The year 2020

 This is the year that historians and scientists and journalists will be talking about for years to come. The things that happened, the words that changed their meaning: pivot, pod, bubble. Even the words that were so overused that meaning started to blur: unprecedented, abundance of caution, mute. It's still 2020. We're still living in that year. 

I'm sure there are lots of articles and news stories and tiktoks summing up the year. I'll leave that to the professionals who will likely do a more comprehensive job than I can. Here's the year I'll remember. This was a very difficult year. We shed all the externals of every day life down the bare skeleton of our existence. What's important? What's essential? 

"Extras" like restaurants and concerts and sports and museums get togethers with friends and family were shut down. But are they extras? Or are they the reason that make the daily grind bearable? We got on our screens every day to work, to socialize, to veg out, to shop, to pay bills. We held the people in our household close because they were the only ones we could hold during a time when we needed others the most. We've lost so many people that we've gotten numb to the numbers. But they're not just numbers. 

And it's not over. Just because the calendar year is flipping doesn't mean there's a switch to the virus being turned off. The opposite is true: hospitals are at capacity, health workers are exhausted, the virus mutated and is spreading more rapidly, vaccine rollout is going excruciatingly slow in the US, and another surge is expected post-holidays after millions of Americans traveled against all the experts pleas to stay home. The darkest days of the virus are still ahead.

Beyond that, though, is hopefully a light. A turn. A change. We have to believe there's an end to the darkness. I have to believe there's hope. It's how I'm wired; it's what got me through the miscarriages and RPL and 7 failed IVF cycles. So I'll join the people showing gratitude for some parts of 2020 and what I'm with leaving behind. 

I'm so grateful to have been home with our son. Between maternity leave and the shutdown he was in daycare for all of 11 weeks. I learned something about myself I never would have known without this opportunity: no matter how I envisioned my life I never thought that being a stay at home mom was for me. I didn't know how much I'd enjoy it. I bet I'd enjoy it even more if we could do things like music class and going to the library and the aquarium and the grocery store or playdates with other moms. 

I don't take for granted that our jobs were able to convert to online work. I recognize that so many people didn't have that option and are truly suffering. As bad as my anxiety and financial insecurity felt throughout the year, I know there are people who are struggling to make ends meet and I'm grateful for the programs and organizations that helped when I felt helpless watching the news about people struggling.

There are some things that had accumulated in our pre-pandemic daily lives that we just kept around, similar to that box of stuff you don't feel like sorting and leave packed in storage but bring with you whenever you move to a new house. Here are a few things I'm ok leaving behind.

- office gossip. Gossip in general but I felt like my office was the majority of where I spent time. It felt like the social lubricant that kept people close. That may be true in some ways but when the pandemic hit, we weren't in the office anymore. In the absence of being in close quarters, we naturally limited our interactions to work-related conversations. It felt really freeing. I don't like being part of drama but I like being in the know. I'm rarely in the know now and I'm ok with it. It made me realize what's important to me. It also clarified to me that I'm ready for a new job. Once all the perks were gone I realized that the pieces holding me there were few and not at all worth it. I'm ready for a new challenge and I hope people start hiring in 2021.

- being aloof. I'm cynical and it takes me time to warm up to people. I will continue to work on my trait of making snap judgements about people. While I'm far from becoming the type that offers free hugs to strangers in the park, I think I need to learn to be more open and trusting.

- fomo. I think there will be a lot of opportunities coming up in the months after the pandemic is over. My goal is to say Yes to things I can join and stop feeling left out of life. It's up to me to create my own happiness. Happiness is a choice and takes work but it is within our control.

I'm sure more will come up and I'll add to the list. Regardless of what this year took from us, I want to try to come out of it a better person. 

Best wishes to you and yours for a happy, healthy, and safe 2021.

But wait...

 After several rounds of labs and telehealth appointments, I've been medically cleared from my endocrinologist and pcp. My TSH came back in the 2s even though I haven't been on medication for over a year. If I get pregnant I'll follow up with my endocrinologist to find out if anything needs to be adjusted. My liver enzymes are still slightly elevated but stable so my pcp recommended continued exercise and weight loss but no restrictions otherwise. All bloodwork from my RE came back fine. The next step is to get an ultrasound and biopsy before transferring. But... in true #2020 fashion we were hit some upsetting news. 

Our insurance will not cover any part of treatment. Apparently the company decided to go through PROGYNY for all infertility related treatment and the clinic needs to be in network in order to qualify for benefits. My clinic doesn't participate in PROGYNY which means that absolutely nothing is covered. The real kick in the balls is that my former clinic, the one ran away from after 7 failed IVFs and recurrent losses they chalked up to "unexplained infertility" is in network. 

I'm not sure what we'll do. We need to figure things out. The FET and medication can cost about $10,000. But money shouldn't be a reason people don't have kids right? I would sell my house before giving up because of money. Or maybe slightly less responsible things like putting it on a cc or dipping into retirement. I guess things are on hold while we process this. 

#2?

We started the conversation about considering trying again. In a nutshell, there is a lot to consider and I'll try to unpack it here. 

Financial

Having a baby is expensive. Doing treatment to have a baby is very expensive before the baby even arrives. I estimated that between the hospital bills, celebration, setting up the nursery, and getting all the gear we spent nearly ten grand. That doesn't even include all the money spent trying. Obviously a lot of items will not need to be bought again (stroller, furniture, etc) and any celebration will be a much smaller affair, if not entirely on zoom. Even so, we still need to factor in potential hospital bills and fertility medication costs. This is before we factor in the monstrosity that is daycare costs for infants under two or the debt we're paying down for replacing the roof last year. 

Medical

My weight is back to where it was before we transferred. I gained 27 lbs during the pregnancy, lost 20 by 6 weeks pp. During the early months of the pandemic I gained an additional 15 lbs - I can blame it on nursing or stress or lack of sleep but it was probably a combination of all of them . I'd like to continue losing weight and focus on healthy eating and exercising. Over the summer I got some labwork done with my pcp for my annual physical that was nearly a year overdue and got some results we're monitoring. One of the liver numbers was high. She said fatty liver can be caused by pregnancy and breastfeeding so she wanted me to retest several months after stopping to breastfeed. I was originally planning to stop breastfeeding around the one year mark but weening has been going slow. I just don't think we were both ready. We're down to twice a day for a few minutes and slowly decreasing. Either way, I messaged my pcp asking about following up and the recommendation was to get blood work and see where the numbers are at. 

Nearly a year ago I stopped taking thyroid medication per my endocrinologist's recommendation. I was about 8 weeks post partum when I realized my refill was out and I hadn't been on the medication for nearly a month. My levels were tested and since they came back within the normal range she recommended staying off of the meds until we can reevaluate at my March appointment. Then covid happened and that appointment never did. The fertility clinic used to recommend seeing a TSH under 2 for pregnancy but now that level has been updated to under 4.5. 

Emotional/mental

Fertility treatment is a roller coaster. It's an exhausting and draining process. Even assuming best case scenario of successfully getting pregnant, the first weeks are rough and we have no support in terms of childcare or cleaning or whatever. It would be all on the two of us so we really have to be prepared for it mentally. 

Covid

There's so much unknown about this. We don't know if covid causes or increases risk of miscarriage or birth defects if someone gets it while pregnant. We don't know if someone who had covid or is vaccinated prior to pregnancy is immune or has increased risk of defects. We're still not really clear on how safe it is to be indoors with masks, even though we know it reduces the risk significantly. So what does this mean for doctors appointments? Potential hospital stays? 

We do know that pregnant people are in a higher risk category. We know that pregnancy can potentially exacerbate covid symptoms. There is no safe daycare option before everyone is vaccinated. Hospital stays are very different than before - you may be allowed one visitor and they may or may not be able to leave. Even if everything goes smoothly with labor and delivery and we all get home safely, there are still so many appointments within the first few months, for baby and mom, and each one can increase risk of exposure - we just don't know where this pandemic is headed or where we'll be a year from now.

Each of these considerations is very serious individually. All together they seem insurmountable. A rational person may say that it's definitely the time to wait. Some may argue that a "vaccine is on the way" and if we hang tight for a bit then the whole covid situation will resolve and a lot of these considerations will become moot. 

All that may be true, but I've been burned before for waiting and I don't want to repeat that mistake. Before trying for our first we waited several years while trying to get our finances in order. We wanted to finish school and buy a house and pay down debt before taking on the challenge of parenting. How did that turn out? Not only did we never fully get to where I'd like financially (thanks, 2008 recession) but we ended up needing multiple years of fertility treatment before being successful. Trying doesn't guarantee success. If we end up needing another IVF to keep trying then we're up against the clock.

I spoke to our RE to catch up. I love her, she's the best. Her recommendation was that it's a personal choice but that she wouldn't put her life on hold due to covid. With regard to our treatment, she would want to do a saline ultrasound and biopsy to see where things are. If all comes back normal then the transfer would be the following cycle. If anything needs to be addressed, then we would treat and take it from there. Before even doing that, I need to address the liver and thyroid issues first. 

So that's the timeline. I'll use December to follow up with my pcp and endocrinologist. In January I'll verify our new benefits and see what, if anything, insurance will cover for a FET and the medication associated with it. Maybe by February we'll know more about a vaccine and we'll be ready to do the u/s+biopsy in the spring. In the meantime we'll continue to try to save money, pay down debt, continue to lose weight, and get in the mindset of gearing up mentally.