Doctor Day

I had an appointment this morning for my endometrial biopsy, followed by another appointment a couple of hours later for us to both consult with Dr E about the plan for our IVF.

It's a good thing that I decided to just take off work, because we ended up being there the whole damn day.

When we walked in, there were a ton of people in the waiting room, and it was probably forty-five minutes before they called me back.

When it was finally my turn, Dr E apologized for the delay, saying they'd had computer problems and more appointments than necessary and two nurses out.

I was hoping that she was taking that all better than I would be, because the last thing I wanted was for her to be stressed out or pissed off while in my uterus.

The biopy itself was about as much fun as it had sounded. I asked her before she started how it would compare, pain-wise, to the HSG, and she said it was probably comparable. I think that's pretty accurate.

The upside is that we (me, Shrike, Dr E and Nurse M) were all chatting and laughing during the whole thing, so that helped to distract me.

Although, laughing with a speculum in is not the best idea!

I'm not sure how we got on this subject, but we were talking about how old people can get away with saying inappropriate and un-PC things, and she told a story about an older, male doctor with whom she worked during her residency, who refered to all women as "broads."

Him: "You know, for a broad, you're a pretty good doctor."
Her: "Well, coming from an old guy like you, that's quite a compliment."

Can you see why we like her? Stay tuned, there's more!

When she was done with me, we went over to my OldWorkCenter to drop off and pick up some things, and visited with ED2 for a few minutes.

Then, back to the clinic for our chat.

Part of that involved going over all the medical history paperwork that Shrike had filled out. After some questioning about whether her last Pap smear (late January 2007) was recent enough ("within a year" - no it's not), Dr E asked if she had one scheduled yet, with Dr B.

"No? Well, come on, girlfriend!"

(Jumping up and heading out the door to the exam room, popping her head into Nurse M's office to say, "We're doin' a Pap!")

Ruh-ruh. And I had promised her she could keep her clothes on. No such luck.

After a quick trip to the potty, she got a Pap smear, cervical culture, breast exam and heart/lung test. Everything seems to have checked out okay, so far.

Then, after more debate about when she'd had the previous infectious-disease bloodwork (July) they decided it was time to do it again (every six months, for "donors").

Oh, and look, it seems that we need a urine specimen, too. Can you do that?

"Oh, no problem," Shrike said, "I can always do that!"

(She is the peeingest girl that I ever did see.)

She wasn't able to give them much (because she had just gone) but it seemed to be okay.

Then she had a bunch more paperwork to fill out, and I went up front to give them all our my parents' money.

When I got back, Shrike told me that she had to pee some more, because it seems she also needed a drugscreen, and it requires a larger volume.

Eight vials of blood later, it was decided that we should go get some lunch (large iced tea for Shrike, please) and come back afterward for the rest of the pee.

When we got back, she tried again, but still wasn't able to give them enough, even with all three attempts combined.

So, she hit the water cooler and we read out of date magazines while waiting for her kidneys to do their thing.

After about four glasses of water, she tried again, and did a bang-up job this time, almost filling the cup on that one trip alone!

Of course, it was so dilute that it was almost clear, but they said it would do. Victory!

About ten minutes into our trip home, we saw a sign at the mall about a going-out-of-business sale at a clothing store, and decided to check it out.

On the way in she said, "Can we stop at the bathroom, I have to go again." Of course, I figured I'd better go too.

The store turned out to be pretty skanky, so we didn't even consider buying anything.

On the way out, "We'd better stop at the bathroom again."

Of course. To pee and to wash our hands, after touching those clothes.

While I was still in the stall, and she was at the sink, she asked me, "Honey, where's your ring?"

"What are you talking about?" I asked, as I checked for my ring. "Oh shit, do you have it?"

"I do now. It's sitting on the counter."

Whew!

(This is my college ring, of course, not my wedding ring, which I've already lost after a hand-washing mishap.)

Now we're home, have had a yummy dinner, and can actually go to bed early, without waiting up to giftme a shot!

So, after this exciting day, what's next in our baby-hunt?

No more shots for now, and I wait to bleed. I should "have a heavy period" (oh goody!) in about four days. I'll call Nurse D and let her know when I start, and she'll give me further instructions.

I might go on birth control pills for a bit, or we might be able to jump right in to my meds for the real IVF cycle, if we've got our other things taken care of.

The big "other thing" is that I need to call the social worker with the clinic, to find out whether Dr T's letter is sufficient, or if she also needs to talk to us, and to schedule at least Shrike, and maybe both of us, to take the MMPI.

I also need to call the attorney that they recommended, and get more information about what the laws are in neighbor state (where we will also deliver this hypothetical child, as the closest in-network hospital is there), and ask her to draw up the right kind of paperwork for our situation, as the only default consent forms they have are for either donors or surrogates to relinquish their parental rights, and rights to control the fate of the eggs / embryos, and neither of us is doing that.

On the consent forms that Shrike's already signed, she just signed off on the treatment things and we crossed out anything saying she would give up anything.

We have to have the social work stuff taken care of before beginning the meds for the real cycle and should have the lawyer stuff, but don't have to.

We also have to sign a "shared risk" contract. I'm guessing that's a "have to" before actually beginning.

Then, they'll take me off the pill to start a new cycle, I'll take the same sort of shots that I did this cycle, plus a few days of Lupron, to supress ovulation, and Shrike will be on the pill to get her in sync, then we'll start her cycle about five days after mine.

She'll get a day 3 ultrasound, and starting that day, I think, she'll get 3 meds per day, but we can probably do it in two shots, because the Gonal-F and Menopur can probably be combined into one. The Lupron (to keep her from ovulating before we want!) will be a separate shot.

Around day 10 or so, she'll start monitoring (blood / dildo-cam) every day or two. When her follicles are at 18 mm or so, she'll get an intramuscular injection of ovidrel (mine was subcutaneous, but they do it IM for IVF, because they were getting too many immature follicles the other way) and exactly thirty-six hours later, we'll do the retrieval.

I won't be allowed in the room with her for that, because it's an OR environment, but I'll be with her right before and right after, and she'll be asleep during.

Then they'll inseminate the eggies, on day 3 post-insemination they'll take a cell out of each embryo for the genetic testing.

Of the ones that are chromosomally normal, they'll pick the best-looking ones (in terms of cell division, symmetry, etc) to transfer to me on day 5, or possibly 6.

Dr E recommends transferring two embryos, if they are good quality, or three if they're not so great-looking.

She also says that the odds of pregnany are about 50% per cycle. I commented that they must be pretty confident about our chances, if they are willing to gamble their money on us. She said that we got no "no" votes from the approval committee.

I asked if that one year between us makes that much difference (since we got the "big fat no" on shared risk with my eggs), and she said that it does, but that, "Her antral follicles and hormones were a lot better, too."

Oh. We knew about the thirty-freakin-six follicles but I didn't realize she was kicking hormonal ass, too. Show off.

Oh - I almost forgot the "more" funny story from Dr E. First I guess I have to explain how this came up, I guess.

Shrike has a bit of a heart murmer, mitral valve regurgitation (I make her heart puke, evidently.) which, of course, was mentioned on the medical history. Dr E was asking about it, and I said that she was told it's nothing to worry about, but that she does have to take antibiotics for dental work - and "Oh, does that mean she needs antibiotics for the retrieval?"

Dr E said they give them to everyone for that, and Shrike and I were laughing about and - of course, I had to tell her about - the World's Most Innappropriate Christmas Letter, which we received this year.

This woman, whom I know through my political activities is about the complainingist old biddie you've ever met. Even their annual Christmas letter is nothing but a full page of pissing and moaning.

A sample from last year: "I'm still teaching medical terminology, but I must not be doing a very good job of it, because after ten years, I still haven't gotten a raise."

But nothing could top this year: "I'm having a knee replacement in December. I was surprised to learn that I will have to take antibiotics for any invasive procedure, even a Pap smear."

What? The? Fuck?

Shrike says, "I don't care of you are a gynecologist, no one should ever use the phrase "Pap smear" in their Christmas letter!"

After telling Dr E about that, I said, "And she's about eighty, so I really didn't need that image."

She then launched into another story from her residency. She had to do a geriatric rotation, and when the others learned about her future speciality, she got stuck with all the gynecological issues, and Pap smears and the such.

She tried to make the argument that she would have plenty of opportunities to do Pap smears, but the other docs needed the practice, and she should go learn about blood pressure medication or something, but it didn't work.

She went on for quite a while about having to do Paps on ninety-year-olds and dealing with pessaries that have been in forever.

(Follow the link if you really want to know - she said, "you don't want to know, but I'll tell you . . . . ")

She said something along the lines of "You can imagine what it's like in there when it hasn't been cleaned out in forever, and it's not been properly maintained or groomed."

Not to mention being told things like, "Now, you won't be able to spread her legs very far, because of her arthritis."

She said, "I'm thinking at that point, maybe a Pap smear isn't your most pressing medical need. Your broken hip's going to kill you long before cervical cancer does!"

And, once again, that is why we like her.