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BettyRubble wrote a comment:
To be honest, I think [the Georgia bill on embryo transfer limitations is] very reasonable. It is unfortunate that it took the birth of octuplets to "command" that a bill be nessessary when most doctors use common sense for how many embryo's to transfer. I could see an uproar if they said one regardless, but two is reasonable.

Note: Here is the bill. I recommend reading through it.

And I responded… not nearly as articulate as my original post, but this will do for the moment:
If it were JUST about limiting the number of embryos transferred I MIGHT agree with you IN THEORY. (Except that I will never agree with legislating something which I believe needs to be a discretionary medical decision – particularly in a state that does not have an insurance mandate. If the state of Georgia isn't going to mandate that insurance companies help PAY for IVF then limiting IVF in this manner is just plain ridiculous).

HOWEVER, they don't just limit the number of embryos to be TRANSFERRED in a cycle. They limit the number of embryos to be CREATED in a cycle. And that is ridiculous. This means that for a woman under 40, only 2 eggs can be fertilized in an IVF cycle and no one will ever have any embryos to freeze (they are specifically trying to avoid a case where anyone will ever have cryopreserved embryos – so that they won't have a Nadya Suleman who has six embryos frozen and decides to transfer them all at once – I get that, but it's stupid, because she's the EXCEPTION). (by the way, this is, I believe, the practice that Italy follows – and they have possibly the lowest IVF success rates in the world).

So if you only fertilize 2 eggs – and hey, guess what? That's going to mean everyone has to use ICSI from now on, so tack on $5K to every cycle cost at the expense of the individual since there's no insurance mandate in the great state of Georgia! Anyway, so if you only fertilize 2 eggs, you're now facing the well-known attrition rate that you always face in the embryology lab. Many women won't ever make it to transfer.

Yes, you can freeze the eggs that you don't fertilize. But there's a reason this isn't commonly done. Egg cryopreservation is relatively new – eggs are far more fragile than embryos and don't withstand the cryopreservation process nearly as heartily as embryos do. They don't survive at nearly as frequent a rate as embryos do, and we all know that even embryos have a pretty high attrition rate in the thawing process (though that attrition rate is getting better over time).

So say neither of your two embryos make it to transfer. Now you've got a woman who's lost a whole shitload of money on her IVF cycle and now has to scrape together money for an FET – oh wait! there IS no FET. But they'll thaw a couple of her eggs – IF they survive and hopefully make 2 more embryos – IF they can – and then she's stuck in a holding pattern on Lupron and estrace (PLEASANT drugs to be on LET ME TELL YOU!) while she's waiting to see if this is even going to work, and maybe while they sit around trying to see if this will even work, and hoping that her lining gets to be thick enough, and, oh gosh, that darned attrition rate, well, we only got one crappy embryo out of it because one of them didn't make it and the other egg was a little damaged coming out of the thaw process. So we'll transfer one in a patient who wasn't actually an ideal candidate for eSET.

Oh and I'm ALL FOR eSET in the ideal patient set, remember. But eSET is best used when you've got a bunch of embryos that you culture out to day 5 and let natural selection choose which one is the best one. And remember, I had 9 embryos growing on Day 2 for my last IVF cycle. By Day 5, I had 4 almost-blastocysts (morulas) I think. By Day 6 I had 2 blastocysts to choose from and a couple struggling ones. Nothing made it to freeze, including that second blastocyst.

Nothing.

So Georgia's worries about me having six embryos leftover to freeze from my 9 embryos I started out with? Hogwash.

Per the Wall Street Journal: The bill was drafted in part by Georgia Right to Life, an organization that opposes abortion and seeks regulation that would treat embryos as human beings. "To us it's a human-rights issue," said Daniel Becker, Georgia Right to Life's president. Embryos deserve legal protection "as living human beings and not as property," he said.

This is where I take issue. Turning IVF into a Right to Life issue gets my blood boiling.

The bill further states that the embryos are NOT the property of anyone and that any custody disputes arising about the embryos will be decided by the judicial body "in the best interests of the embryo." Now, that's a standard used in custody cases for children. How exactly is the judicial body going to apply that standard to a blob of cells sitting in a petrie dish?

"Nadya Suleman is going to cost the state of California millions of dollars over the years; the taxpayers are going to have to fund the 14 children she has," Republican state Sen. Ralph T. Hudgens, one of the sponsors of the bill, said in an interview. "I don't want that to happen in Georgia."

Tell me that isn't him admitting this was a knee-jerk reaction?

I can't condone a law that was written, not with the aide of medical practitioners with time and thought put into it, but in a knee-jerk reaction, with a mere month between the time of the birth of those octuplets and the release of this bill and written by politicians and the Georgia Right to Life.

The bill (if passed as written) will shut down the Georgia IVF industry as far as I can figure – because people will simply go out of state to get better, more successful, care – a multi-million dollar industry for their state.

And that is only the tip of the iceberg on what my issue with the bill is.

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I'm not going to write  on this blog any more about this stage of our infertility journey.  I may still post occasionally about the topic in general.  After all, infertility is a large part of my identity now.  But this stage of the journey won't be posted here; I'll be posting elsewhere. 

This includes the details of my appointment with the RE yesterday, which didn't go as well as I'd hoped, but didn't go as badly as I feared it might, so all in all, it was a wash, so to speak. 

I know it's ridiculous that I'm starting Yet Another Blog (YAB), but I just can't think of another solution.

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Anniversary
Today is the sixth anniversary of the day after I got married to the sweetest man in the world.  We celebrated by going to see Cirque du Soleil on Sunday and leaving all four children with my mother.  Can you imagine?  It wasn't so bad, actually, the babies were napping most of the time we were gone, and the J-man was meserized by the computer the whole time we were gone.  I think my mom even squeezed in a nap.  Good for her!

Get out the Vote!
I voted today.  That shouldn't sound so monumental, but I'm ashamed to admit this is only the second time in my life I've voted.  I intend to change this.  I believe very strongly in the civic duty to vote, and yet, I'm a big slacker.  I think it's such a powerful right that we have.  Truthfully, I find the rest of the ballot – the bits AFTER the presidential question far more empowering, because those were the parts where my vote might make an impact.  My state is a blue state, you see.  It wouldn't have mattered who I voted for in the presidential election today, it wasn't going to change the fact that my state would fall out as a blue state.  But there were several questions on the ballot that did matter that I had a more direct ability to affect.   The thing is issues appear on the ballot every year, not just every four years.  And I owe it to my children to set a good example.  So I am making a personal resolution to vote next year – a non-presidential election year.    (Update:  as I was writing this, they called the election for Obama.  I'm not stunned at the result, but I *am* stunned that this election was called at 11pm… I expected to go to bed tonight without knowing who our next president will be)

Sick Baby
Ellie-bean is sick.  All three babies had a cold about three weeks ago.  And the cold hasn't really gone away.  And last week, Ellie got a cough on top of the cold.  It was a horrible seal-barking cough – yep, croup.  And the seal-barking cough calmed down, but a milder cough persisted.  So I called the doctor yesterday and asked if I was overreacting by thinking maybe this had gone on a little too long.  He said for sure I should not let this continue through the week, and to bring her in if I felt like she wasn't getting better.  So I brought her in today.  Double ear infections (mild, but there nonetheless), lots of goo in her nose and throat.  All clues point to secondary bacterial sinusitis.  Bleh.  And I think Abby has it too, but I didn't realize that until too late.  So my bet is that in a couple days Abby will be heading to the doctor also.  And heck, if I take Abby, I might take Sam too, because his nose is all gooey still too, even if he's not coughing yet.  Better safe than sorry, right?

Toddlerhood
Sam is totally a toddler.  He doesn't crawl anymore if he can help it.  He's all about the walking.  Mommy is traumatized by this development, because her little baby boy is turning into a big boy and …  oh!  no one gave him permission for this!

On Infertility
To answer some of your questions:  Nothing changed in Seth's insurance that meant that I used to have coverage under my old clinic and don't now.  I used to be covered under my own insurance, but I changed employers after the triplets were born and my new employer does not have fertility coverage.  But Ms. Perky, you might ask, Isn't Maryland a mandated coverage state?  Why yes, yes it is!  But there are loopholes to that whole "mandated" thing… specifically, my employer "self insures" which gets them out of the mandate.  Several of you asked if there is any other clinic closer that my husband's insurance will cover and the answer, simply, is no.  He works for a major hospital system, and they will only cover fertility treatment done through their hospital system. 

Mostly, right now, I feel a little bitter, and I feel like my hand is being forced on this.  The clinic I have to use does quarterly "batched" IVFs.  All their patients do their cycles all at the same time and they only do them quarterly.  So we're moving forward with a consult now, rather than waiting until the first of the year.  Which means I'm weaning nowish, rather than at the end of the year.  It also means that I'll have no control over timeline.  The insurance situation means I'll have no control over my doctor, my clinic, my geography, my timeline, and quite possibly, my protocol.  More frustratingly, the clinic I'll be forced to go to performed zero elective single embryo transfers in the last year that they reported to the CDC.  I gotta tell you… that worries me.  I know that I should reserve judgment until I've actually met this doctor, but I admit, I'm skeptical, and I'm angry that my choices have been taken away from me.  Infertility is so often about losing control, and I feel like I've lost even more control over this situation, which aggravates me to no end. 

I'm sure once we start moving forward, I'll be over it.  But until then, I remain irritated, anxious, frustrated.  I find myself paralyzed about the whole thing, unable to even so much as make a phone call about the whole thing – I even punted off making the phone call about setting up the consult to Seth.  I told him that since he worked there and he knows his schedule and I want him there at this appointment, I'd rather he schedule the appointment, but the truth is, my frustration about the whole situation just has me unable to even deal with it.  Yet, I don't want to waste more time and lose more control.  I have another birthday in January and I hear the tick-tock in the back of my head all the time. 

I appreciate that I received so many supportive comments on my last post – I know I'm crazy, I know not everyone would make the choices I'm making, but it's nice to know that I have support here.  That being said, I'm still torn about blogging about the whole infertility-thing here.   Blogging about it in the abstract like this is one thing.  But if I do start cycling again?  I'm not sure how I feel about writing about the specifics.  There are just enough people reading here who know me in real life that I don't love the idea of posting about it.  So I don't know how candid I'll be.  Perhaps I'll post privately about it, and then share those posts after-the-fact.  I'm not sure.  I haven't figured out what the right answer is yet.  Just letting you know what's going on in my head.

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It seemed like such a simple request from my five year old:  "Mommy, could you please have another baby?"

He's been asking more and more lately.  You'd think with three little siblings taking time and attention away from him, the J-man would be just about babied out, wouldn't you?  But he has the biggest heart possible and he seems to have no end to his capacity to love these babies and to want more babies to love.  He tells me that these babies are so much fun and that he wants more babies to love.  Me too, J-man, me too.  If only it were that simple.

Friday, my cleaning lady said, "Don't you think it's about time for another baby already?"

After the triplets were born, I started having regular periods for the first time in my life.  Every 29 days like clockwork.  All signs pointed to the likelihood that I was ovulating for the first time in life, right down to the little slice of hell called PMDD.  All this, despite nursing triplets.  Go figure.  I admit, it did leave me with the teeniest little bit of hope that maybe, just maybe, I'd have the slightest possibility of a "happy accident" along the way, but no such luck.  As I near the point that I'll be weaning Sam and Ellie (I've already stopped pumping for Abby), my body has already shifted back to its "normal" anovulatory, amenorrheal self.  Isn't this a little backward?  So I'm left realizing that the only way we're going to have another baby is to return to Ye Ol' Fertility Clinic.  (Admittedly, I knew this all along, but you can't blame a girl for hoping, right?)

So.  Where does that leave me?  Normally, I'd say that leaves me making an appointment with my old fertility clinic, but there are two problems with that.  The first is I'm pretty sure they're still pissed at me for not reducing the triplet pregnancy.  The second is insurance coverage.  I don't have insurance coverage for fertility treatment through my employer, but we do through my husband.  But his coverage only covers me at the clinic at his hospital, not any other clinic (including my old clinic).  This is a real pain in the neck, by the way, because my old clinic?  is fifteen minutes away from my office.  And the clinic that is covered?  Is in Baltimore.  An hour from my office.  And the coverage includes an ENORMOUS deductible (several thousand dollars).  So it's going to suck. 

I know it seems ridiculous that I'm even thinking about having another child.  I know it seems ridiculous that I have three one year olds and I'm already thinking of having another child.  But the truth is, I know I want another and if I weren't an infertile myrtle I wouldn't have to justify myself.  I'm so tired of justifying myself.  Yes, I'm crazy.  Yes, I'm greedy.  Yes, I want more than I deserve.  Yes, I want more than I'm entitled to.  Yes, there are women in this world who haven't been blessed with even one baby, and here I am with four blessings, and I'm asking for one more miracle.  And why now?  Because the honest truth is that I don't know if I'm going to be granted another miracle.  And I don't know how long it's going to take to achieve that miracle if I make it there.  It took five years, twenty thousand dollars, and a vast error in judgement on my doctors' parts to get the triplets.  

So how do I answer my five year old's innocent question?  "Mommy, could you please have another baby?"

I hope so.  I just wish I knew how. 

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Calendars are funny things.  The most widely used calendar in the world today is the Gregorian Calendar, which is a solar-based calendar.  The Jewish calendar is based on an adjusted lunar calendar, which sometimes makes it difficult to explain to people why it is that certain dates have significance to me, or why the dates that have significance to me may seem inconsistent at least as they relate to the Gregorian calendar. 

Last Thursday was Yom Kippur, the Jewish Day of Atonement.  The holiest day on the Jewish calendar.  This year, Yom Kippur fell on October 9th on the Gregorian Calendar.  That meant that the date marked two dichotomous anniversaries for me, showing just how far my world has turned around: 

October 9th marked 2 years since I had a miscarriage from my first pregnancy.  I wondered then if I would ever carry a pregnancy to term.  Truthfully, I suppose I should still be wondering that, because technically I haven't yet managed to do that.  But, last year on Yom Kippur, my two daughters were officially given their names.

You see, in Jewish families, girls are given their names in the synagogue after they are born.  The father is called up for an aliyah (an opportunity to bless the reading of the Torah),  a blessing is recited for the health of the mother and the child (in this case, children), and then if the child(ren) is a girl(s), they are formally named at that time.  Boys are named at their bris (usually 8 days after birth, unless their health prohibits it – Sam had his bris when he was about 5 1/2 weeks old)  This can be done on any day that the Torah is read:  Mondays, Thursdays, Saturdays, and holidays.  My babies were born on a Wednesday, so Seth had intended to name the girls the next morning, but I had such a horrific night at the hospital that I'd called him in hysterical tears and he was with me at the hospital instead of naming the girls that morning.  Instead, he named them on Saturday, which was also Yom Kippur, the holiest day of the year – indeed, an auspicious day to name our miracle babies. 

This week is the holiday of Sukkot.  Sukkot is a beautiful holiday – a festival commemorating the 40 years of wandering in the desert and the final harvest.   It is such a joyful holiday that it is referred to as the Season of our Rejoicing.  Sukkot used to be my very favorite holiday.  Everything about it was beautiful to me (well, everything except the esrog, which I'm allergic to).  But two years ago, October 9th fell on the third day of Sukkot, and for that, I'm not quite ready to forgive Sukkot.  This is the funny thing about the way that the Gregorian calendar and the Jewish calendar cross paths.  Which day do I remember?  Both are significant to me.  October 9th also happened to be Columbus Day that year.  Last year, Columbus Day was the day I had my 2 week post-partum check up with my perinatologist.  Somehow, I don't hold Columbus Day in contempt, but I never said I was logical.

Next week are the last of the Fall holidays on the Jewish calendar:  Shemini Atzeres and Simchas Torah.  Two years ago, on Shemini Atzeres, I was back in the emergency room with complications from the D&C from my miscarriage.  On Simchas Torah, I was back in my synagogue, pretending to care about anything there, but hating every second of it.  The singing and dancing with the Torah around me – I hated everyone for being so happy.  I hated the merriment.  I hated the oblivion.  I left that night, angry, sad.  Mostly sad.  Horrified, even.  Last Simchas Torah, my three babies were in the NICU.  Seth was at the synagogue with J, dancing with the Torah, while I sat in the NICU listening to a doctor explain to me that my tachycardic daughter needed a blood transfusion.  Though we'd known it might be coming, we'd had no idea it was coming so soon – if we had, we'd have asked permission from our Rabbi for Seth to carry a pager that day, but as it was, I had no way of reaching him.  So it was up to me to decide that despite the myriad of risks listed on the consent form, none of which would have bothered me in the least bit had I been signing the consent for myself – but all of which terrified me while standing next to my two and a half pound baby – she was to have a transfusion that day.  

Honestly, I'm not sure that I'll ever quite feel the same about Sukkos, Shemini Atzeres and Simchas Torah.  I still love them.  I still rejoice in them.  And there's a great deal of healing to be had in the birth of my three beautiful babies.  I'm very lucky.  But I admit, there's still a taste of bitterness in my heart.  I think it will be bittersweet for a while, but my hope is that the rejoicing of my children in the years to come will ultimately override any remaining bitterness.  Maybe someday I won't feel like my favorite holidays were taken away from me.  Maybe I won't even feel like October 9th is significant in any way.  It's funny how these calendars play tricks on us, you see.   

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Anna asked the following question:

I don’t understand why you have to quit nursing…I know several people that have continued to nurse during pregnancy…..

In order for me to get pregnant, I will have to return to Ye Old Fertility Clinic.  In fact, as I’ve stated quite clearly in my posts, I will be pursuing IVF (with single embryo transfers!).  Before the fertility clinic will even start testing to pursue a new cycle, I must have stopped breastfeeding. 

Yes, fertile myrtles breastfeed during pregnancy.  People who get pregnant while nursing without Assisted Reproductive Technology continue to nurse while pregnant.  It’s not for lack of trying that I’m not pregnant right now, but you know what? I’m not a fertile myrtle.  As I’ve said before, it took five years, twenty thousand dollars worth of treatment, a late miscarriage, and a vast error in judgment on my doctors’ parts to get my triplets.  I have no guarantees that I will EVER get pregnant (and stay that way) again.  And I don’t know how long it will take if I am able to achieve pregnancy again.  Waiting is an option, but for how long?  And at what cost? 

So yeah, I could nurse while I’m pregnant.  If, you know, I could GET PREGNANT.  You know, if only that tiny little detail weren’t so darned difficult for me.

Edit: Anna, sorry for jumping all up and down you.  It’s not the question I have a problem with.  It’s the tone you take with your questions… in my blog and elsewhere.   You might consider that next time.  Thank you for your comments on this post; they’ve helped give me a little more perspective.

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A couple notes about my CD1 Post:

1.  I wasn’t assuming I wasn’t ovulating due solely to the fact that I’m nursing, though do bear in mind that this is not an unreasonable assumption, given that I’m providing milk for not one, but THREE babies.  Even though they are now getting a fair bit of solid food, and therefore taking far less milk, I’m still producing about 40+ ounces per day, I’d guess, which is more than enough to suppress ovulation.  Most women face issues with nursing not suppressing ovulation when their production dips as their babies start nursing less than full time.  That being said, I’m not relying on nursing being birth control.  My OB wasn’t saying that my periods were likely anovulatory because of the nursing; rather, he was saying they were likey anovulatory because I’ve almost never ovulated on my own in my entire life.  Why start now?

2.  I’ve taken OPK’s, and they’ve all been negative.  However, OPK’s are often unreliable for women with PCOS, so who knows whether that’s a useful data point?

3.  Someone suggested that my best bet might be to try and take advantage of this time for some natural babymaking.  It’s not for lack of trying, I’ll tell you that.  But even the months where all the stars were aligned and things have fallen into place for the timing to seem appropriate (based on when I assume ovulation would have happened IF it happened, even though I don’t have really reliable ways of telling for sure if it happened), not so much with the luck.

4.  I am in no way trying to prevent the babymaking from happening at this point (nor have I done anything to prevent it since the triplets were born), though I am not yet prepared to make a trip back to ye ol’ fertility clinic.  I expect to return sometime around when the triplets hit the one-year-adjusted mark.

5.  Finally, my original RE (whom I adored and would have stayed with forever, except she moved to an office much further away and much less convenient), had told me during my first (failed) pregnancy that I should expect some normal periods after I delivered, but that I would most certainly revert to my  anovulatory, irregular, unpredictable cycles after a several periods, so not to get too used to regularity.  This may be part of what she was talking about.  Admittedly, I had assumed that those regular, normal periods wouldn’t start until after I was done nursing, but apparently that part was optional. All I do know is that my body can’t figure out which way is up anymore and what it’s supposed to do.  That being said, my guess is that these normal, possibly ovulatory, periods won’t last forever.   And anyway, fat lot of good they’re doing.  Since anovulation wasn’t my *only* problem leading to fertility treatment, I don’t imagine it will make a whole huge difference in the long run, anyway.  I’m still betting on being back at the clinic in November or so and cycling in Jan/Feb-ish.

Edited to Add:
6.  You know, losing 70 pounds could also have something to do with the mysteriously appearing periods, though, again, you’d think that nursing triplets would give me the "get out of PMS free" card for at least a FEW months, right?  Anovulation wasn’t our only obstacle to me getting preggers, so this is unlikely to resolve my/our infertility issues all together, but it’s a nice thought.

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