Monday, September 23, 2019

Having crappy ovaries and a crappy uterus on a freelancer's budget

So, looking at my old posts, at one point I broke down the costs of buying a house. Well, let me tell you, being an adult comes with expenses a lot less fun than that, though at the time I didn't know it. Though a lot of things in my life are going really well, and I don't feel particularly elderly, in the last year I have truly been slapped in the face with the reality of aging.

Specifically, with how quickly fertility can decline with age. For anyone looking at egg freezing or IVF, let me break it down for you a little. Because I really had no idea when I got into this.

So first, a short back story. About a year ago I started feeling unexpectedly crappy. My normally regular period showed up, and then refused to leave. I bled for about 40 days straight. I felt crampy and nauseous, and actually had to leave work early a couple times. For me, this is not normal. I've shown up to work running fevers before, because as a freelancer, if I don't work I don't get paid.

I made a doctor's appointment and also started googling pretty intensely. After a visit and then an ultrasound, my suspicions were confirmed. I had some pretty big fibroids. These are non-cancerous tumors that grow in your uterus. Mine were big enough that they'd likely make getting pregnant hard. They were causing all the bleeding and symptoms I was feeling. Though they are very common, actually, most don't get big enough to cause the problems these were causing. I basically had a couple small oranges and a lime (kiwi?) growing out of my uterus.

So, okay. Now what? My OBGYN recommended I talk to a fertility doctor about the next step. Older women often just get hysterectomies when faced with bothersome fibroids, but I want kids. I really, really, really want kids. After talking to the specialist, he recommended a myomectomy (surgery to remove the fibroids from the uterus and then repair the uterus). But he recommended not doing it yet. Since fibroids tend to grow back, he wanted me to wait until I was ready to get pregnant, so that I didn't have to get operated on more than once.

Simple enough, right? Wrong. Because he also ran some additional tests. And those additional tests showed that not only was my uterus a hot mess, but I had really low AMH. And what THAT means, is that my ovaries were also not operating the way they should for someone my age. I basically had diminished ovarian reserve (DOR), meaning I was running out of eggs way sooner than most women do. My AMH was more similar to a woman in her mid-40s than someone in her mid-30s.

So my uterus is full of benign tumors and my ovaries are starting to run out of eggs. And I'm 34(then), and in a new-ish relationship, and a freelancer with uncertain and unsteady income (and health insurance!).  My doctor recommended freezing some eggs, stat, and putting the fibroid situation to the side for now. He wanted me to aim for 20 frozen eggs.

So, I went on continuous birth control to try to stop my constant bleeding. It took a couple months before all the breakthrough bleeding stopped, but it worked. And then I did two rounds of egg freezing, to fairly depressing results. I do not have 20 eggs. I have more than zero, but not 20. And it was all very expensive.

For those thinking about it, or interested, these are some of the costs I encountered:

- The initial ultrasound that diagnosed the fibroids, despite having insurance, cost me a couple hundred dollars. They accidentally billed me twice, though, and it took MONTHS and so many incorrect bills to get it fixed.

- Then I did a saline ultrasound (where they inflate your uterus with water first, to get a better look). I thought this would be covered under my insurance, but they rejected it since it was considered fertility-related (vs gynecological), and it cost me close to a thousand dollars, unexpectedly, out of pocket. It almost cost me 2k, but I argued and pleaded and kept calling the billing department until they took pity on me.

- The two rounds of egg freezing, including medication, cost about 20,000. The medication was about $3,000 per cycle, with the rest going to the doctors. The first round cost more than the second, because my clinic gives women a 1k discount for subsequent rounds, plus I had some medicine left over. Regardless, about 20k combined.

- Acupuncture was recommended. I spent over 1,000 on acupuncture, because the woman my clinic recommended cost about $100 per session. She was great, and I think it did help some, but again, all out of pocket.

- I also spent some money on better food. I tried to cut out alcohol and coffee, at least during the cycles, and upped my consumption of fish and leafy greens. Avocado, pomegranate, eggs, and other fancy, expensive foods.

- LOTS of supplements. The supplements were maybe a couple hundred all told, but were a drop in the bucket by this point. Prenatals, folic acid, DHEA, Vitamin D, and COQ10 were all recommended to me.

ALL OF THIS was out of pocket. Money I had painstakingly saved to hopefully one day buy an actual home (not an investment property) went to this instead.  My insurance covered a few of the blood tests, but basically nothing else.

Was it worth it? Yes. Maybe. I'll know in a couple years. The first round of egg freezing I got only 3 eggs. Most women my age get about 15. The second round I got 6.  So I'm at 9, out of the 20 my doctor initially recommended.  I'm not going to make it to 20, I think. I just don't have the money.

I'm going for round #3 this year, though, after saving some more, because 9 just doesn't seem like enough.  The initial ultrasound I did today ($320, out of pocket) showed even fewer follicles than last year. About half, in fact. So my crappy, crappy ovaries are getting even crappier.  Oh, and the fibroids seem to have grown. And now there are more than the initial 3 - he saw little lumps all over my uterus. No wonder I've been feeling so bloated.

Even scarier: I'm freezing eggs, rather than embryos. So I don't know if my eggs are even good enough quality to successfully become embryos.  But, as wonderful as things are with my boyfriend, unless we know we're getting married, I don't want to make embryos I might have to throw away if we break up. They are too hard for my body to make. But I'm also really hesitant to use donor sperm when I'm in a very nice, committed relationship. That feels wrong. So, egg freezing it is. Over 90% should survive thawing, per my doctor, so out of my 9 eggs, I'm hoping all survive, or at least 8.

So, hopefully this information is somewhat useful to someone out there thinking about freezing. And I so, so hope women approaching their mid-30s think about getting their hormones and fertility checked. I had no idea things were so bad, since I don't smoke or drink excessively and I was always fairly healthy. But my reproductive system sucks. And so might yours! So just get checked, for peace of mind if nothing else.

In the next year, I'll have to decide what the next step is for me. So will my boyfriend. That's scary, too. It doesn't look like I'll be one of those mythical women who fall pregnant easily in their late 30s/early 40s.  But until then, I'm going to do what I can, which amounts to setting money on fire, and I'm going to hope it's enough.

Tuesday, September 10, 2019

The More Things Change...

Time for my annual update (just kidding...kind of)! It's funny, I feel like I've come such a long way the past couple of years - geographically, financially, with my personal life - and yet, some things haven't changed at all.

Though I'm able to charge more than I did, and work has become more steady, I still freelance, and therefore still deal with periods of unemployment and constant job hunting.  I now have more in savings, but also much higher expenses and obligations. These include happy expenses, like a nicer rental home and improvements on my investment property, as well as slightly less enjoyable expenses that include egg freezing and ultrasounds after some out-of-the-blue negative news about my fertility. Though, duh, I'm not as young as I once was, so maybe I shouldn't be so surprised.

And of course, I'm now an LA resident with a lovely LA boyfriend. Creeping up on three years together, and I still like his stupid cute face and his hugs and his goofy jokes.

So overall, I know I'm very lucky. I do feel it. I do appreciate it. There's still a lot of restlessness, though, as well. A lot of uncertainty about the future, and what comes next.  I'm creeping up on middle age, somehow, insanely. I'm 35. I don't feel it. I still feel 25. At least I finally don't feel 15.

Is it just me? I know that I used to think 35 was ANCIENT. I was just going into middle school when my parents were that age, and I thought they were definitely old. And yet, I do not feel old at all. I'm still figuring so much out. I don't have kids yet. I don't live in a house I own yet. Never been married. Doing better work-wise, but still so much I want to accomplish.

So is it perception or reality? DID my parents have it so much more figured out at my age? Or was I a dumb kid with no idea of how young and confused my parents still were? Maybe still are now? Or am I just some sort of immature avocado-toast-eating millennial who is refusing to grow up? I don't even know. I look at my friends and I don't think I'm doing so much worse than they are, so if it's me then maybe it's all of us. Maybe we have it harder. Maybe we're just softer.  Maybe every generation is actually the same, and I'm just too far into it to be able to notice yet. I guess if I live long enough, I'll figure it out.