Thursday, July 2, 2009

Off schedule

I like my job; I like being a lawyer. (Not entirely sure what that says about me as a person.) In the nearly-five years that I have been a lawyer, there have been considerably more days when that has been true than not. I have never once, in the almost eight years since I went to law school, regretted my decision to change careers.

The one-and-only thing I miss about being a hospital nurse is my schedule. Though it often meant working overnight shifts and weekends, for most of my career, I worked only 3-4 days a week. I had loads of flexibility. And when I wasn't at work, my job duties were someone else's responsibility.

Why am I posting about my job when I devote this blog to information and thoughts about TTC and IF? Keep reading.

My RE's nurse called me yesterday with my protocol for my next cycle. The RE plans for me to use Follistim on five different days: 125 iU on CD 3, and 75 iU on CDs 4, 6, 8, and 10. I will also take Clomid 50 mg CD 3 through CD 7 and an hCG trigger shot. The monitoring he does for this cycle is similar to the monitoring for a Clomid-only IUI cycle--one mid-cycle u/s to check follicle growth--except that it occurs on CD 11 rather than on CD 14. I will start using OPKs on CD 8 rather than on CD 11 as I had been doing.

As I was lying in bed last night thinking about all this, it occurred to me that the week when it is most likely that my mid-cycle u/s and IUI will fall--the week of July 12 through 18--is one of my busiest at work this summer. I have a half-day on-site meeting on Monday that cannot be postponed and starts early enough in the morning to conflict with a 9:00 a.m. appointment (the standard for u/s at my RE's office). The meeting has been delayed weeks already due to others' vacations and is crucial to our defense of a multi-million-dollar claim. Tuesday and Wednesday, I will be 100 miles away assisting with jury selection on a trial which my supervising partner is doing in another county. My attendance at both days of jury selection is not only helpful to the partner, it is mandatory per the insurer's policies for a second attorney to assist. Because our firm has only two associates, there is no one else available who could attend in my place. Thursday I will be attending a mediation with a client and insurance company representative all day starting at 8:30 a.m. The mediation has been set for three months and involves four other parties besides our client. Finding a date to hold it took weeks. It cannot be rescheduled, barring a true emergency. (And the client and insurer--not to mention the partner on the case--would not consider a potential conflict with fertility monitoring or procedures an "emergency.")

AF has not yet arrived, but I expect her at any time. The last cycle I used progesterone gel, it delayed her arrival considerably: I started five days after my BFN. If this cycle follows the same pattern, I could expect to start on Saturday July 4th. If July 4th is my CD 1, I'm screwed: that would make July 15th CD 11, when I am out of town. If she arrived today, CD 11 would fall on July 12th. All well and good for my mid-cycle u/s, but that would put my IUI smack-dab in the middle of all my work commitments.

I finally puzzled out that the only way I will be able to be available for a mid-cycle u/s and IUI this month is if AF doesn't arrive until Monday July 6. Not impossible, I suppose. Really, this being only the second cycle I have used the progesterone gel, I don't have any way to predict precisely when AF will arrive.

Yet again, I am struck by the fact that significant events in our TTC efforts are in direct conflict with work commitments. I am totally and completely available the week of July 5th and the weeks of July 19th and 26th. It seems all-too-coincidental that, once more, the only out-of-office commitments I have are likely to fall during the most crucial point inmy cycle.

There are those who have suggested that perhaps this is a way of the universe telling me that my priorities need to be realigned while TTC. But I am not choosing to put work first, so it isn't a matter of priorities. We need my income just to live, let alone to pay for fertility treatment. In this economy, even if I wanted to change to a less demanding job, it likely wouldn't be an option. It would definitely be a significant pay cut. I don't have the luxury of taking a pay cut or cutting back on work. Because of the size of my firm (small) and the type of work that we do (litigation), I don't often have the luxury of rearranging my schedule to accommodate my TTC efforts. Most things that are set on my calendar are set weeks or months in advance, in coordination with the schedules of several other people.

MM and I discussed this dilemma a little, and he suggested that we take a break this cycle. He doesn't want me to spend the money on the drugs (the Follistim is expensive: the nurse told me it would be over $250 for the amount I need) and go through the stress of taking them only to end up not being able to be properly monitored or be available on the day I need to have the IUI. His reasoning is sound and logical.

My only problem with taking a break is that constant, nagging feeling I have that I've wasted too much time already. I am committed in my mind to doing at least four cycles of IUI + injectibles before giving up or considering other options. Skipping this month means not starting my first cycle of that protocol until August. Assuming I need all four cycles--and assuming I don't have any other conflicts that cause more delay, not a fair assumption based on past history--I am still potentially looking at December before I have completed four cycles, depending on the length of my cycles. (And my cycle length has been increased by the medications I have been using.) By the time I know the outcome of the fourth cycle, we could be into 2010. I hate the thought of turning the calendar to a new year and still not being pregnant.

On the plus side, though, I know that taking a break in May--and an unplanned one at that--was a really good thing for me mentally. Maybe it is good to give my body a rest in between treatment cycles. I could use the month to re-focus on healthy eating and exercise and lose some weight. (I actually lost over 4 lbs this cycle, just be working out hard the first two weeks and eating better.)

I suppose my ultimate decision will be dictated by when AF arrives.

5 comments:

  1. I know you guys aren't sure you want to move on to IVF, but I've seen on several websites that after 3 failed IUI/clomid cycles, studies have shown that moving on to IVF is a better choice. Just a thought to keep in mind.

    Also, I've used progesterone three times, and I usually get my period exactly three days after stopping it each time, so it's always been pretty predictable. I don't know if it's always the same for everyone.

    My last point is that even though I'm qutie a bit younger than you, I'm not too far ahead in the TTC journey. The longer I'm in this, the more I realize that one month of lost time doesn't matter as much as the benefit you can sometimes get from a break. I'm guessing it's different when you have fewer fertile years ahead of you, but that's just my two cents.

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  2. sunflowerchilde, thanks for the comment.

    I am 98% sure that we will not move on to IVF EVER, but particularly not at this early stage. Our insurance pays for 50% of our IUIs, up to six cycles, and zero for IVF. It wouldn't make sense not take advantage of what little coverage we have, even if the odds of success are not quite as high. (At 38/39, the odds of success with IVF using my own eggs aren't very high either, and it costs about 10x as much.) At this point, we have only done one cycle of Clomid + IUI; my last cycle of Clomid was done with timed intercourse only.

    I have not read that 3 failed Clomid + IUI cycles mean you should move one to IVF, and my RE told us that he usually tries IUI + injectibles before moving to IVF. In fact, I have read to the contrary: that many women who do not get pregnant using Clomid + IUI have success with injectibles + IUI, and the literature cites a higher success rate for IUI/injectible cycles than for IUI/Clomid cycles in patients with unexplained IF.

    I'm not really sure if one or two months make that big a difference, but my RE has stressed to us at every appointment that at my age, I have no time to waste.

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  3. Here's the blog post, with a link to the study, saying that IVF is better than IUI with injectibles after 3 failed clomid/IUI cycles: http://myemptynest.wordpress.com/2009/06/24/if-iui3-fails-what-next-doctors-opinion/

    I forgot you'd only had one clomid cycle w/out IUI - I guess that shows you could still have a chance with IUI if you can ever get the timing to work out.

    And I don't have infertility insurance coverage, so I always forget that can be a factor for people. I have to pay 100% out of pocket, so it just doesn't occur to me.

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  4. don't put yourself under extra pressure, do your work thing because that is more important right now - a month is truly not a big deal. Don't get too hung up on timing right now, or you'll drive yourself insane. ;)
    Maybe these coincidences between work and cycle are happening for you to embrace the lack of control that IF brings into your life? As you can probably already attest most of us in the blogosphere are control freaks, and you seem to fit right in with the club. :) But one of the first things I see everyone forced (myself included) to throw out the window is the tight calculations of days and trying to fit everything neatly together. Life is messy. And as you well said, in the economy right now, your job is a priority. And you can plan everything, and be surprised with good news when you least expect. Everything is possible because so much of life is absolutely in the weaving hands of mystery.
    Although it is tough for you to be facing IF, you are still in the beginning of your journey (hopefully it's a short one for you), not long over the 12 months thing that medically "declare" us as infertile. Do it the natural way this month - you seem to be in the unknown category, so you can always have hope with that.
    About the follis.tim. I used it in my IVF and in my IUI cycle. It's pretty expensive. It works really well and you need monitoring! it stings pretty badly too... just so you are prepared for when you get it.
    good luck on your journey!

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  5. This is likely too late anyway, but I was going to suggest staying on the progesterone for a couple extra days to delay AF - with your doctors approval of course.

    I'm sorry that real life has to get in the way of all the appointments and procedures. I know that frustration all too well. Sometimes all we can do is go with the flow (bad pun intended)...I hope all is working out in your favor.

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