Open House

February 19, 2012

At the nursery school Open House, we discovered that two classmates were born within a week of Burrito and Tamale’s birthday.

One of those dads said, “I guess a lot of us were gettin’ it on around New Year’s!”

What I said to him: “Actually, they were preemies.”

What I thought immediately: “Well, now I know one couple in this room who definitely isn’t infertile.”

What I realized later: “My egg retrieval for IVF #2 was on New Year’s Eve.
I’m pretty sure there was no ‘gettin’ it on’ within a month of New Year’s.”

Thoughtful ThursdayStill in limbo. It has gone from being delicious to excruciating to a chance to practice being patient and back again.

One of the things I’ve been doing while in limbo checking out alternate scenarios in case this job doesn’t happen — how would it play out if we stay here, where else might we move, etc. Mostly, though, I’ve been keeping tabs on our potential new city.

Any new housing listings being posted in the desired areas? An exciting new option might come along, or the owners of the house we’ve already settled on may decide that they can’t stand this limbo any longer and need to rent to someone else.

I already know which organic market I’d shop at. Which farmers markets operate on which days.

I’ve drawn up a short list of preschools — not for this year, and probably not for the next year, but the one after that.

I know what route I’d take to get to work every day.

I know which gym my husband should join, and I know where to find yoga classes for myself and for my little budding yoginis.

I have scoped out every playground within walking distance. I know which museums have reciprocity with my existing museum memberships. I know which pumpkin patch we’d visit for Halloween.

The one thing I don’t yet know, the one thing I haven’t allowed myself to search for? Where I’d do pottery.

For each of the other cities we’ve thought we might move to in the past year, I looked up all of the options and settled on a pottery studio. By drawing this boundary, I’ve simultaneously given myself something to look forward to and kept myself from getting too entrenched in one possible future (as if the farmers market and yoga schedules are not entrenched). The line is arbitrary and artificial and silly, but the existence of a line means that I stay (vaguely) grounded in reality instead of only What Ifs.

Sort of like when I was in infertility limbo. In each city where we lived during IF, I had selected an OB, a prenatal massage therapist, a studio for prenatal yoga, a doula… I’d picked out names, and strollers, and car seats… I literally read a dozen books on pregnancy the first year I was TTC… but I didn’t allow myself to buy a single baby item. In that case, it was already too late to keep myself from getting mired in What Ifs. The boundary was more about waiting for reality to catch up with fantasy. It’s a good thing that I established that particular boundary: if I’d actually bought a car seat when I started TTC, long before I ever got pregnant with Burrito and Tamale that car seat would have passed the expiration date.

Do you ever draw lines for yourself? Do the lines represent real, meaningful boundaries, or are they arbitrary?

Thoughtful ThursdayJumping off from the Dollars and $ense of Family Building (and by the way, if you haven’t checked out the blog hop yet, please do — and if you want to contribute your own post, even better!)…

One theme I’ve seen come up over and over again in the Dollars and $ense posts is money spent on failed cycles and other efforts that didn’t pan out. Some people seem to accept it as a necessary part of the process. Other people seem to lament the waste. I’ve referred to it in my own post and in a blog post years ago as water-under-the-bridge money, and for the most part that’s how I’ve approached it.

Some people are prudent in their approach to sunk costs, cutting their losses and moving on. Others keep going because of the resources already invested, even when it doesn’t make any sense to keep going.

Eating something that tastes horrible?
Halfway through watching a terrible movie?
Paid thousands of dollars in repairs for your crappy car?
Invested a couple of years in a bad relationship?
Spent tens of thousands of dollars and years of your life trying to have a baby?

With the little things, eating something yucky or watching a bad movie, I’m likely to just finish, even though it would be wiser not to. When it really counts — relationships, big ticket items — I think I’ve been good about cutting my losses. With infertility, though, I was in between: I accepted the losses as water under the bridge, but I couldn’t ever bear to cut my losses and move on. The hard part is that during infertility, you don’t know whether you’re showing perseverance necessary for achieving your goal, or whether you’re succumbing to the sunk cost fallacy and throwing good money after bad. Of all of the awful things about infertility, that part — not knowing if you will ultimately succeed if you just keep going or if everything you put in will ultimately be wasted — is, to me, the very worst.

When there are sunk costs, do you move on or try to stick it out? How does your typical sunk cost approach relate to your family building efforts?

Welcome to my contribution to the Dollars and $ense of Family Building blog extravaganza!

I am one of the organizers, along with Lori Lavender Luz of WriteMindOpenHeart. At Lori’s blog you can get the background and overview of the project, as well as add a link to your own post if you’d like to join the fun.

Lori and I wanted to get a variety of bloggers’ perspectives on the role of finances in family building, and you can find a dozen others at the main Dollars and $ense page. There are infertility and adoption bloggers with just about every perspective you can imagine. The perspective I’m bringing is that of a longtime infertile who pursued treatments with no regard to the cost.

I didn’t set out to break the bank. I got into treatments, both financially and medically, little bit by little bit. I started TTC at age 26, and after more than a year of patience I decided that my charts just didn’t look right and I needed some help with my luteal phase. I was a graduate student at the time, so I went to the student health center. The pediatrician who saw me obviously didn’t know how to handle infertility, nor did the gynecologists who spent most of their time preventing girls from getting pregnant. They immediately referred me to a specialist affiliated with the medical school, who just so happens to be a world-famous reproductive endocrinologist (Dr. Fancy Pants, as I’ve called him before on my blog). It doesn’t really make sense to send someone just starting out to a doctor at the very top of his field, but that’s where I was sent.

I expected Dr. Fancy Pants to start slowly with a month or two of assessment, but he preferred to jump right in with Clomid and do the assessment along the way. It was just a little pill, it didn’t seem like a big deal. Then the next cycle we added progesterone. Then the next an HCG trigger. Meanwhile I was paying out of pocket for each ultrasound (performed by the doctors themselves rather than a tech, ooh la la), each blood draw, and everything else. A hundred bucks here, a couple hundred there. Before I knew it we’d spent over $10,000, which was all of the money we had saved in the 6 years we’d been married. We stopped treatments, in part because a miscarriage took the wind out of my sails but also in part because we were out of money.

I needed to stay away from treatments for a couple of years but decided to try acupuncture (which was covered by my student health plan). When I finished my graduate program, acupuncture stopped being covered, but by that point I felt like it was benefitting my cycles enough to be worth the expense. Through two long-distance moves I pursued Eastern rather than Western medicine. Casually at first only every few weeks, then I added herbs, then I started going weekly. All of those treatments added up too. Eventually my (3rd) acupuncturist and I simultaneously came to the realization that I’d given Eastern medicine a full try and it was time to go back to Western medicine. He referred me to Dr. Full Steam Ahead.

By that point I had turned 32 and “you have plenty of time” was starting to become “you’re not getting younger.” Along the way we had sold a house at a large profit (thanks, housing bubble!) and had replenished our savings substantially. We decided to go full steam ahead with Dr. Full Steam Ahead, who within 6 months had put me through a full assessment, two IUI cycles, and my first IVF. DH and I had committed to finally getting pregnant successfully, no matter the physical or financial cost. Adding a second IVF that year, we ended up spending so much money on medical expenses in one year that it recently resulted in an IRS audit.

At that point our ample savings had ceased to be ample, and we wondered how much longer we could keep going. As with Dr. Fancy Pants years earlier, each new cycle brought an additional tweak such that each time it seemed like this must finally be it. Add this drug. Try IVF. Try ICSI. After the second IVF failed, though, we’d been through 10 treatment cycles and the excitement had worn off. We also looked at our finances and realized that our large savings had now become rather small. Along the way I’d taken a new job largely motivated by the need to secure (any) health insurance. The new insurance happened to cover IF – but only assessment and IUI, which we’d already moved beyond. Then I learned about a way that I could get health insurance that would cover IVF. (I was sure I’d blogged all about the trick long ago, but I can’t seem to find the post… hmm. Briefly, it requires starting your own company, and it only works in certain states, but if you can pull it off it’s a fantastic loophole.) In preparation for that, I did one last IUI to satisfy the future insurance company’s requirements for IVF, and from that perfunctory IUI came my twins.

In an alternate universe, if it hadn’t worked, we would have secured the IVF-covering insurance and exhausted the 3 IVFs it would have given us, bringing us to a total of 5 fresh IVFs. If that still hadn’t worked, I just don’t know what we would have done. Presumably by that point some doors would have started to close themselves – maybe the doctor would have declared that egg quality or my body’s response was inadequate, or something about the sperm-egg combo, or who knows. We very well might have gone back to paying out of pocket, and if we’d had to pursue something like donor eggs we definitely would have paid out of pocket. Thankfully we didn’t have to find out, and I was able to end my infertility tally at only $70,000.

Now, answers to specific questions that the participants raised.
1. Consider your now or future children as adults, and consider the fact that you had to spend money to either conceive them or make them part of your family. What effect do you think the latter will have on the former one day? What, do you think, your grown children might feel about the funds it took to create your family?
Honestly I think it’s a huge compliment to them, and a testament to how very much we wanted to bring them into our lives. While they’re slinging burgers to pay for college they might lament the “wasted “ money, but without all of that water-under-the-bridge money spent, they wouldn’t have come into existence.

2. How did/would you handle it if your child asks you, “Mom, how much did I cost?” How would you answer at age 7? At age 18?
At 7: We wanted you so much that we did everything we could to bring you into our lives. It did cost a lot of money, and we had to experience a lot of medical procedures, and it was very hard, but it was all worth it. We love you so much, and we loved you so much even before you ever existed.

At 18: Bringing you into the world cost a lot less than we’re about to spend on your college education.

3. When calculating the costs of your family building, what do you include? The direct costs are easy (such as RE fees for a cycle or homestudy fees), but what about fees that didn’t directly lead to your child’s existence in your life, such as cycles that didn’t work, adoption outreach avenues that didn’t work, failed adoptions, avenues that were explored (and that cost something) but not pursued, etc.?
I count everything. Each cycle that didn’t work was a necessary step in bringing us to our children, and each dollar spent was a dollar that we spent.

4. If two children in a family “cost” different amounts, should that have any significance?
My two children happen to cost exactly the same amount because they are twins who were conceived in the same cycle. If we’d had two singletons who came from cycles with different fees, I don’t think that would matter to us. But, if we had one child from treatments and one child naturally (did you know that people have babies without doctors? or maybe it’s just a fairy tale), it would seem significant – though less because of the financial cost and more because one conception was so much “easier” than the other.

5. To what extent have finances determined the family-building decisions you have made? How have you able to balance financial considerations against other factors such as medical, ethical, emotional…?
Finances have determined our decisions far less than they probably should have. As I mentioned above, we stopped treatments for a few years to replenish our savings, and we did opt for our 11th cycle to be an IUI rather than IVF specifically because of insurance requirements. We also opted to start IVF when we did rather than continue with another IUI or two because the IUIs were so expensive with such a low success rate that IVF just made more sense. Otherwise we didn’t pay much attention to money and just kept writing the checks until the account was empty. I don’t know that I recommend that approach, even for those who have the means, but it’s the approach we took.

6. Has institutional and governmental support for certain family-building paths impacted your choices? For example, ART being covered by insurance, tax deductions for adoption expenses, etc.
The fact that ART was not covered by insurance for most of our journey certainly had a huge financial impact. Once we secured insurance that covered treatments, you’d think that it would have been liberating. In fact, in our interactions with the insurance process, I realized how much leeway we had when we were paying out of pocket. For example, in our one covered cycle, the FSH wasn’t approved until it was too late to start the cycle, and I was only able to proceed as scheduled because I had leftover (and presumably spoiled) FSH from a previous cycle. If we’d ended up doing IVFs covered by insurance, I’m sure there would have been a lot of bureaucracy, to the point that it would have interfered with the cycles in terms of timing or even what procedures/drugs could be used. At $15K per cycle saved, though, it would still have been worth the hassle.

7. Have you considered having ART treatments abroad, either due to lower cost or due to certain methods being unavailable or illegal in your own country? In your decision-making, how did you balance the financial savings against issues like the unknowns of the country, perhaps not speaking the language, and medical practices that may differ from those of your home country? If you did travel abroad for treatments, what was your experience? Would you do it again?
The “IVF cycle as extended vacation” idea crossed my mind only because I’d seen others do it, but doing it locally was more practical and there wasn’t anything we could do abroad that we couldn’t do at home. There are other participants who can answer this question differently, though… Speaking of which, it’s time for you to visit the rest of the Dollars and $ense posts! Thanks for stopping by!

Visit Write Mind Open Heart for more perspectives on the Dollars and $ense of Family Building and to add your own link to the blog hop by May 1, should you want to contribute your thoughts.

Thoughtful Thursday: Goal

January 7, 2010

(Intelligentsia coming in next post. There’s a thing.)

Thoughtful ThursdayThis week’s topic follows last week’s on what kind of person you’re trying to be, as well as a post on another blog. Earlier this week, Carrie from Tubeless in Seattle had a beautiful post about the kind of mother she thought she’d be versus the kind of mother she is. I’ll wait while you read it.

Doot doo doot, boop doo dee doo waaaaaaaa

Okay, great, you’re back.

As you just read, Carrie asked:

Are you a different mother than you’d imagined? Are you still trying to become a parent? What is your ideal role? Do you have peace about your mothering?

I commented:

I am much more willing to share them with others, probably in large part because they are multiples. Ultimately that’s a good thing for all of us. I think if I’d had a singleton I might never let anyone else hold the baby.

I am not as doting as I thought I’d be. I just don’t have as much to give as I thought I would. I think that will come with time, and with sleep.

Everyone constantly remarks about how laid back we are as parents. I expected that DH and I would be the way we are, but I didn’t realize how non-laid back everyone else is.

I know that I am doing a great job of mothering, but peace is not the word I’d use. Can you feel peace with one part of life if you don’t feel it in some others?

For Thoughtful Thursday, let’s examine a variation on Carrie’s question.

What kind of parent do you want to be?

This applies both to those who already have children, as well as those who are working on becoming parents for the first time.

As for me, I want to be a mother who loves her children like crazy and expresses that love constantly.

I want to show my children the world, literally. We’re already talking about a trip to Europe in the fall, though DH thinks it’s nuts to go when they’re less than a year old and can’t appreciate it.

I want to teach them and to help them learn for themselves.

I want to be patient.

I want to ignore the crap that comes with American parenting like consumerism and helicoptering and competitions with other parents.

I want to foster their relationships with each other, family, and friends.

I want to make the most of every day.

I want to think through the decisions I make.

I want to enjoy my own non-parenting pursuits like my career and hobbies and, by being away from them sometimes, be a better mother when I’m with them.

I want to share this journey with my husband with laughter and sweetness.

I want to benefit from the years of infertility by appreciating them for the miracles that they are.

Not too tall an order, right?

What kind of parent do you want to be?

Thoughtful Thursday: Far

December 10, 2009

Thoughtful ThursdayHow far would you go?

My husband doesn’t like What If questions. He finds it pointless to dwell on the hypothetical and instead prefers to deal with actual situations as they arise.

Separately, he really really likes tigers. Whenever we hear about the slaughter of tigers for purposes like creating alleged aphrodisiacs with their penises, he gets terribly angry.

So, you can imagine his frustration when I asked him last year:

If you had to kill a tiger for us to have a child, would you do it?

Oh, he did not like that hypothetical question about slaughtering a tiger at all, not for its penis nor any other part. Eventually he grudgingly acknowledged that if there were absolutely no other way, conquering infertility would trump his love of an endangered species.

Thankfully, it never came to that. Also, tiger penis doesn’t really cure infertility.

We did, however, resort to other avenues that we didn’t envision when we started out. Injecting myself with hormones derived from hamsters and from human urine. Draining our savings, then waiting a few years and draining our savings again. Spending the equivalent of a part-time job, for many years, on treatments and on tears. So many other things that, when I started out, I never thought I’d do.

Because really, I would have done nearly anything for a baby. No amount of money, no number of years, no measure of pain would have been too much. Some people are more sensible and less obsessive, and they know their limits. I wouldn’t have hurt any people (or endangered species), but there’s not much else I wouldn’t have done. I honestly don’t know whether that’s good or bad.

How far would you go (or would you have gone) to have a child?

Fertility Massage

December 2, 2009

Wait, what? Is that title right? Yes it is!

A recent post from Gracie in Brooklyn about uterine massage reminded me that I never blogged about the fertility massages I used to get. Gracie’s post is the first blog I’ve ever seen talk about it. I was always surprised that no one in the entire IF blogosphere ever mentioned it.

I had no idea that fertility massage existed until I saw it offered at my acupuncture clinic. So, as a public service, I’ll tell you what I experienced, and you can decide whether to see if you can find a practitioner in your area. There aren’t many, unfortunately. I suppose that if you have a massage therapist that you already like and trust, you could ask him/her to incorporate some of the techniques.

The “fertility” part combined several massage techniques:

  • uterine massage, in which the uterus is massaged very deeply — strangely pleasant, as Gracie describes
  • femoral massage, which fans of Randine Lewis’s book The Infertility Cure may recall, in which the circulation in the femoral artery is temporarily blocked to pool the blood in the uterus
  • reflexology on points specific to the reproductive organs
  • lymphatic drainage, which I’ve never fully understood so can’t really explain to you

These techniques are primarily focused on increasing blood flow to the uterus. Some women do have fertility problems caused by restricted uterine blood flow, and for them, fertility massage would be perfect. Because my fertility problems are unexplained, it’s not clear whether increasing blood flow would do anything, and I can’t say whether fertility massage actually did anything to help me conceive. I can say that I enjoyed fertility massage even more than acupuncture, and infinitely more than anything that involved my RE.

As someone with chronic back problems, it was wonderful to be able to justify spending money on frequent massages. By my skewed logic, I rarely spend money for my own well-being, but with anything that involved TTC, I spent money hand over fist.

Postscript (mentions pregnancy and babies): I had so many fertility massages that the massage therapist and I became friends. I continued to see the same woman for prenatal massage. When I was hospitalized, she drove almost an hour to visit me in the hospital and to massage me for free. I have seen her for massage a couple of times since giving birth, and in addition to the usual, she has been massaging the site of my C-section to reduce scar tissue (which never would have occurred to me; I thought I’d just have a lumpy scar forever). We also brought Burrito and Tamale for a class she taught in infant massage.  At the class I saw a woman from my old infertility support group. Her baby is a month older than B & T, and we traded parenting tricks and massaged our babies. Full circle.