So I only ended up having to call Tepeyac three times before the nurse called me back. I feel bad because I must sound like a banshee on their answering machine. Three messages in an hour, telling them it's urgent and that they HAVE TO CALL ME BACK. But there have been days I have left just one or two messages (telling them, for example, that it has been a month and they still have not provided my bloodwork results), and never gotten any answer AT ALL. I don't want to be a monster (most of the time), but I feel like I don't have a choice.
Anyway, the nurse said that Dr. L could fit me in at the end of her day (i.e., stay later). I appreciate that. I really do. I know it's my fault that I couldn't get myself there at the time I had the appointment scheduled, and she shouldn't have to work later for that. However...I work around their schedules to a degree that makes my life extremely difficult and often makes it impossible to schedule treatment. And I know - I know - that if I had simply called the receptionist to ask whether it would work if I were 25-30 minutes late (my first call of the day), rather than calling the receptionist three times; or only called the receptionist three times; or only called the receptionist three times and the nurse once - I would never have gotten a monitoring appointment for yesterday. Or even for my next cycle. They're up-front about how they can't possibly see me during a three-week period (you know, when I need an appointment within a range of three days). But they don't volunteer anything in terms of what they can make work unless I verbally abuse them. What kind of arrangement is that?
So I appreciate the office being accomodating, even if I feel like I have to become the worst person in the world to get them to treat me like a human being.
Sadly, the happy(ish) thoughts end there, because the results of the appointment itself were a total disappointment. I wanted to know: (1) do I have endometrial cysts again (I am convinced the answer is yes); (2) if not, what is making my ovaries hurt; (3) have I actually ovulated, or do I have an unruptured follicle; (4) what is the thickness of my lining. It was logically impossible to get answers to fewer than three of those questions. How many answers do I get? One: my lining was 1cm, which is good. Isn't that nice - a great implantation site for my eggs that are never fertilized.
So, how is this possible, you ask? Well, keeping in mind that I am neither a gynecologist nor a sonographer, here's my understanding. On my right ovary there is a 3.5cm cyst. (Dr. L/C didn't think that size was anything remarkable, but I've had a lot of cysts, and that's not small! Certainly enough reason to cause pain - I had right-side ovarian twinges just yesterday before the ultrasound, and I have to assume they're related.) It has blood in it, so it could perhaps be an endometrioma (it's my cyst, and that's what I think it is), but Dr. L/C was more inclined to think it's a hemorrhagic corpus luteum. The fun part is, she tells me, with a hemorrhagic corpus luteum, it's not clear whether it ruptured and released an egg, or not. So I didn't even get that answer! Good news or bad news - I don't even know.
She didn't find anything else of note on my ovaries that would explain the pain. But, she couldn't find my left ovary at all. I remember AYWH said she often had this problem, so I didn't freak out. I can't imagine she would have given me a post-surgical debriefing last October and omitted to mention that she removed my left ovary, and I had one before that, so I have to assume it's still there, and hiding somewhere.
Here are a few other complications I thought of: my CM pattern indicates that Thursday was definitely peak day - nothing at all after that, and a good five-day pattern before. And on Friday my temperature spiked (it never happens that fast for me, so I was delighted). But when I took temperatures again on Monday and Wednesday, it was just 97.7, which is the same as several pre-peak temperatures. That makes the cycle look anovulatory, but...why the textbook CM pattern, then? Presumably if the pre-peak pattern is that clear (i.e., high estrogen), a corpus luteum at least formed...and maybe didn't rupture? But in that case, where was is? The cyst she found would be one candidate. But if that cyst is an endometrioma, where did the corpus luteum go? I assume here that the left ovary would not have been invisible if it had had the corpus luteum, since those are big, right?
Finally, we discussed medication options. I said that until we can rule out further endo activity as the cause of the pain (and the cyst), I don't want to take tamoxifen, clomid, femara, or anything that stimulates ovulation. Especially since the beginning of my cycle looks normal, and I've always figured I was ovulating. But the end of my cycle is clearly weird. So she gave me a prescription for HCG shots, which I will fill soon, and be able to take next cycle.
With respect to the cyst, I am going to set another ultrasound appointment for pre-peak, two cycles from now (next cycle that phase will be over the holidays), and if the cyst remains, we know it's an endometrioma.
Oh, yes, and lastly: I am going to continue getting treatment at Tepeyac as long as they have something to offer me. If I find out another doctor can do better, then I'll switch. And TCIE, yes, the distance is precisely the problem. Scheduling appointments around work is already such a headache I am often tempted not to make them at all, and Tepeyac is under an hour from my house (around two hours from work). If I switched to Dr. S, as a practical matter, I would cease to get treatment at all. I cannot have my job and undertake that kind of travel for regular treatment. I think most of the people who are able to have variable/non-traditional work schedules, substantial amounts of regular time off (i.e., academic calendars), or don't work. I know there are exceptions (people who take two or three straight weeks off to go to Omaha, for example), but I don't think the typical American job makes that remotely feasible.
I think this may be one of the many fronts in which I'm a freak from the point of view of other infertiles, and I'd like to get this explanation out there. I wanted motherhood to be my primary career, and was willing to give up being a lawyer for that. I think being a lawyer is good (there are benefits and drawbacks). I think being a mother would be better. I think being in treatment for infertility ranks somewhere above having my fingernails pulled out with pliers - just above. Another woman who had been willing to put motherhood first, the way I wanted to, would just have sent her eldest child off to start school this past fall. I have spent that same period dealing with, or being emotionally incapable of dealing with, fertility treatment. Conceivably (no pun intended) I could spend the entire period it would take a child to get from conception to moving out to go to college, getting treatment. Many people seem to see being in treatment as part of being a mother. I see the two things as so different I can hardly even fathom a connection. It's like the difference between being an artist and being waterboarded with paint. Would I accept being an artist for five years? Sure. Waterboarded with paint? Obviously, no.
I fully understand that a lot of the other IFers (the majority, it sometimes seems), work on a schedule that offers three months off (plus multi-week holidays); or work on a flex-time schedule; or work with the medical facility that offers their treatment; or don't work at all. For people with these arrangements, I imagine that the hassle of getting treatment seems like a small thing, such that flying to Omaha or making a two-day trip out of seeking treatment in Pennsylvania would appear reasonable. To do these things, I would have to accept that I cannot actually be useful to my employer. And I would have to put my job in jeopardy in that fashion for the sake of treatment, which I hate. Hate. Which, for me, has almost no hope of success - I'm just checking a box. I cannot even imagine a rational basis for doing that. So I am always surprised when somebody suggests that I travel farther than I already do, or undertake treatment more inconvenient than the serious inconveniences I already have. I know other people make decisions to do this, and I respect their decisions, but I cannot understand them.
It's obvious to me that others are no better able to understand me (this is even harder to comprehend, but I have to assume that it's true). That's why I get so many comments - in person and on my blog - about "why don't you just go to __________." Even "why don't you just find a different doctor," while apparently an obvious comment, doesn't make a lot of sense. Finding another doctor who will offer the treatment I need (and am willing to accept), and accepted my insurance (not willing to pay out of pocket when insurance is part of my compensation for my job) would probably be worthwhile, if it did not entail a 40 hr/wk job in itself, and if it were even possible, which it may or may not be. But it's certainly not simple. Again, if I did not work, it might be; I'm not sure.
So, in sum: I'm divisive, argumentative, often belligerent. Even if I get angry about it, telling me I should just do x or y for treatment is probably fair game. But I am not sure that every infertile wants to have every one of her difficult decisions picked apart by the peanut gallery on a regular basis. I don't even criticize people's decisions to use IVF, and I disagree with them morally. (I might take up the issue in a one-on-one in-person conversation, in which the other woman had an opportunity for give-and-take, and I could see whether I was upsetting her.)
However good your doctor is, or your treatment regimen is, or your herbal remedy is (and this isn't directed at you, TCIE - I have no problem with you cheerleading for Dr. S, this is a broader issue I want to take up), telling someone else that that's what she should be doing has the underlying message that she is not doing a good enough job finding treatment; that however much treatment takes out of her emotionally, it's inadequate; that she doesn't want to be a mother as much as you do; and, perhaps, that if her treatment is ultimately unsuccessful, it will be her fault, because she didn't do everything she could have done.
After all the hurtful things the world says to infertiles, I think it's our obligation not to heap more criticism on each other. (I generally distinguish "have you heard of" or "you might be interested in" or "I've heard"-type comments as being harmless and merely sharing information, but other people might not take these in the way that I do. For anyone I've hurt with my comments, which I hope were merely unintentionally judgmental, I'm sorry.)
Again, I appear to think differently from at least half the infertile population on most matters, so if you take a different perspective on the suggestions to others, please chime in - I am interested to hear what others think.