the best laid plans…

This isn't going at all the way I planned. From day one it's been nothing but chaos and unpredictability. I should get used to it, it's been two years already and yet it still catches me off guard.

Last month the plan was to try two cycles naturally and then move on to injectibles. Injectibles and IUI for four cycles, which brings us to the end of this year. Next year, start to think about IVF. It was a good plan, only I didn't ovulate so there's no point to trying naturally. We went back to see the doctor yesterday and work out a new plan.

Maybe we should stop calling them "plans." In my head, that means something we can go by, a sort of road map to this crazy ride. But there are too many twists and turns, and it's really not possible to plan for everything.

Here's the new plan (for lack of a better word). This month is out. I'm going to be out of town for a training seminar during the week of ovulation, so if we were to do any medications this cycle I wouldn't be here on the days necessary for IUI. I'm not feeling up to shooting myself up while I'm away, and if there's no sperm around with the egg is ready, there's really no point. I could cancel my trip, plan on doing the training next year, take my certification exam later… But honestly, I'm sick of putting my life on hold for the Maybe Baby that keeps not showing up. My coworker gave up her spot for the training so I could go (boss lady didn't want us both gone at the same time). And I've already shelled out about $2000 for the class, hotel, supplies, and exam. So I'll go on hold for a month to get this taken care of.

Next month, back to the dreaded Clomid. It will be a smaller dose, and I'm only going to do it for one cycle at a time – which means if I tolerate it well this time at the lower dose I might do it for up to three cycles, but I'm not planning on it because the thought of spending another three cycles crying makes me want to, well, cry. One cycle only, and they'll be monitoring me, and it will be okay. Really, it will.

Then we're on to injectibles. Daily shots at home, given by DH. We get to mix and administer the drugs ourselves – what fun. I'm not a huge needlephobe, but the thought of DH with a syringe, coming at my ass… You can imagine how much I love that idea. Again, IUI. We have four left this year covered by our insurance, might as well exhaust that route before bringing out the big guns.

Next year, IVF. They don't do GIFT anymore. I am very upset by this, I just assumed they did because the doctor who referred me here had twins through GIFT at this clinic with this doctor. The doctor says that the risks are higher, the success rate is lower, and it's just not worth it anymore. Less than 1% of ART in this country is GIFT anymore. 99% is IVF.

Problem is, IVF is pricey. We have two options at this clinic. One can be summarized as a "Buy Two Get One Free" plan. You pay for two full cycles of stimulation, egg removal and insemination, freezing, and frozen embryo transfer. This is about as fun as it sounds, and it costs $10-15K each time. Not covered by insurance, of course. With any luck, enough eggs are harvested and successfully inseminated that there are some left over in case it doesn't work, so you can do a cycle of two of just frozen embryo transfer. But after you go through this twice, you get a bonus round. Basically, the clinic feels sorry for you and says "here, this one is on us." You still have to pay for meds, though, which run $2-5K.

The second option is the "Shared Risk" plan. You agree to a 6 month course of IVF treatments, alternating three fresh cycles with three frozen cycles, for a set price of $18K plus meds. If at the end of the treatments you don't get to take home a real live baby of your own, you get 70% of your money back. If IVF works the first time, you end up losing a lot of money by going this route. But if it doesn't work, you save a lot and have the added peace of mind that you're not spending all this money for nothing – you get a big sum of it back, or you get a baby.

If there are frozen embryos left over, you get to make a pretty big decision. Do you keep them, paying about $50 a month to store them, so that you can have a second child down the road? You'd only have to pay for the transfer, assuming the embryos survive the freeze and defrost okay. Do you donate them to another couple who is having trouble with their own eggs and/or sperm? Or do you just throw them out?

This is my biggest problem with IVF, the point with which I am trying to make peace now so I don't have to rush into anything later. I don't feel right donating them to someone else – to me, it feels like I'd be giving up my babies for adoption, and I have no control over what kind of parents the adopters will be. An even worse choice to me is to destroy them, throw them out. I would feel like I was killing my babies, and how do I choose which to implant and give a chance, and which to give up? I could store them, but that's a temporary solution, and an expensive one. $600 a year for a "maybe" chance at a future IVF. And when we're done building our natural family, we still have to decide what to do with them.

Oh, and at my particular clinic, for women in my age group, IVF has a 60% success rate. There are still no guarantees. We could still come to the end of it childless.

So perhaps this rage and sadness and hopelessness I feel on an almost constant basis makes sense. For most people, making a baby is an act of love. For us, making a baby is an act of will. It requires financial planning, many many trips to the doctor and hospital and pharmacy, hope and heartache on a 28 day cycle. We will have our family, but only by the sheer force of our will, the skill of our medical team, and the grace of God – mostly by the grace of God, for there is nothing anyone else can do to guarantee results. I will have a very difficult time relaxing into pregnancy, as my risk of losing the baby will be high. I am likely to have twins, which will increase the risk of my pregnancy (not to mention the difficulty of taking care of two infants at the same time). I will not truly believe that I get to be a mother until I hold my child in my arms and smell that newborn baby head smell.