ask to be put on a wait list for any earlier appointments that might come up with the RE (I was and had been). Then, he made a note to himself to talk to an OB/GYN affiliated with the medical practice I have an RE appointment with, who was coming in a few days to talk to her about my case. He said maybe he could see if she could see me before mid-May just to get me into their system (which he has no access to) and get some things rolling.

So, my plan for my next round of bloodwork is to wait for my next cycle and do all the bloodwork within that cycle. I could have gotten my progesterone done now then waited for my cycle to start next week and do my day 3 repeat, but I called the RE’s office to see if there were any cancellations and to confirm they have a note to give me an earlier appointment should it come up. It seemed to me that the chance of getting in any earlier than mid-May is low to impossible. So, I thought I’d collect some good data on myself this next cycle and try to get as much out of my next RE appointment as I can. One thing that has been nagging me is whether I’m really ovulating. I’ve read that people with POF can have an LH surge and all the signs of ovulation but no ovulation. And when I was temping before, I had a temp rise after my LH surge but it was moderate, and I would see only see a more substantial rise 3 days later. I never knew what that meant but maybe with some bloodwork and close monitoring I can get a better picture of what my body is doing.

So, the BBT is coming back out of retirement for a few weeks and I know I’ve got some OPK’s under the sink somewhere. I’m going back to monitoring my temps for my next cycle so I’ll know what “dpo” I get my progesterone drawn. Then, it’s just a matter of waiting for the test results and maybe another pick me up appointment with Dr. Receptive before seeing the new RE.

Reaction to Karen’s post

I read Karen’s post this morning and started typing a comment which turned into a (bad) college essay. So, instead of using up her space, I’m posting it here..

I have mixed emotions after reading the two review articles on Debora L. Spar’s book The Baby Business. The tone of both reviews sounds like it was written by someone who read the book, but clearly never had to deal with IF. The business week article, in particular, was highly judgemental about IF treatment and adoption. It seemed like it was written by a person who was more interested in perpetuating his/her disdain of IVF (which seemed to be based on either an ignorance of technology or an over-simplified understanding of it) rather than a review of what was actually written in the book.

I was especially irked by two things written in the business week article:

“…in the emotional world of infertility, couples often keep paying until they run out of money; very few run out of will. Those who do give up can turn to adoption along with about 120,000 other U.S. families each year, shelling out up to $35,000 per child.”

“The most disquieting parts of the book are those chapters that detail some very advanced reproductive technologies. Doctors can now remove one or two cells from a two-day-old embryo in a test tube, tell the parents its gender, and test for certain genetic defects. The parents then choose which embryos they want implanted. Scientists are also only steps away from cloning a human.”

The first because it feeds the desperation concept (us infertiles will throw all our money at IVF treatments, then throw another 35k we don’t have to adopt—plus, it implies the 35k is all going to one source to “buy” a child) and the second because it equates IVF with eugenics and human cloning. We are not “steps” away from cloning a human. That is a misconception perpetuated by the media and by a general public fear of cloning.

I thought the Plotz review was slightly less judgemental and at least it seemed to deal more with the content of the book. I do agree with the fact that one aspect of IVF clinics is that it is a business. (I also think that medicine is a business, but calling something a business doesn’t mean that it is bad. I think businesses can do good things, including helping people.) And that some IVF clinics maybe many (but not all) are ran more like businesses than medical treatment facilities (for example, those that exclude women from treatment because they deem them as having a low chance of success, in an effort to maintain high stats for CDC). But, I think the business aspect of medicine is inherent in all medical care in the US. I also agree with the assessment that some RE’s don’t wish to deal with or want to recognize (publicly) the business part of their practice, that they like the perception that all medical professionals do their job solely because they want to help people. And that this leads to a

“…pretense of noncommercial activity makes infertility opaque for customers: They don't know whether they ought to be paying what they are paying, or if they are getting a good service, because the usual market checks — information, competition, transparency — are absent.”

I think that most of the time, medicine lies somewhere in between being a business and being altruistic care of people’s medical needs and it would be nice if more people, especially doctors, acknowledged that.

As for Spar’s point about a need for more regulation of IVF like what is seen overseas (number of eggs retrieved, number transferred, etc.), I have problems with that. Each person is different with a different set of circumstances. Medical choices, it seems to me, should be made, assessed and presented by medical experts and chosen by the patient, not by any branch of government.

From the reviews of the book (which I haven’t read yet), it seems like Spar presents a very academic, economic and cold assessment of reproductive technology and forgets (or more likely never considered) the emotional, human aspects. From the salon interview she gave, I don’t think it was ever her point to consider any emotional aspects of IVF because that was not what she was interested in. She is interested in assessing the business aspects of IVF, not making judgements on the people undergoing IVF. It’s the reviewers of the book who are making judgements about infertiles. I think that is where the damage lies. That people will only read the reviews and the reviewers' biases and misconceptions about IVF and adoption and believe infertiles are all desperate people willing to do everything and anything to “buy” a baby.

Behavior Modification

When I first started this blog, I envisioned it as a place I would go to be quiet with myself and dig deep so to be more aware of what I am feeling. I also thought if I gave myself this safe place, this haven, I would be able to sort out issues or give voice to feelings I wouldn’t normally allow myself to speak of otherwise. When I was thinking about a name for my blog, Worrier/Warrior seemed to perfectly define the states of my mental life when dealing with life’s struggles. I begin by worrying about every possible detail and the things that can go wrong then develop a methodical attack in hopes of conquering them.

I notice that many of my posts in the last month or so have been Worrier-driven rather than Warrior-driven. And I don’t like it. I don’t like it because it’s a reflection of the fact that I have started treating my blog as a place I go to only to put down my negative or confused thoughts rather than a place where all my emotions can reside. It’s like I’m giving too much power to my negative emotions and not nurturing my positive ones. When I focus on the struggles and emotional turmoil, I give them more worth and by default, the good things in my life become worthless. So, these last few weeks I have been trying to modify my behavior. I have stopped checking the various infertility and related boards every day and limited my blog reading to lunchtime. I had been a little afraid of this change because it meant I would have more time on my hands. For so long, that time on my hands meant the emptiness which encompassed my body after my miscarriage could surface and I would aimlessly go through the motions of “working.” Not so these days. Most of the time, I am able to focus and actually be productive.

One side effect of this behavior modification, though, is an avoidance to blogging. I’m not sure why. I get the feeling that I am in the process of integrating my IF into the bigger scheme that is my life. That while IF has been the central focus of my life for a long time, I am only now, fully realizing the chronic nature of being in the midst of and eventually going through ovarian failure. It means that my road to motherhood will be long, most likely difficult and possibly filled with making hard decisions. It means that even if I achieve motherhood, there are health consequences that will require my attention for at least decades if not for the rest of my life. And, while I started this blog with all intents and purposes as a chronicle of my IF journey, IF is not the whole of my life.

So, I intend to keep on with this behavior modification experiment for awhile longer to see where it leads me. I don’t know what that will mean for the frequency or quality of posts. I plan to post updates on my on-going (but perhaps fruitless efforts) to work with doctors on campus while I wait for my RE appointment. I think, eventually, I would like my blog to reflect the whole of the person that I am and not solely my infertility. If and how that will come about, I can only wait and see.

Results Normal…for cd19

Well, got my results today from my retest (of FSH, estradiol, TSH, LH and prolactin). My FSH was a 3.1 for cd19. That’s exactly ten times lower than my cd3 levels I had taken back in October. But, since this is a luteal phase FSH level all it does I think is rule out the fact that I’m in menopause. I’m still not sure what if anything this latest round of bloodwork is really useful for except to confirm my TSH, LH and prolactin levels are normal. I didn’t question what Dr. Receptive was ordering last Friday because, really, I just wanted a referral to an RE from him. The fact that he listened to what I was saying was a bonus. When I called earlier this week to get an RE appointment, the earliest they could give me was Mid-May. Yeah, that’s right, not for another 10 weeks. The receptionist said she made a note to move up my appointment if another one opened up earlier, but I’m not about to rely on someone catching that so I will call the office every couple of weeks to see if there is a cancellation. Though Dr. Receptive was attentive, I am hesitant to do consult him in the interim since I still question his thinking that taking a cd19 FSH was useful. (At one point during the appointment he had said something to the affect that he was curious to see what it was. I didn’t ask why.) Plus, really, he has no expertise in this area and I think I’m much better off seeing someone who is at least more knowledgeable about ovarian function even if they don’t know anything about POF. The only reason I may go back to him is to ask for a luteal phase progesterone level and there’s no reason to rush that one since I’m about to start my period either tonight or tomorrow. What next? I don’t know yet. I’m feeling a bit fragile which probably has more to with the fact I’m about to get my period than anything else. But, I’m feeling disappointed in myself that I didn’t push more on getting my FSH on day 3 and/or calling back to get progesterone levels as well (as Thalia suggested in the comments of the last post). I think I’ll revisit all this in a few days when, hopefully, I’ll be over my PMS and can think more objectively.