Dear Human Resources,

For the record, my boss is freakin awesome! Really, truly, awesome.

I drafted up this letter, based on the sample that RESOLVE offers, and she sent it off to HR. She is one of the big bosses, so maybe something will actually come of this... The RESOLVE website says 65% of employers who provide infertility coverage said they do so because they were asked by an employee.

Dear Human Resources:

I have been contacted by a Company employee who is suffering with the disease of infertility. An estimated 1 in 8 couples have similar difficulties, so I know that this couple is not alone. On behalf of this couple, and all other Company employees who are silently struggling to overcome infertility, I would like to request that you advise me as to the action necessary to include coverage for infertility treatment with the Company health benefit package. I imagine that this might be a larger issue that requires some attention from Corporate and would appreciate your guidance about who in that organization might be most appropriate to contact.

I have been informed that insurance coverage for diagnosis and treatment of infertility is currently excluded from the Company health insurance plan. I have also been informed that California Insurance Code requires insurers to offer coverage of certain infertility treatments (see reference below), which I assume gives the Company an option about whether or not to include infertility as a covered benefit.

I want to be sure that we are providing comprehensive coverage options that both make sense for our employees as well as our fiscal bottom line. A 2003 Harris Interactive Poll indicates that there is broad public support for infertility coverage; 80% of the general population believes infertility treatment should be covered by insurance. Because of this, I believe that offering this comprehensive health benefit will support our hiring and retention strategies.

Often employers believe that adding an infertility coverage benefit will increase health care costs. However, recent studies indicate that including comprehensive infertility coverage in a health benefit package may actually reduce costs and improve outcomes.

For example, a recent employer survey conducted by the consulting firm William M. Mercer found that 91 percent of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage. In fact, the cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusetts mandate. (Study by Griffin and Panak, Fertility & Sterility, 1998). 

According to the American Society of Reproductive Medicine (ASRM), 85%-90% of infertility cases can be treated with conventional medications. In vitro fertilization accounts for less than 3% of infertility services.

Often patients select treatment based on what is covered in their health benefit plan rather than what is most appropriate treatment. Comprehensive infertility coverage may actually reduce premium expense by as much as $1 per member/per month by allowing employees to choose the most appropriate and effective treatment, rather than more expensive less effective procedures that are covered by insurance.

Medical outcomes are also better for couples whose health insurance includes infertility coverage. The rate of multiple births, which often result in high-risk pregnancies, delivery complications, and extended stays in the NICU, is lower in states that have mandated infertility insurance. Furthermore, the improved mental health and general productivity of employees who are able to access timely and appropriate infertility treatment cannot be underestimated.

I would like to be sure that our Company health insurance plan is as cost effective and comprehensive as possible to meet our staff’s needs as well as our own for a healthy, motivated, productive workforce. Please let me know if you would like any additional information on this issue. I look forward to your reply.


Sincerely,
Foxy's Super Awesome Boss


cc: RESOLVE – The National Infertility Association, 1760 Old Meadow Rd., Suite 500, McLean, VA 22102

Cal. Health & Safety Code § 1374.55 requires health care service plan contracts that cover hospital, medical or surgical expenses on a group basis to offer coverage for the treatment of infertility, except in vitro fertilization. The law requires every plan to communicate the availability of coverage to policyholders. The law defines infertility, treatment for infertility and in vitro fertilization. The law clarifies that religious employers are not required to offer coverage for forms of treatment that are inconsistent with the organization's religious and ethical principles.

Cal. Insurance Code § 10119.6 (1989) requires insurers to offer coverage of infertility treatments, except in vitro fertilization. Infertility, in this case, may be a result of a medical condition or may refer to the inability to carry a pregnancy to term during a one-year or more period of time. Infertility treatment refers to diagnosis, diagnostic tests, medication, surgery and gamete intrafallopian transfer.

Hope Hope Hoping

I am hope hope hoping that the Cade Foundation selected us for their 2011 grants cycle. They will be announcing their awards before the end of September and I am counting the days. I really think that we would be an awesome couple to represent their work, for so many reasons.

I hadn't realized that the month was almost over until this weekend when my mother in law asked about 'the grant'. She was visiting us for the weekend. She is so sweet and well intentioned, but doesn't always deliver her loving comments the way we'd like to hear them. It was the first time she's visited us since our wedding over 6 years ago. I know it meant a lot to ML to have her come up to see us and see our home.

Ohh, Cade Foundation, please make your announcement soon.

Her son was conceived with IVF

I have been so insanely busy. It is great to have the energy again to keep up with the life that I want and enjoy living. But I miss having time to write here, and to keep up with my reading.

****
For the record, I have to say that I absolutely love the klono.pin that my dr. prescribed me a few weeks ago. It magically calms the crazy swirling thoughts that apparently were sucking so much of my energy up. and also, at night, I actually fall asleep instead of laying awake for hours, and I sleep so well and wake up feeling rested. I seriously love this stuff. My dr told me I could take two pills every day (morning and night), but I only take half every other day because I am afraid that I'll get addicted or something. I read some scary stuff on the internet about this medication, but feel like it has given me my life back.

****
There is a lady who I know. I met her some time ago when we were volunteers on a local school district committee. We were like-minded in our approach to solving the problems facing our committee, and spent many evenings in the parking lot talking after the meetings. She was older than me, and had a child in the schools. We were in very different places in our lives, but there was always a connection. The committee ended and we went out separate ways, crossing paths every so often. She eventually ran for the school Board, while I ended up serving on another district committee that advises the Board.

The District has been in desperate need of funding and finally put up a school bond measure for the November election. I was asked to be a signatory on the ballot statement in support of the bond, along with a few other very prominent community members. I am not sure what makes me qualified to be at the same status of these other folks - former mayors and local philanthropists - true community leaders. But they asked me, and I said I'd be honored.

In the last week, I've ended up working incredibly closely with this Board member, nearly every minute that I am not at work, to campaign for the passage of this school bond. She really is awesome. And then, on Thursday, as we walked to our cars after a late meeting, I shared that it had been a really difficult year for ML and I.

I broke the silence and said "we found out last summer that we can't have kids."
and she said her son was conceived with ivf.
she understood. she really understood.
and I realized that she also lived with the silence.

I can't stop thinking about how glad I am that I said something to her. Why would she have ever brought infertility up to me?

I want to hug her and tell her that our exchange means the world to me. Instead I wrote her a card today - it just said that I think she is awesome and am so grateful that we are friends.

It seems that I am going to be sucked into this campaign. I keep telling people this bond will benefit my someday kids. The more I refer to them, the more real they become, my Someday Kids, My Someday Twins. The need for this Bond is so great. And my need to be distracted is pretty big right now too. ML has his FNA Biopsy next Wednesday. We'll get results back by October 15th. That will be a tough two week wait for me, and I have every expectation that I'll fall apart when we get the results. So having something else, something bigger than me, to focus on might be a really great plan.

My Puppies. 

*****
Much love to everyone visiting from ICLW. I promise to come visit your site in the next few weeks, and make up for all my missing comments during ICLW. Your comments pop up on my phone throughout the day and make me happier than any words can express. One more picture of my puppy's for your viewing pleasure.  Love to all!

My Weekend with the Girls

A few weekends ago I went on a girls getaway trip. I wrote about the anticipation of it in one of my first posts.  I wrote this right after the trip, but apparently forgot to publish it! 

It was a great trip, but I couldn’t help but feel like I was going thru the motions. 

My Bestie brought her Little One (who I’m going to call LO). Her little one is A.DOR.ABLE. Seriously the cutest sweetest little thing ever. and she loves me. really! We giggled together and cuddled and played all weekend. I told Bestie that she should not pack the stroller so that I could hold the little one instead. and I did, and it was wonderful. 

Bestie knows everything. and she is so sweet and supportive. and of anyone else who knows, I feel like she understands best. She has had her own struggles, struggles that I will never comprehend, and for better or worse she has that pain to draw from. 

Another friend met us, and brought her little girl. She just found out that she is pregnant again. I can’t say that I have much in common with this lady. She is nice, but not someone who I’d want to get into it with. She has a general idea that we’ve encountered struggles, but doesn’t know much more than that. All weekend she kept making comments about movie stars or other ‘single older women’ who use artificial insemination to get pregnant. I’ve never thought to by offended by that term, but omg I hate it. I hate the way she said it, the way she judged. It made me feel so sick. I wanted to scream at her ‘shut the F up and don’t talk about things you know nothing about’. 

I also hated the way that she challenged Bestie’s parenting style. Bestie is the most wonderful loving mother, attentive to the needs of her precious babe. I love watching Bestie be a mother and have so much respect that she stands her ground in the face of others who challenge her mothering. I may not personally agree with the parenting choices of this lady, but I sure as hell down’t put her down for making those choices or challenge her reasons for raising her daughter the way she is. grrr. 

Bestie’s sister who is also a good friend came too. She is a sweetheart, married to the. nicest. guy. I’m not sure what her plans are for starting a family, other than a desire to have their finances secured a little. Besties sister is super creative. She helped me make my first quilt a few months back and always inspires  my creative side. Her ipod was full of music that made me feel so happy, and I came home with a list of artists that I want to download into my music library. (Lauren Hill - remember her? totally takes me back to a very specific semester of college; Jack Johnson - I’d kindof forgotten about him, but have heard his songs pop up here and there a lot recently; Matchbox 20 - yep I loved their cd and their music reminds me so clearly of being on my college campus.)

I do really love girls weekends - getting away from the day to day distractions of life; having the time to have substantive conversations with good friends; remembering how much I love ML and my home. I couldn’t help but thinking that it would be amazing to have a getaway weekend with all of you. I start planning it out in my head, but then realize that none of us have the extra spending money to make something like that actually happen. I do think it would be the most amazing experience to spend a few days with a group of us who have this shared experience. Vegas is a pretty central place with cheap flights and cheap hotel options. If anyone is interested, let me know, and I would so love to plan an infertile weekend retreat. :)

Gold Star for the CDC

The CDC is paying attention.  :)


Today the Centers for Disease Control and Prevention (CDC) along with the Male Reproductive Health Alliance is hosting a stakeholder meeting entitled, Advancing Men’s Reproductive Health in the United States: Current Status and Future Directions in Atlanta, GA. The meeting will highlight multi-disciplinary approaches to improve men's reproductive health outcomes through public health activities. The meeting’s agenda includes presentations and discussions by stakeholders regarding strategies used to address male reproductive health problems. Participants will represent government agencies, national organizations serving health professionals or consumers, as well as academic programs involved in promoting men’s reproductive health.


I also wanted to make sure that you all saw the new CDC webpage about Infertility. I posted a while back about the email exchange I had with the CDC asking them to revise their website to include reference to Male Factor Infertility, and THEY LISTENED! The new site provide a much more balanced picture, and hopefully will help raise awareness about the importance of male reproductive issues as well.


UPDATE:
Check out Dr. Turek's post about speaking at the CDC conference. Gold stars for Dr.T too!

post secret Sunday

I adore ML. I never could have imagined finding such a wonderful soul to share my life with. I am thankful every single day that he is my partner.

One of the most heartwarming things about reading all of these blogs is seeing just how much love and passion we all have for our spouses. I smiled when I found this post secret card this morning, loving the fact there there is so much love in this world.

PS: Thank you Julie for sharing your favorite websites in a post a while back. Post Secrets was a great new find for me!

IUI questions

I am thinking a lot about what comes next. Regardless of what it is, having a plan that I can follow makes the whole process so much smoother. There is of course the risk that the plans I make will get changed at the last minute, which seems to occur at nearly every junction. Yet, in the meantime, my anxiety is much more manageable when I can see our potential options laid out ahead of us.

Barring a miracle with this FNA MAP (which we scheduled for September 29th) we will be proceeding with donor sperm. I want to start working through some of the choices that I'll be faced with. Ultimately, I am trying to balance the emotional, physical, and financial components.  I am hoping that some of you who have been here/done that can offer your advice.

How do I choose a RE for dIUI?
There is one local RE who has a very small boutique practice. He is fairly new and only had one year worth of IVF results reported. (He'd only had 4 IVF patients and only one was successful.) It would be so much easier to have a local Dr, but I have a general distrust of our rural medical practitioners and worry about a 'one man shop' being the right fit for me. I would not do IVF with this Dr for those reasons. PROS: local, personal, less time off work, ML could be with me at all appts,  CONS: one man shop, I'd only do IUI with him

There is the big university hospital RE program in the City. I had an initial consult and ultrasound with the head of their program, they did my saline sonogram, and their geneticist reviewed our records too. It is a 3 hour drive each way to get to the City, which requires a day off of work. I trust their medical judgement and like the fact that although I'll have a primary RE, there is a team approach to every case. PROS: reputation, trust, team, consistent care if we move to ivf, CONS: travel, time off work, ML couldn't be there at every appt.

The other option would be to find a different RE in a nearby city. I might be able to cut an hour off the drive while still benefiting from the larger practice.

What questions should I ask the RE?
How much experience do you have with IUI? dIUI?
What can we expect as a IUI success rate with your office?
Do you have a preference for medicated vs unmedicated cycles?
What hours are you available? Evenings? Weekends? Holidays? Emergencies?
What lab do you use?
Where did you train/residency? Where did you work before?
What are the costs associated with dIUI? (actual procedure, monitoring, sperm prep, other?)
At what point would you recommend we switch to IVF?
What records / tests will you need from me? Do I need to repeat anything?
How quickly could we start a cycle?

How to choose sperm?
Oh My, this is a loaded question that deserves its own post.... but here goes.
Which sperm bank to use?
How do we narrow our choices and make a selection?
Are there cost differences between the banks and donors?
Which bank will give us the most information about the donor?
How do ML and I do this together? Will ML do this on his own?
Things that are important to me:
Open donor, not a CF carrier (full screening?),

What do we tell people?
Who do we tell?
What exactly do we say?
How much privacy do we maintain for the child to choose to disclose?
What kinds of reactions should we expect and how to best respond?

I think that this is a good start at organizing my questions. I am going to keep this post active and add to it as I think of other questions or topic areas. I really would love your wisdom and experience about all of this - comments, links to other posts that explore these questions, any resources that you know about!

Three cheers for the ALI community. Thank you for being here.

Time Waits for No One

I have so much to write about. So many thoughts to get down on paper.

In the meantime, I wanted to share this quote that my therapist gave me yesterday. I've never been the kind of person to let life get in the way of me living it, but this concept is most definitely relevant for me right now.

for a long time it seemed to me that life was about to begin 

-- real life.

but there was always some obstacle in the way, 

something to be gotten through first,

some unfinished business, 

time still to be served, 

a debt to be paid.

at last it dawned on me that these obstacles 

were my life.

this perspective has helped me to see there is no way to happiness.

happiness is the way.

so treasure every moment you have 

and remember that time waits for no one.

Happiness is a journey, not a destination.

~ souza

One thing that I enjoy so much every single day is the love of my adorable puppy. This picture was taken a few years ago at my favorite beach. She had been playing all day long, swimming, chasing her ball(s), etc. She is the sweetest dog, so loyal and loving. and a big time cuddler. Every morning she waits for ML and I to stir and then she crawls her way up to our pillows so that she can lick us. It is one of the sweetest things to start off every day with. (and totally makes it worthwhile to let such a big dog sleep on our bed!) 

I love seeing pictures of all of your adorable pets, and figured it was about time that I share a picture of our little furbaby. 

I'm Confused by Resolve

I just completed the RESOLVE "Tell us about yourself" survey. It was short and sweet, so get online and fill it out yourself.

But now I'm sitting here with a scrunched nose. I'm confused.
Question number 6 asked:

*6.	Question - Required -How many years have you been trying to conceive?Less than 1 year 1-2 years 2-3 years 3 or more years No longer trying to conceive That seemed pretty straightforward, but then I got stumped by question number 7.

*7.	Question - Required -If no longer trying to conceive, which family building options are you pursuing?  Adoption Third Party Reproduction (donor sperm, donor egg, donor embryo, or surrogacy) Childfree Undecided None of the above

I am desperately trying to conceive. And the only way I can do that might be with donor sperm. But the question implies that I am no longer trying. And in some way I guess that trying implies that there is a chance it could happen any month, but it can't because we don't have sperm.  and all of that is actually a bit upsetting to me.

So I realize that RESOLVE deals with some of the most hormonal delicate sensitive ladies out there, and it must be really hard to chose the right words all the time, but still.... I wasn't expecting to get upset about an 11 question Resolve demographics survey.

*****

I had a dream that we were selected by the Cade Foundation for their 2011 family building grant. They will announce the awards later this month. In reality, I think that our application was really strong, but I worry that they won't understand some of the complexities we are facing with the MFI diagnosis. The application was definitely geared towards female factor infertility. For instance the application required a letter from our RE, even though we aren't working actively with an RE. I ended up sending a letter from both the UR and the last RE we met with.  Maybe next year I can offer a few suggestions for their application.

I am actually a little nervous, because if we are selected then we will have to 'go public' with our struggle. I knew it when we signed up, but it still feels really scary.



*****
I saw my regular dr today for what I think is a UTI, yuk. We had a chance to review my meds and my mood. I feel like she really listened to me and trusts what I am telling her. She suggested increasing the happy pill (lex.apro) dosage to 20mg, and adding Clonaz.epam .25 mg on an as needed basis. I'll still have the x.anax as a fast acting panic management tool, but hopefully will not need to use it as often. She assured me that, assuming this new plan works well for me, that I could maintain it through treatment. She said that we could reevaluate if/when i get preggers and likely stay on it until the third trimester. So that is good, and it feels good to know that I have a local doctor who is committed to helping me get through this.


*****
Ohhhh, and most exciting news - My friend, the sweetest strongest lady who did ivf with mtese a couple weeks ago, emailed me today with the results of her beta. The girl is PREGNANT! The beta was so high that the nurse thought it could be twins!!! There is good news sprinkled along this journey, and friends who I never would have met otherwise. Her success, Dory's success, Julie's success, Kakunaa's Success, Bea's success, Circus Princess success - You ladies give me hope that the impossible is possible.

Crazy Swirling Thoughts

I make these plans in my head.
I create timelines of what comes next.
I try to plan for all of the different contingencies.
The thoughts swirl round and round in my head.

If the FNA shows sperm, then we'll do IVF with mtese. How soon after the FNA can we schedule the mtese? How quickly could they get me ready for IVF ? Should I review the IVF calendar with the RE before the FNA? Which RE should we use - the big university RE where our first UR was or the private RE that is connected with our new UR? It's been a year since I had my bloodwork and ultrasound and hystrosonogram - will I need to get all of that done again?

If the FNA shows no sperm, then we'll do iui with ds. How quickly could we move forward with iui? Should we travel to the City for the university RE or the private RE? or should we interview the one local RE? Do we really want to do iui? - how many? - medicated? - before we switch to ivf with ds?

In either case we'll need donor sperm. If we wait until after the FNA will there be enough time to order ds so that it arrive in time for the ivf or iui? How long will it take us to choose? How will we choose? What if we can't choose? What if we can't choose, and ML decides that he wants a known donor and we have to wait another 6 months for quarantine?

The costs keep adding up.
The waiting keep adding up.
My tolerance for living like this is growing thin.
My happy pills don't feel like they are working.
I feel like giving up at the same time that I feel like desperately hanging on.

I watch each month pass me by. Before we know it my sister will be pregnant, my bestie will start round two. ML wants to take it one step at a time. Wait until we get the FNA before we consider the next step. He feels okay about losing a little time in between decisions. I feel like I've been waiting for so long, and lost so much time already that there isn't any time to lose.

Besides that, I need to end this journey as soon as possible. Time lost isn't really time lost, it is more time spent in this suffering. It's not neutral.

We are quickly approaching the end of the 6 months of FSH therapy. I wrote to the UR last night to schedule the final SA and FNA Map. We'll run out of the FSH on October 15th. At $1,700 per month, I'd rather not order a 7th box unless its necessary. The FNA results take about 2 weeks. So we want to schedule the FNA for the last week of September. I'd thought that we could maybe go right into the mtese/ivf with my October cycle (and be pregnant by my birthday in mid November), but in her reply email, she said that the Dr prefers to wait 3-6 months between an FNA and further surgery.

If the FNA shows sperm, I will cry with joy at the chance to spend another $4-8k on ongoing FSH, but it is an additional chuck of cash that I hadn't added up in my head yet. And that would put us into February as the earliest we could do IVF. and the waiting game continues.

I slipped it in, and I know it is yet another unrealistic idea, but I'm thinking about it. My birthday is in mid November, and if we did an October ivf/iui cycle I could potentially get my bfp as a birthday present. It is a crazy dangerous thing to think about, I know, but its what i think about.