Not Created Equal

I know, I know...Two posts in one day. I guess I'm making up for not posting for the past few days. Anyway, I know I've posted about this before, but it's been bugging me a lot, particularly after my failed IVF and I just had to put it out there again.

This from the Kaiser Health Network:
Asian, Black Women Have Lower IVF Success Rates Than White, Hispanic Women, Studies Say
[Oct 20, 2004]

Asian and black women who undergo in vitro fertilization have lower rates of success than white or Hispanic women, according to two studies presented on Monday at the annual American Society for Reproductive Medicine convention in Philadelphia, the Philadelphia Inquirer reports. Dr. David Grainger, an infertility specialist at the University of Kansas-Wichita, and colleagues analyzed IVF clinic records between 1999 and 2000 for more than 75,000 patients whose race and Hispanic origin were reported (McCullough, Philadelphia Inquirer, 10/19). The average live birth rate among all women who underwent IVF using eggs that had not been previously frozen was 25.7%. However, black and Asian women had lower birthrates -- 18.7% and 20.7%, respectively -- than white and Hispanic women -- 26.3% and 26.7%, respectively, Reuters Health reports. In addition, black women had the highest rate of miscarriage -- 22% -- compared with 13.9% for white women, 16.4% for Hispanic women and 16.2% for Asian women. The reason for lower success rates for Asian women is unclear because Asian women do not have high smoking or overweight rates, according to Reuters Health. However, the researchers speculated that the increased rate of overweight and fibroid and uterine disease among black women might contribute to lower IVF success rates among black women, according to Reuters Health (Kerr, Reuters Health, 10/18).

Second Study
In a second study, researchers at the University of California-San Francisco who analyzed 1,200 IVF attempts at their own clinic, 27% of which were among Asian patients, found that Asian women had lower pregnancy rates than non-Asians whether the implanted embryos were fresh or frozen, the Inquirer reports. "Being 35 and Asian was equivalent to being 40 and white," UCSF researcher Karen Purcell said, adding that they did not know why this was true (Philadelphia Inquirer, 10/19).

And there are even more articles:

Standford University resarch - Reuters article

The American College of Obstetricians and Gynecologists article

Several different studies show that Asians have a lower rate of success with IVF. Being of Asian descent, this is a real concern. Not only do I have to worry about my impending AMA, but on top of that I also have to deal with my race placing me at disadvantage compared to others. What else could be next?

Limbo

That's where I am right now. Just sort of waiting to see what happens. Trying not to stress and seeing if I can go with the flow.

Yeah, right, like that ever happens when you're TTC and all you can hear is your freakin' biological clock ticking.

I'm not sure if this is a good thing, but I can honestly say that I'm not as neurotic as I was before IVF when I was checking my CM, taking my BBT, using OPKs AND using a fertility monitor. Yes, I was doing all that and don't ask me how I had time to do anything else like work, sleep, eat. Now, all I'm relying on is my trusty fertility monitor and here I find myself (yet again after 6 months) waiting to see that damn egg and a peak day.

Although I'm happy that I'm a bit more laid-back about the whole situation, I sincerely don't believe it's because I've become a more relaxed person. Sadly, I think it's because I know deep in my heart that even if we do "our thang" during the peak window, we have almost no chance of conceiving. It's a futile effort, so I'm not going to agonize over whether or not I've actually ovulated.

My hopes are all on IVF #2 and that being said, I've started on my next obsession which is to better prepare my body (my eggs included) by taking a full arsenal of herbs and supplements. So, here's my list based on info from fertility sites, boards, and books.

CoQ10 as an antioxidant
Royal jelly with propolis for general fertility
Prenatal
Wheatgrass for egg quality
Calcium with vitamin D for overall bone health
B50 complex for energy
Herbs from my acupuncturist

For awhile I also tried out DHEA, but that was just giving me knarly headaches, so I gave that up.

Hopefully, something does the trick. Whether it be the herbs, the supplements, or just IVF. I don't think I can handle a #3.

Fortunate Fool

Sometimes I forget how fortunate I am for all the things that I do have. It's too easy to focus on the bad things, like dealing with insurance and getting sucked into the TTC vortex. Bitching is sometimes so much easier than being positive. There are times, though, when something happens and you realize. Holy! My life ain't so bad. Actually, it's pretty damn good. Yesterday night was one of those moments.

Doc got a call from an old friend of his (let's call him Dude). We haven't seen Dude since his wedding in August of 2008, so he hasn't even been married for two years yet. Anyway, when he got married and we met his wife, both Doc and I thought to ourselves: Wow...They're very different. I wonder what they have in common? Anyway, Doc and I thought, they must love each other and love conquers all, so let's be happy for them.

Dude is a guy's guy. A bit on the particular side, but likes to snowboard, hang out with his buddies, watch action flicks, grab a beer, etc. Dude's wifey on the other hand is a classically trained musician. She grew up very sheltered and is very, very quiet. Doesn't enjoy anything athletic and pretty much just likes staying at home.

So, now here we are, not even two years later and Dude is calling Doc because his marriage is falling apart. He asks Doc how often do we fight? Doc and I have had probably less than 6 full out arguments in during our 4+ years together. Two of those were when we were planning our wedding and another 1 was during my crazy hormonal mood swing while taking IVF meds. Anyway, Dude tells Doc that on average they fight 1+ hours/day and 7+ hours on the weekends. WTF?!

When Doc was relaying this to me, my jaw just dropped. How does someone even have the energy to fight that much? Out of exhaustion alone, I'd just give up, crawl away and let the other person win. Life must be absolutely miserable.

I felt horrible for Dude, but at the same time I felt so much love for Doc. I realized how lucky we are. Sometimes I take it for granted and it takes moments like these to make me realize that I have something very, very special. Doc and I can spend weeks together 24-7 (like on our vacations) and we will never have even a minor spat. It takes work and patience, but it's so worth it. Having Doc in my life is the best thing that has ever happened to me.

Frustration!

I probably shouldn't be complaining since we're fortunate enough to have coverage for this, but I'm so frustrated!

I have $1000 worth of acupuncture coverage through my insurance, so I've been going to acupuncture since last July, but I switched acupuncturists in January of this year. With my prior acupuncturist, I always self-billed the insurance company myself -- paid cash to the acu and then got reimbursed by the insurance company. A slight pain in the ass, but no big deal.

Anyway, with my new acupuncturist, I was going to do the usual self-billing. Her rate is $85/session, so very reasonable, but she told me that she had a great insurance-billing company and that they could do the billing, no problem. I jumped at this because it would save me some paperwork. However, she neglected to tell me that the insurance rate was way more than $85!

I didn't find this out until the insurance company screwed up and sent me the reimbursement checks which should have gone to her. I looked at the claims and each session was billed at $270/session!! I emailed her and basically said WTF?! After 4 sessions my $1000 coverage was all used up.

She emailed back and said that her billing company had screwed up and they should've billed $170/session because that is her insurance rate and her cash rate is $85. Had I known that her insurance rate was 2X her cash rate, I would've just done the billing myself!

All of this seems a bit fishy. Can a doctor bill the insurance 2X as much as the cash rate? How the hell did she initially bill the insurance company $270/session? Why didn't she disclose how much she was billing the insurance when she knew that my coverage only covered up to $1000?

I'm pretty pissed about all this. I tracked all the sessions and the payments and made sure that I didn't exceed the $1000 limit. Right now, I'm refusing to pay anything else out-of-pocket. I'll give her what the insurance company paid me, but that's it...nothing more.

Her Name is Rio

Once upon a time, when my life wasn't filled with blood samples and vagicams, Doc and I used to go on vacations...real vacations, to far away countries. Twice a year, we'd pack our bags and take a flight to some pretty remote places. The more remote and random, the better. (I've posted a few of our pics from different vacations).

Doc has always had wanderlust. He's been to over 50 countries and typically plans all our vacations -- no tour groups or organized trips. So, really, all I do is pack my bags and show up. Prior to dating Doc, I had been to Japan, India, France, Mexico, Germany, and Switzerland, but my country count definitely increased once we became a couple.

We are not the relax-on-the-beach-and-drink-mai-tai vacationers. Our first year together, we took our first trip to Vancouver Island and spent a week camping and kayaking with orcas (during their migration). Six months later, we took our next trip to Barbados and Dominica (not to be confused with the Dominican Republic), where we went scuba diving and hiking for 2 weeks.



Mongolia

In our second year together, we took our most adventurous trip which included Korea, China and Mongolia (this was the adventurous part). Korea and China were pretty standard, however, Mongolia was something else. Although, there wasn't much to see in terms of sights, the people and the vast expanse of land were amazing. Mongolians live very much like they did 1,000 years ago. Many of them are still nomadic, moving with their herds and pitching their gers (or yurts) wherever there is food for their animals. There are no roads outside of Ulaanbaatar, so we'd drive over hills and across the plains hoping that we weren't lost and we'd get to our ger camp. From there, we'd have meals of lamb and more lamb and even more lamb...morning, noon and night. No vegetables, just lamb. Let me just tell you, it gets old very quickly. But, it was a trip that Doc and I still talk about, even now.



Indonesia - Borobudur

Our second trip that year was our honeymoon to Malaysia, Indonesia and Singapore. We had a great time. Malaysia had some of the best diving we have ever experienced. Singapore had wonderful, delicious food! And Indonesia (Bali) was so relaxing -- beautiful beaches and warm ocean water. We'd go back in a heartbeat.



Dubrovnik, Croatia

We spent a good part of our first year of marriage traveling. In the spring/summer we took a month to travel in Central/Eastern Europe. Starting off in London, we made our way to Hungary, Italy, Slovenia, Croatia, and Bosnia. It was an amazing trip, but the highlight was without a doubt, Dubrovnik in Croatia. Right on the coast of the Adriatic, it is one of the most beautiful cities I've ever seen.



Serengeti, Tanzania



In December of that year, we took a month and traveled to Africa, specifically: Reunion, Mauritius, Mozambique, Tanzania, and South Africa. We spent a good amount of time scuba diving in the Indian Ocean and another chunk of time on safari. We were lucky to be able to catch the wildebeest migration in the Serengeti. It's exactly like something out of National Geographic. Amazing is the only word that describes seeing miles of wildebeest and zebra in the natural habitat as far as the eye can see and watching the lions lying only feet away from our jeep. We loved every minute of our trip.



St. Basil's Cathedral, Moscow

Last year, because of our TTC ordeal we only went to "safe" locations and spent two weeks in Hawaii and another 1.5 weeks in Russia (St. Petersburg and Moscow). Our time in Russia was great -- very cold, but so interesting and nothing like we had imagined. All that Cold War propaganda while we were growing up really brainwashed us into believing that evil KGB agents were lurking around each corner. Instead, what we found was a beautiful country with very friendly people and tons of culture and history.

This year, we've also decided to take it easy with the trips because of you-know-what and so, our spring/summer trip will be to Puerto Rico. We're excited, but it's not technically international, so our excitement and sense of adventure are a bit subdued.

To make up for this, we made a decision this week that our fall trip would be to South America! We'll be spending two weeks in Brazil, Argentina, Paraguay, and Uruguay. I'll be singing Duran Duran until November!

I Want My Life Back

I think this is a perpetual theme in my TTC story. I constantly feel like my life has been hijacked by my (our?) infertility and now that IVF #1 was a bust and I've gotten over the initial shock and dismay, I'm actually somewhat happy.

I feel like I have my life back again, or at least I have a bit of my old life back. I had coffee this morning and sushi for lunch and this weekend I'm going snowboarding for the second time this season. But, most of all, I can exercise again. I went running last Monday night, right after I found out that the beta was negative and I went to spin class on Tuesday. I went running again this weekend and will hit the gym tonight.

But, in the midst of my happiness, I also feel guilty for being happy...Shouldn't I be wallowing in the pain of a failed IVF? Shouldn't I be crying every time I see a pregnant woman or commercials with Gerber babies? I feel like I've got it all wrong and that maybe I'm not taking things seriously enough. But, damn, the relief that I feel over not being a hostage to IVF (even if it is only for a couple of months) is so overwhelming that I can't really feel anything else.

Yes, I would be much happier if the IVF had been successful, but at the same time, this is what life has dealt me and I might as well enjoy it while I can. I know that all too soon my life will revolve around doctor's appointments, blood draws, and staying sedentary. Is it so bad to thoroughly enjoy this moment of normalcy?

What's Next?

We had our delightful WTF appointment with Dr. P yesterday and we discussed all the things that may have gone wrong and all the things that we could try for the next cycle, assuming that I stay with Dr. P.

First off, he told us that he's only had the immature egg situation happen to him one other time and the woman did not cycle with him for IVF #2, so he didn't know what was changed in the second cycle or even if she was successful.

As for my cycle, he said based on my E2 levels and the size of my follies, at least 7-8 of the eggs should have been fully mature instead of just three. There didn't seem to be an issue with fertilization since 2 of the 3 fertilized which is a pretty good rate. And he also doesn't think that there is an issue with my uterus because my lining was ok, not super thick, but fine nonetheless.

So, what are the changes he'd suggest? Well, first off no birth control pills because that seemed to oversuppress me, probably add estrogen priming to the beginning of my cycle, and then move me to a microdose flare protocol. Other changes he would make include: adding an hour between the HCG shot and retrieval and possibly allowing my follicles to grow for one more day.

I asked him about DHEA as a supplement for improving the quality of my eggs and he said that although there is some research out there that shows improvement with the inclusion of DHEA, there's nothing definitive. He doesn't think it will hurt, but he's still a bit wary of incorporating it into the cycle.

Now, I'm just waiting to schedule a consult with Dr. Zed and see what he says. We're going to a seminar tonight to see one other doc in our area whom I'll call Dr. Gruff (because he doesn't have the best bedside manner), but a lot of reviews say he's great.