Saturday, May 19, 2007

The road not taken

As the exhaustion and morning sickness subside, I've found myself obsessing about my body a bit less (there's not really that much going on, other than absolutely absurd intestinal issues that are too embarrassing to discuss in public), and thinking about how I got here, and all of the choices that I made along the way.

I'm sometimes amazed at the diversity of decisions that people make when dealing with infertility. For some people, the natural first choice is to adopt. For others, the obvious thing to do is to run to the doctor after just a few months of frustration. Others wait for literally years before seeking medical attention. Others seek medical diagnoses quickly, but refuse treatment. Obviously your own family background (and that of your partner, if you have a partner), your level of knowledge about fertility/infertility, and your economic resources will affect your decisions. Still, people in really similar situations seem to seek very different solutions.

My Mystery Man grew up in a very poor country, and had a neighbor that struggled with infertility. Seeing a doctor was impossible, as they couldn't afford it, and even if they could have, there wasn't an RE for hundreds of miles. They just continued to try for over ten years, and finally got lucky. Other couples in his country simply have to make do with childlessness, having no alternative. Mystery also has a friend whose father divorced his first wife because they didn't have a child after two years. This man just naturally assumed that it was his wife's "fault", and that the natural solution was to trade her in for a different model. Can you imagine how this poor woman must have felt, especially after she then had to watch the new wife have nine children? Knowing this, I never forget that we're the lucky ones. Still, having adoption and a dizzying array of treatments at least nominally available can make moving forward very hard.

If you decide to adopt, there are a million choices to make. Foster-to-adopt? Private adoption? Open or closed? Domestic or international? If international, what country? Do you care about the sex? The age? What about special needs?

For me, adoption has always been (and remains) a good option, from an emotional perspective. However, as every infertile couple (but astonishingly few fertile couples) realizes, it's really not that simple for many or most of us. If you decide to foster-to-adopt, you have to qualify (living in Korea would certainly put the kibosh on that for us), and in most cases will end up with a special needs kid. It can also be difficult to be matched with an infant. For us, the latter issue was also a serious issue. We speak two languages at home, and plan to continue to do so. Adopting an older verbal child who did not share my husband's language would force us to either try to force an already traumatized child to learn a new language, even though we COULD communicate with the child in English, or to entirely give up on my husband's language, which is like giving up on a part of our souls. It's tempting to think that the child would just "pick up" on a new language, but the fact is that would never happen if we spoke English to the child. While kids can be language sponges, they do tend to take the easy route when given the option. We're also not particularly well set up for a special needs kid, given our rather mobile lifestyle. Obviously we may end up with a special needs kid regardless, and will do our best to provide a loving supportive home for whatever child we end up with, but deliberately choosing a special needs child didn't seem wise.

Other adoption options were also out for two reasons: first, the money. We would really struggle to afford to spend $20,000 on a private adoption right now, and we don't pay US taxes, so the tax credit wouldn't help. Second, we seriously doubt that a birth family would choose us, given our lack of white picket fence, our highly mobile lifestyle, our stay-at-home dad plans, and our insistance on speaking a language largely perceived to be useless 90% of the time.

The other issue, which might sound absurd, but is very real to me, is that I don't think I could bear the paperwork, home study, and general invasiveness of the process right now. When my dear Mystery Man applied for his US visa to come to my country to marry me, we had to fill out a mountain of paperwork, provide letters and explanations of our relationship, proof of our sincerity, photos, phone records, and affadavits from friends, as well as detailed financial records and every identity document that you can imagine to the INS. It was supposed to take 3 months. Then the INS was absorbed into the US Department of Homeland Security, and became the BCIS (that was before it was the USCIS, for those of you who are up on your immigration trivia). In the process of becoming more "secure", they developed an enormous backlog, and his visa application ended up taking almost 10 months, during which time we were stuck in different countries. Those were the longest 10 months of our lives. We got no feedback whatsoever during that time, other than that the application was "being processed". There was no guarantee of success, and in fact, we know several people whose applications were rejected during that time. The best part is that if they reject your application, they don't even say why.

Luckily for us, Mystery Man's application was approved, and suddenly we were given three months to get married and prove it, or he'd have to leave the country again. Luckily, I'd never wanted a big wedding, but still, three months struck me as a bit unreasonable. We managed, though, and I thought our troubles were over. Then we had to apply for his green card so he could stay in the US. The process was at least as onerous as the visa application, and just as unsettling. While his application was pending (1 year), he couldn't leave the country, and we were not told when to expect that situation to change. So, we lived in fear that something would happen in his family, and we'd be faced with the awful choice of not being there for them, or going back to square one with all of the paperwork. Luckily, all was well, and in a year he was given a "conditional" green card, good for two years. After two years, we then had to apply for his "permanent" green card. This is when it got really invasive. Not only did they want to see our financials again but they also required that we provide letters from family and friends about the nature of our relationship, and other "proof" of the relationship. (The reason for the "conditional" status is to make sure that it's a "real" marriage.) I don't know about you, but I found asking friends to write letters to the US government stating that my husband and I actually love each other really mortifying. They were understanding, and wrote really touching letters, but still... When I went to file the paperwork, the agent in charge told me that they only actually interview some of the couples that apply for marriage-based green cards. I asked how they choose, and she said "well, I'm sure they'll interview you, because you don't have kids." (I'll bet you were wondering what this all had to do with infertility, weren't you.) So, I actually considered getting a letter from my RE stating that we were in fertility treatment, and that he had repeatedly (albeit unsuccessfully) inseminated me with my husband's sperm for the purpose of getting me pregnant and sending it to the fucking US Department of Homeland Security for the amusement of a bunch of bored paper-pushers. Now can you tell me how that incredible invasion of my privacy would make the homeland any more secure?

Well, long story short (you thought that was long? I've barely begun with my tales of immigration woes--I spared you the entire story of how they sent the green card to the wrong STATE a few weeks before we were leaving for Korea), Mystery Man now has his green card. I, however, will never be the same. The very thought of preparing an adoption dossier makes me sweat and shake. I have no doubts whatsoever about how much I would love and cherish an adopted child. However, I'm just not ready to put my happiness in the hands of faceless bureacrats again quite yet.

So the decision was between treatment and no treatment, and what treatments to pursue. Now I'm a proactive kind of girl, and never seriously considered postponing (or declining) treatment. My sweetie, however, took some convincing. It wasn't that he didn't want a baby, he just was a) hung up on the idea of doing it the "natural" way, and b) reluctant to spend money on treatments when he still believed that we could get pregnant the old-fashioned way. So, we started with testing, and found nothing. No explanation, no hope for improvement, nothing. However, I think that meeting with the RE helped him to understand that no diagnosis did not mean that everything was OK, and that given my age (did I mention that we had planned to start trying as soon as he arrived in the US, so the Department of Homeland Security's administrative delays actually cost me 10 months of my reproductive lifespan? Do I sound bitter?) we'd really better not dither around too much. So, we started with clomid, then clomid/iui (times 3). Nothing worked. I was in despair. I had a lap, they found and removed endo, but still nothing. My insurance only paid for 50% of infertility-related tests, treatments, and meds (so we were already out several thousands of dollars), and specifically excluded IVF. Meanwhile, our RE said that IVF was by far our best option. For me, the decision to pursue IVF was never difficult from a medical or emotional perspective. I was always more afraid of childlessness than needles, and was not particularly hung up on getting my "natural pregnancy" merit badge. However, the financial angle was huge. My doctor said that he'd give us about a 40% chance of succeeding with IVF per round, and the out-of-pocket cost for each round would be around $12,000-$15,000. Now I'm sometimes painfully logical, and couldn't help but notice that this meant that there was about a 60% chance that we'd be out $15,000 and still have no baby. The fact that it took my sister 3 rounds of IVF to get her BFP really didn't reassure me on this point either. Now we probably could have scraped up $15,000, but would have really felt the loss. I don't mean felt it like "no new car this year", but more like "well, I'd really like to buy that can of beans, but we really can't afford it, so I guess we'll just be eating ramen this week". (I guess I've never mentioned this but we're paying for Mystery Man's little brother and sister's private schools, so even though I make a decent salary, and Mystery had a decent salary while we were in the US, our money doesn't go far.) So, moving to Korea was an absolute godsend for us. With IVF at $3000/shot, I knew that we could go ahead and plan for 3 rounds of IVF. My number-crunching told me that we'd have a really good chance of succeeding at least once in three rounds.

After the first failed round, I never for a moment reconsidered that plan, and I never had a moment of regret about the decision to try. I can't say how I would have felt if all three rounds had failed. However, it's hard for me to imagine that I could regret trying more than I would have regretted not trying. So, it's sometimes a bit hard for me to understand how other couples who have insurance coverage for IVF can be so reluctant to move forward. I know that everybody is different, but for me, giving up on my own "natural" fertility and putting it into my doctor's hands was such an enormous relief.

The other day, Mystery Man said that now that we've succeeded with IVF, he feels a lot more optimistic that we'll get pregnant naturally with #2. I nearly fell out of bed laughing. The very thought of deciding to try for #2 and not starting by calling the RE is absurd to me. Not only do I think that we'd have basically no chance of success, but the thought of getting back onto that natural ttc roller-coaster is horrifying. I guess I'm an IVF addict, but I'd far rather just pay $3000, take my shot, and get my answer in a few weeks than spend another 3 years facing negative after negative.


megan said...

while only immigrating from the States to Canada, your immigration story sounded nearly identical to mine. we too had to provide letters, phone records, photos, the works...what harrowing days.

Samantha said...

I have heard other immigration nightmare stories, including a friend of my mine from Mexico who married a U.S. citizen. She was working on her Ph.D., which required her to leave the country to gather data. She got special permission to leave before the year waiting period, but somehow the paperwork got fouled up and she was almost deported! It cost her additional thousands of dollars to straighten things out and she basically had to start over.

What worries me about adoption is the homestudy too - having someone come over and decide whether you're good parents. What if they say no? How heartbreaking.

Anonymous said...

Heehee! You Mystery Man is funny with his blinders on!

I'm glad you found success with IVF at a fraction of the price you would have paid at home.

Marie-Baguette said...

Yep US immigration s*cks. My favorite story is when I came back with a brand new visa to NY from Paris and then HR told me that the immigration guy at JFK had scribbled the wrong date on my form. He had written June 2006 instead of June 2008, so I had no right to work after June 06 in the country. I was to go to Canada and re-enter so that the date could be corrected. At the same time, I was told by my RE I had miscarried after my first IVF, and that I was not allowed to travel because I was at risk for an ectopic pregnancy. At some point, I thought I would lose my job on top of my pregnancy... Happily my company's lawyers worked everything out. But you can imagine how stressed out I was. I am so sorry you had to go through hell to secure a green card for your hubby.

Marie-Baguette said...

PS: my worst immigration experience was not with the US, Singapore or Thailand, all countries where I worked, but... Canada! A country who supposedly encourages French immigration!

peep said...

Wow. I'm glad I don't have immigration to deal with in addition to infertiltity!

Sarah said...

i'm always thinking about the next try. i sit around and plot out how long i should wait after this baby before starting the next IVF cycle or how many more times i'll do it. i'm with you, the natural way sucks and leads to years of misery and failure. it's as frustrating as immigration.

Lut C. said...

People not only differ in the decisions on how to proceed. They also vary greatly in how they deal with IF.
I've always been one to get as much information as possible. Some people prefer to just leave it up to their doctors.

I can imagine the immigration ordeal would leave a mark.

The price of IVF is scandalously high in the U.S.