First Trimester Screening, Part I…

I suppose something good came out of the whole insurance debacle I wrote about last time: I got to spend close to 20 minutes seeing my babies via ultrasound during the Nuchal Translucency (NT) Scan.  Because honestly, given that a) my husband is in his mid 30s, b) the egg donor was 29, and c) the embryos were already PGD tested, it isn’t likely that something will show up.  Under typical circumstances with that kind of information, Evil HMO probably wouldn’t have approved it.  Then again, I’ve hit that special “1 in 1000” nail right on the head twice when it comes to dealing with medical issues–so I really wanted to make sure that should it happen a third time, I’m not caught unprepared.

The scan appointment, however, didn’t start off so great.  Our GS got lost on the way to the clinic, so she showed up late.  At first I wasn’t worried, because they told us to be there 30 minutes early.  But then she ended up arriving 20 minutes after the scheduled appointment time, which meant that she was really 50 minutes late.  We walked up to the desk to check in, and the girl told us that they have a “15 minute” policy, where 15+ minutes late = no scan.  But rather than flip my lid, I appealed to her soft side.  I explained that we were only told that the appointment had been approved the morning before, it was scheduled shortly after that, I made travel arrangements in the afternoon, and flew down from the Bay Area the same evening.  To add extra emphasis, I added that I drove 75 minutes to get to the appointment from where I was staying , and my husband and I were spending our anniversary apart because my attending the scan was so important to us.  (Lest anyone think I was taking advantage of her, everything I said was the absolute truth. Well, maybe not the 75 minutes, but only because I was driving way faster than I should have been. 😉 )  When I finished, she asked me in an incredulous voice if I had really bought same-day travel tickets and flew all the way down just for this one appointment.  I replied in the affirmative, and she said that she’d check to see if they could squeeze us in.

2 minutes later we were led back to the room, and the tech started the scan.  And oh, my goodness, the difference between 8 weeks and 13 weeks is incredible.  The heartbeats weren’t just flashing points of light, but actual muscle contractions that I could see pushing the blood through the twins’ bodies.  The arms weren’t just barely-visible bumps, but discernible limbs used to smack each other in the head with and fight like siblings do.  The most poignant moment, though, had to be watching one of them practice opening and closing the mouth.  For some reason, that made me reach for the stool and sit down for the rest of the appointment in awe.

Once the tech was finished getting all the measurements, she left the room and told us that the doctor (a perinatologist) would be there in a bit.  I figured we’d be waiting a while and didn’t mind at all, since they had made accommodations for us to be seen.  During the break, the agency coordinator texted me to inform me that our GS’s first appointment had been moved to the next day, which meant that I could attend it before flying home.  It was definitely a wonderful, unexpected surprise. 🙂

When the peri came in, he cranked up the ultrasound machine again to double check the tech’s work.  At first he claimed that one placenta was anterior and the other was posterior, which was good because it would make it easier to identify one as Baby A and the other as Baby B (until gender became apparent).  But then our GS’s uterus “shifted”, and both placentas were determined to be posterior, with one being high and the other being low.  Both the peri and the tech claimed to have never seen such a thing before, but told me not to worry, as the twins were still just as active.  Had they not mentioned it with such surprise I never would have noticed, being a novice when it comes to pregnancy ultrasounds.

At the end of the appointment, the perinatologist handed me a report and some pictures printed during the ultrasound.  Most of them aren’t too clear, although I think one is a facial profile, and another is a picture of a developing brain.  As amazed as I’ve been thus far by the science and technology we have at our disposal, I’m pretty sure that there’s still a lot left to be seen.

Oh, and I wanted to say thank you for coming back, especially after my ranting in the last post. It’s part of the journey, though, so I’m not going to remove it.  And besides, if a girl can’t rant on her blog, where can she do so? 😉


The “Joys” of Insurance…

For the record, I’ve never had a problem with military insurance–even when seeing doctors that are civilians.  The money is taken out of my account automatically every month, I get a referral from my PCP when I need to see a specialist for the first time, and usually can schedule an appointment within a week–two, at the most.  The appointment itself may not be in that time frame, but at least I can get on the schedule.  In the last 10 years of living with Lupus I’ve seen an assortment of cardiologists, gastroenterologists, nephrologists, neurologists, ophthalmologists, and rheumatologists (still with me?).  There have also been appointments with reproductive endocrinologists, but those were surrogacy-related, not for Lupus. 😉 I’ve been poked, prodded, and punctured to be diagnosed and treated, and have honestly lost count of the number of appointments I’ve had with the various specialists and the techs.

My point is this: in dealing with all those specialists and that insurance, never once did they put me through the kind of stress I’m dealing with now.  Seriously, my hair is falling out more than usual, my sleep schedule is jacked, and my appetite is off–all due to the CF this other insurance company has created with my surrogate (for those who don’t know, in this case CF is an abbreviation for Charlie-Fox, or ClusterF*ck).  While most anyone would be stressed, the fact that I have Lupus makes the effects worse, and potentially damaging to my health.

Before I really get going, I have to say that the agency and the coordinator have been awesome through this mess.  They’re the ones that have been dealing with this insurance company (heretofore referred to as Evil HMO) and the OB’s office the whole time.  The phone calls, faxes, and all the other crap have been handled by them, trying to get Evil HMO to do what they’re supposed to–and for that, I’m truly thankful.  I can’t imagine how much more of a wreck I’d be if I were the one trying to get this stuff pushed through, because I have no experience trying to make things work with any insurance company, much less Evil HMO.  As far as I’m concerned, the agency has definitely earned its fee and more.

The agency is the one who writes the check to Evil HMO, and does so for 6 months coverage at a time. The policy was purchased early this year, after our GS’s screening but before contracts.  Apparently some moron with Evil HMO’s billing entered the wrong amount of payment on the account.  It wasn’t like the idiot transposed a pair of numbers, either, which I could totally understand.  No, it (I won’t dignify this individual with a gender pronoun) entered the perfect number of $800 for no obvious reason, instead of the $1958.61 (or something like that) we paid by check to cover 6 months.  Apparently when that amount ran out, Evil HMO cancelled the insurance for non-payment–even though they had cashed the check for more than twice that amount.

The whole issue didn’t come to light until the agency and the coordinator started trying 3-4 weeks ago to schedule an OB appointment for our GS.  The agency coordinator (AC) proved to Evil HMO that the check had been cashed, so they were expected to reinstate the insurance and provide services. Evil HMO claimed to have refunded the money (it didn’t show up until late last week), and demanded another check which AC overnighted to them.  But even after the check was delivered, the billing idiots still hadn’t posted it by the next week, so the OB’s office wouldn’t allow us to be put on the schedule.  After a ton of phone calls with all kinds of people, it was agreed last week that we were allowed to schedule, as long as AC promised that the first appointment would be paid for in cash if the insurance hadn’t been straightened out by then, and that Evil HMO would reimburse us when it was fixed.

Then came the kicker–the OB’s office didn’t have any new patient appointments available until August 1st.  That would put our GS at 19w4d, and the last time she had seen a doctor would have been the RE at our ultrasound 9 weeks earlier.  If she were pregnant with a singleton, I still would have been nervous and trying to find a way to get her in earlier. But with twins? UNACCEPTABLE.  AC agreed with me, and managed to get Evil HMO to admit that maybe another OB’s office might have an appointment in 3 weeks, but a lot more conversations would have to take place before an appointment could be made.

At this point, figuring that wouldn’t go anywhere fast, I changed tactics.  I’d heard about NT scans (though I had forgotten what it was called at the time), and knew that they were generally done between 11w0d and 13w6d. It seems that they’re pretty common with surrogacy, although I know of women who had them even though they were pregnant “naturally” and weren’t of advanced maternal age.  Even though we used PGD, there’s still the possibility that something went undetected–and if there is an issue, I’d rather know about it sooner rather than later.  So I asked AC about the scan usually done around now, and if we could get our GS in for one.  She felt it was worth requesting, and pointed out that if it got approved, the GS would have to be seen this week, as she’ll be 14w0d on Sunday.  And by getting a scan, she’d probably need a follow up appointment after that, which would be sooner than the appointment we might get in 3 weeks.

Amazingly enough Evil HMO agreed–maybe because they were sick of hearing from us.  Yesterday we got approval, and were allowed to schedule the scan for today.  So I hopped on a plane to San Diego last night, and will drive up to the scan today.  I’m missing spending our 8th anniversary with my husband, but we agreed that it was more important for me to attend the appointment.  We’ll just celebrate this weekend. 🙂

The tl;dr version:  As the Marine Corps teaches everyone who makes it through boot camp, Persistence beats Resistance.  And if one is pursuing surrogacy (either as an Intended Parent or Surrogate), persistence is mandatory.

Ultrasound #3…

Since the pictures from the 3rd ultrasound arrived in the mail yesterday, I figured that I should probably write about it while it’s on my mind. 😉

The appointment was on May 31st, and the last one at Dr. K’s office.  It was also the first one I didn’t attend, even though I really wanted to.  Surrogacy is an expensive process, though, and we’re being as responsible as we can with our funds–especially since we’re expecting twins–which means we have to pick and choose which appointments I travel to make.

However, I was able to listen in because Dr. K called me right before getting started.  He announced that the babies looked fantastic and healthy, and that their development was great.  In fact, each of them were showing off in a different way.  Baby A was demonstrating some dancing skills and wiggling all over (our GS noted that she felt it, and had actually started feeling movement for the first time the night before).  Baby B decided to wave for the camera, so one of the pictures focused on the head and arm–it’s amazing how much detail is shown, especially for how small they are.

As always, the sound of their heartbeats made me both giddy and a little weak (in a good way :)).  Since I’m not able to feel the babies myself or experience any of the pregnancy symptoms, that sound is the most tangible connection I have with them.  Hearing their hearts beating away is proof that they exist for real, and not just in my dreams.  I have to say, though, that if I already feel like I’m going to melt just at the sound of heartbeats, I’m probably going to need some kind of physical support (like a chair or wall) in the delivery room when they actually arrive!

Stats at 10weeks, 3 days:

Baby A measured at 10w6d (3 days ahead), CRL 35.5mm, and heart rate was 175bpm

Baby B measured at 11w1d (5 days ahead!), CRL 39mm, and heart rate was 171bpm.

Ultrasound #2 (aka the 3 week late update) …

Finally getting around to writing about the 2nd ultrasound, which happened May 17th.  Sorry it took me 3 weeks to do so.  Whoops.

This time I flew into San Diego, and drove the 150 miles to the clinic.  Since I have family in the area, I chose to fly down the night before the appointment and spend a couple of days, rather than repeat the whirlwind trip from 2 weeks earlier.  Unfortunately, this made for a very long day in the car–especially since it’s almost impossible to go through LA twice during daylight hours without hitting traffic.

The appointment was set for noon, and I got to the clinic parking lot at 11:40.  My husband was in Germany for work, but called for a minute to say that he was back in the hotel room and available for a Skype call.  I told him I’d try to use Skype mobile on my phone to contact him, but I wasn’t sure if the cell reception in the office would be up to the task.  If that didn’t work out, though, I had already arranged with the Nurse Coordinator for part of the ultrasound to be recorded and e-mailed to me so he could listen to the heartbeats later.

When I walked in to the clinic, I was surprised to not see our GS.  It was only 10 minutes before the scheduled appointment, and she had been early for the previous 2 appointments.  The real shocker came when I checked in, though, and was told that the ultrasound had already started.  Apparently the NC interpreted my GS showing up 30 minutes early by herself and my request for a recording to mean that I wasn’t going to attend the ultrasound (even though I had communicated my intent to do so the previous day via e-mail).  I’m not even embarrassed to admit that I almost ran over the poor woman whose duty it was to guide me to the correct room.  I had, after all, driven 3 hours that morning to get there–and did not want to miss any more of the ultrasound than I already had.

My entrance interrupted the recording, but at least there was good news available–Dr. K had already looked at both babies, and they were doing great.  He was more than happy to stop things for a moment (although our GS probably wasn’t quite as thrilled, given that this was not an abdominal ultrasound) while I connected with my husband via Skype.  I held the phone up to the monitor’s speaker so he could listen to the heartbeats for the first time, as well as Dr. K’s commentary on each of the babies.  Even though he had seen the pictures from the previous ultrasound, at that moment, I think the pregnancy finally became “real” to him.  I also think that whoever invented Skype deserves an award for giving us that amazing moment.

7 hours’ worth of driving for 7 minutes’ worth of time with the doctor, our GS, and the babies.  Totally worth it. 😀

Stats at 8weeks, 3days:

Baby A measured at 8w3d (spot on), CRL 16.9mm, and heart rate was 175bpm.

Baby B measured at 8w5d (2 days ahead), CRL 18.8mm, and heart rate was 171bpm.

10 years

I remember it like it was yesterday.

Sitting in the doctor’s office, waiting for him to come in and give me the news.  Wanting a diagnosis, but scared of what it would be.  Wondering what my life would be like in the years to come, hoping that I could still achieve my dreams—and at 22, I had a lot of them.  Looking at all the models and diagrams of healthy and not-so-healthy body parts, curious as to what mine looked like.

The door opened, and in he walked.  He sat in the chair, took a quick glance at the folder he was carrying, and then set it aside.  Without inquiries as to how I was feeling or any other preamble, he issued a statement:

“You absolutely, unquestionably, without a doubt, have Lupus.”

I sat there and blinked for a moment, letting the words sink in.

Lupus.  Finally, a name to go along with the symptoms I had been experiencing for the previous 3 months.  Hair loss, such that every time I ran my fingers through it, I ended up with a small handful of hair tangled in my fingers.  Fatigue, to the point where if I had 30 minutes of spare time, I was napping—even though I was already sleeping 10 hours a night.  And above all, PAIN. In my fingers, wrists, and elbows. In my hips, knees, and feet–so much so I was taking 2 Tylenol and 3 Advil every 5 hours just to walk.

The doctor was already describing the treatment protocol. Prednisone (a corticosteroid), to reduce the inflammation.  Plaquenil, to suppress the immune system in overdrive that was causing some of the symptoms. Celebrex, to help with the pain.  Daily doses, it was hoped, would ease the symptoms over a 2 month period.

“And then?” I asked.  “After 2 months, will I be able to go off them and get back to my normal life?” (oh, the naïveté of such a question makes me laugh now)

I could see him holding back a chuckle as he said, “This is your normal life, now.  Lupus is a chronic illness; it won’t go away.  If 2 months on these doses doesn’t result in an improvement, then we’ll have to increase them, and maybe add another medication or two. They should ease your symptoms, but I don’t know for sure.  Only time will tell.”

“What about my job? I’m a Marine, learning Arabic. I have 6 months until I graduate. Will I be able to stay in, or will this get me kicked out?” I’ve finally found a place where I feel like I fit in.  What will I do if I have to leave…

“I don’t know.  But stress is bad for you, as are long hours. You might want to see if they can make accommodations for you.”  Now I was holding in the chuckles; obviously this guy had never served in the military.

“Will I still be able to have kids?”  (Even then, I knew that I wanted to be a mother some day.  Not soon, but some day.)

“I don’t see why not.  It’ll depend on certain factors, and the timing will have to be right, but women with Lupus get pregnant and have children all the time”.  (If only he could see me now, needing a gestational surrogate to become a mother, because of Lupus.  If only he knew that I spent 2 years trying to get stable, then 2 weeks trying to conceive, and then 2 more years trying to recover from the “safe for pregnancy meds” that messed up my system in the 2 weeks I was on them.  If only he saw the Rituxan infusions that didn’t work, the last ditch effort to put me in remission, that I might be able to try again.)

And with that, my time was up.  He handed me the prescriptions, some informational pamphlets, and walked me to the front desk.

10 years have passed since that day.  I generally don’t dwell on it, but since May 10 is both World Lupus Day and my sick-a-versary, I felt that I should recognize it somehow.  Writing it here seemed fitting, as it was the start of my surrogacy journey–even though I didn’t know it at the time.

The First Ultrasound…

Friday morning, I flew down to Burbank to attend the first ultrasound, courtesy of my parents.  Given that the clinic is in the LA area and it was a Friday, I was pretty sure that traffic from the airport to the clinic was going to be awful.  To make sure that I had plenty of time, I took the first flight down there at 6:30am–which meant that I had to be up at 4:30.  While I’ve had my share of early mornings (hello, USMC), it’s still tough to be up at least an hour before the sun is even getting close to rising.

The flight and car pickup were uneventful, and I was surprised by the traffic, which actually wasn’t too bad.  I even had time to stop and eat breakfast.  Since our GS has started experiencing some nausea, I also picked up a small package of Preggie Pops for her.  Reviews on those are mixed; I know some who swear by them, and others who swear at the fact that they didn’t help at all.  I figured that at worst they would do nothing for the nausea and just act like candy, and at best they would make her feel less queasy.  And for $5, it would be easy enough to find out 🙂

As for the ultrasound itself, the first minute was excruciating.  Would there be one or two in there? Did we have a splitter? Or, worst of all–would there be an empty sac?  Dr. K asked me how many we put back, and I told him 2.  He asked how many I wanted, and I told him that I’d be happy with either one or two.  He smiled, and said…

“You’ve got twins on the way!”

Both measured at 6w2d gestation, which he was happy with.  As far as he’s concerned, if they’re within 3 days of the calculated gestational age, then things are good.  Gestational age starts at 14 days before egg retrieval (not transfer, like I had originally thought)–which means that they were technically 6w4d at the ultrasound.

I was a little surprised by my reaction to the heartbeats.  Seeing the tiniest points of light on the screen flashing on and off, knowing that it was the beating hearts of my children, was far more powerful than I had imagined.  I expected to get a lump in my throat, or maybe even some tears; I did not expect to be struck dumb, mouth hanging open, unable to get any words out.  For the record, one was measured at 114bpm, and the other was 126bpm.

After that we scheduled the next ultrasound (I’m going to that one too, since I already made arrangements to fly to SD and drive up), and then she and I went to lunch.  It was nice being able to sit and chat over a meal; even better, she was able to enjoy her food without feeling ill.

I then drove back to the airport, returned the car, and passed the time calling immediate family members with the news.  While my parents weren’t quite as excited as my husband and I are (I don’t think anyone could have been, to be honest), they were still thrilled to hear that they’re finally going to be grandparents.

And now, the big question:  Is it too early to start shopping? 😉


(Edited to Add:)

Stats at 6weeks, 4 days:

Baby A measured at 6w2d (2 days behind), CRL 6.6mm, and heart rate was 114bpm.

Baby B measured at 6w2d (2 days behind), CRL 6.6mm, and heart rate was 126bpm.

Making Travel Plans…

Our first ultrasound is coming up at the end of next week.  Originally, I wasn’t planning on attending.  Not because I didn’t want to, but because there’s quite a bit of time and expense involved.  As I don’t live close to the clinic, I’d have to either fly from the Bay Area to LA and rent a car, or fly to SD, borrow a car from my parents, and make the drive (5-6 hours round trip).  Since heartbeats are only a possibility this early (it’ll be 3 weeks and 6 days after transfer), I was going to wait until the 2nd ultrasound 2 weeks later.

A couple nights ago, my dad called me and asked if I wanted to go to the ultrasound.  I said of course I did, but felt that it wasn’t the best use of our budgeted surrogacy funds.  If we had unlimited resources, I wouldn’t even think about it–I’d just go.  But since we don’t know for sure how much this process is going to cost (or how many kids we’re going to end up with), my husband and I are trying to be as fiscally conservative as possible.  In other words, we’re being cheap when we can. 😉

At any rate, my dad said that I was being wise to not throw away money, but he felt it was important for me to go.  After all, it’s the first ultrasound.  And while there are going to be a lot of “firsts” in this process, the ultrasound is one of the biggies.  So, he was willing to pay for my plane tickets and rental car.  In his words, “Your mother and I have spent money on stupider things in our lives. It’s way better to spend it on something important and special, like this.  Consider it an early Mother’s Day gift.”

If I could have jumped through the phone to hug and thank him, I would have.  Not just because he’s paying for my one-day trip to the ultrasound, but because he called it a Mother’s Day gift–something I wasn’t sure I’d ever be fortunate enough to receive.  I know he chose those words specifically to show his support, but I doubt he realized the effect they’d have on me.

And while I didn’t turn into a blubbering mess on the phone, I did have to dry my eyes before running into the other room to tell my husband that he was going to have to get up and take me to the airport before dawn next week so I could go see our child(ren) on an ultrasound monitor.

Choked up in one post, teary-eyed the next.  What’s this once-tough emotion-controlled Marine becoming?

Beta…round 2!

2nd beta draw was Friday, and the number is pretty encouraging:  958.  It was around 72 hours since the first one, which means that our doubling time was good (approximately 56.5 hours).  Based on those things, it sounds like we’re on the road towards a viable pregnancy.

The RE was also kind enough to call me a couple hours after the NC e-mailed me the results.  He wanted to make sure that I understood the significance of the numbers (apparently not everyone researches these things for 2 years like I did), and to see if I had any questions.  Overall, Dr. K’s been awesome.  I don’t think I mentioned before that our transfer took place the day before Easter, which was supposed to be the last day of his vacation.  He came in to the clinic that morning specifically for our transfer, waited around an hour afterwards to make sure our GS was feeling all right, and then left.  Given that I’ve heard of RE’s manipulating cycles so all retrievals in a month are done over a 4 day period, then all transfers done the next 5 days for their convenience, I was really touched that he was willing to sacrifice a vacation day for us.  Although they probably didn’t compare to some of the gifts from other patients, I brought in 4 dozen homemade cookies (chocolate chip and white chocolate cranberry oatmeal) for him and the staff as a small thank-you. 🙂

Anyways, he also told me that if I wasn’t able to make it for the first ultrasound, the clinic would call me during it so that I could listen in.  Not quite the same as being there, obviously, but that’s still better than nothing.  If there are heartbeats at that time (I don’t think it’s likely, since we won’t even be 6 weeks yet), then they’ll even make a recording so we can listen to it again later.  It’s a little embarrassing to admit, but I actually got a little choked up by all this.  It’s hard to believe that I might actually, finally, become a mother.

Beta # is in…

It’s 396!

My contact at the clinic thinks twins are in our future.  But if I’ve learned anything about beta numbers over the last 2 years, all they really do is tell you that pregnancy is achieved.  Some women produce lots of hCG (making everyone think they’re carrying multiples when it’s a singleton), while others don’t.  There’s no guaranteed way to tell, aside from waiting for the ultrasound.

So yeah, we’re pregnant!

The journey so far…

Most people who blog about surrogacy, it seems, start at the beginning of the journey.  They write about agency applications, searching for a match, first contact, and then being “officially matched”.  Next come screenings and contracts, followed by appointments and calendars.  After that there’s the excitement (and usually photos) of that big ol’ box of meds and needles arriving, plus all the stuff that accompanies it–like having to actually stick said needles in your body once, twice, and sometimes thrice daily.  Next there’s more appointments, followed by the egg retrieval, fertilization reports, PGD results (sometimes), and then OMG IT’S FINALLY TRANSFER DAY!!!

Not me.

For one thing, I was afraid of making any premature announcements.  So often on the surrogacy message board I frequent ( SMO, a fantastic resource for anyone considering surrogacy), you see people announce their match only to have it fall through during further discussions or contracts.  While there’s nothing wrong with that (ending a match is way better than having a bad one), I didn’t want to worry about the potential drama that could accompany posting about a breakup.  I was also concerned about it falling through in other ways–the clinic suddenly deciding our GS was no longer a good candidate, the donor not responding well, or one of the many additional things that can go wrong.

Above all, though–I didn’t really have anything I felt worth reporting.  After all, a blog with 1 sentence updates or no updates isn’t very interesting.  Since my eggs weren’t going to be used, I wasn’t going to be on any injectables.  That also meant I wasn’t having any appointments, so the clinic didn’t need to be in constant contact with me.  I suppose I could have started writing on transfer day, but I wasn’t at home, with my regular computer.  Fellow bloggers know these things are tricky to set up–especially for those of us who aren’t the most technically savvy individuals.

Suffice it to say that we matched with our GS through a great agency, used another agency to find an egg donor that met our requirements, and the clinic approved of everyone.  Both the donor and GS responded wonderfully to their protocols, and according to the RE the transfer of 2 PGD blasts went perfectly.  There were also quite a few 5-day and 6-day embryos frozen, just in case.

And since tax returns are due today (even though I’m no longer employed by an accounting firm I still had to do returns for us, my brother, and handle the extensions for my grandfather, his trust, and estate), I really didn’t have the time and energy to start messing with this blogging stuff until last night.  Plus, our first beta is being drawn today–so I needed something to take my mind off the anticipation.  Although, given the pic our GS sent us Saturday morning, I have a pretty good feeling that we’ll get decent numbers this afternoon…