Thursday, June 14, 2007

'Lesbian' is not a synonym for 'infertile'

I loved my first obstetrician. Loved her. Since none of my lesbian friends had been through a pregnancy when I was trying to figure out what I needed to do, I got a recommendation from a straight friend at work. I went to my consultation with some trepidation, unsure of how the lesbian card would play. But she was wonderful and put me at ease. She looked at my medical history, discussed the process for getting started, and made it very clear that we didn't need to make things any more complicated than necessary. It was right around my 29th birthday: "You're young still. There's no reason to expect you'll have any trouble." And then the line I still like to quote: "It's not a fertility problem, more like a supply issue."

The biggest stress of that process was the fact that they would only do inseminations on regular workdays. My first attempt, on a Monday, was probably 16-24 hours too late. I worried before the second try that I was going in too early, but I had already picked up the pop-sicle and the next day was July 4th--closed for the holiday. But a little early ended up being just right.

This time, circumstances came together in such a way as to mandate the clinic I'm using. To get the pop-sicle into Canada, we would need to do all sorts of paperwork. Moving the process to Buffalo makes things easier, although there are further limitations to where I could do it. Because our cryobank is back where we used to live, any place I used needed to have storage available for me. And only one place fit the requirements, an infertility clinic.

The clinic is professional and has good results. They have protocols, and the specific one you follow depends on your exact situation. But even though they have worked with lesbians before, they cannot get out of the mindset that they are "treating" me.* The process they first set out for me:
  1. Call them on Day One of a new cycle and set up an ultrasound for Day Ten.
  2. Go in for ultrasound on Day Ten. This is to make sure that a follicle is developing and my lining is thickening.
  3. If given the go ahead, begin peeing on ovulation sticks to check for LH surge. But only first thing in the morning.
  4. Call on the morning I surge to set up insemination for the next day.
  5. Go in, have ultrasound to make sure lining is still OK and see if egg has been released (though technically conception is still possible if it has just been released).
  6. Inseminate and keep hips elevated for 15 minutes.
  7. Wait 2 weeks to see if the cycle starts all over again.
For the first cycle, they were willing to skip both ultrasounds, citing my travel time from Toronto and the fact that I'm paying out-of-pocket. But then they started to creep in. Even though this is not my first time through the process and I can usually advocate for myself, I found myself succumbing to the mindset and thinking of these interventions as necessary.

When I decided to take a couple of months off from trying around the holidays, I also reassessed what I was doing. And I knew that part of the problem was that I had bought into their approach and was ignoring my own instincts. Instincts that told me I am better off inseminating before the egg is released and that waiting for the surge line on the ovulation test would be too late. Instincts that got me my son.

So I listened to my body and called the clinic on the morning that felt just shy of ovulation. Claimed I had seen the surge. Which came that afternoon. Two weeks later I was pregnant. Although that pregnancy did not go past 9 weeks, I was at least validated in thinking I could read my own body's signs better than a pee stick.

So now I'm looking to start trying again and called the clinic to initiate the process, ready to stand up for myself. I want to say: "Since I ovulate regularly, I see no reason to come in for a preliminary ultrasound." But, of course, I have to play phone tag with the nurse and don't want to try to leave a detailed message, so I ask the answering service to leave something like: "I need to talk about timing for my cycle."

When the nurse called back, I discovered that this had been relayed to her and the doctor as, "I need to talk about the next step." She began by informing me that the doctor wanted to put me on a low dose of Femara, but this would require a consultation and had to be started on Day Three of my cycle and so we could do that next cycle.

I was momentarily stunned, but then gathered myself and said, "I'm not really comfortable with the idea of a fertility drug at this point. I ovulate regularly and I've only had the one miscarriage, and there's no reason to consider that a fertility problem." In the end, I was able to get her to agree that I would go about this cycle as usual (but without the extra ultrasound, as I wished).

After the phone call, I did a little research into Femara to see what exactly the doctor would have put me on. The intended use of Femara is as a drug to stop recurrence of breast cancer. Its fertility use is off-label and its safety in that regard has been debated. It works by inducing ovulation in those who do not ovulate regularly. For those women who are already ovulatory, it encourages the ovaries to mature and release extra eggs. Trillian and I had the same reaction: NO WAY! There is nothing in my history to suggest I am anovulatory. And although we would welcome twins if things worked out that way, we see no reason to encourage such an outcome.

If I had another option, I would not stay with this clinic. I do not like that their immediate answer is to put me on a fertility drug and an off-label use at that. Never mind that two minutes of research show me that this particular drug is just about the last thing I need. It just proves to me that they are not looking at me as an individual case and that they automatically treat pregnancy as a state that requires medical intervention.

Now I'm not saying that lesbians never deal with infertility issues--I've heard of plenty of lesbians who have discovered, once they start trying to get pregnant, that they need more help than they expected. But that should not be the default assumption and I resent being pushed into this category, especially when my history proves that I am fertile. Being treated like getting pregnant will be difficult raises my anxiety--talk about adding unnecessary stress.

I'm a lesbian and it's a supply issue!


Laural Dawn said...

I can't relate (as usual), but ...
My last doctor's appointment I was told that I need to hurry up and get pregnant before I have to deal with infertility due to age.
The funny thing is that when I had my son I kept being told (at 25) how young I was. Now at the ripe old age of 29 I need to start worrying about being too old.
This whole childbirth/planning pregnancy thing totally sucks.

crazymumma said...

shit...I wish I wasn't phobic of medical things , especialy stuff like this.

you should see me when I go for my yearly pap...what a drama.

so sorry mouse, i just couldn't read it, I would have passsed out. so sorry and pathetic....

cinnamon gurl said...

Wow, that sucks! It really makes me angry when doctors' first response is just to throw more drugs at a person, for anything, without looking at the person as a person. Arggh!

Aliki2006 said...

Well said. I get so fed-up too with the propensity to toss drugs at people constantly--even at kids. It's a lazy short-cut, IMO.