1. dag på jobb, CD2 og mail fra Dr. D.

Vel, i dag er første dagen tilbake på jobb. Heldigvis har avdelingslederen min gitt meg lette arb.oppgaver i dag, mest kontorarbeid. Så nå er jeg tilbake på mitt lille kontor etter å ha møtt/sett de fleste av kollegene mine igjen på morgenmøtet. Sist gang de så meg var jeg lykkelig og håpefull gravid, nå er jeg ikke. Det er noe spesielt med å få drømmene sine knust i all offentlighet.
Har pratet med lederen min om ting som skjer fremover, og til og med det var tungt. Jeg synes på en måte det er feil at livet går videre, og det å skulle planlegge prosjekter fremover høsten virker veldig fjernt. I tillegg føler jeg at de synes jeg har forsøkt nok nå, og at de på en måte forventer at jeg blir mere en ressurs fremover enn det jeg har vært så langt de siste 1 1/2 årene. Mens jeg er i planleggingsfasen på å gjøre et siste desperate forsøk på dette høyt ønskede barnet. Å skulle sitte i styringsgrupper etc fremover virker bare helt søkt og fjernt for meg, selv om jeg vet det er viktig for meg selv at jeg sitter der. Karrieremessig ihvertfall. Har mulighet til å bygge opp min fremtidige arb.plass, og det er jo en fin ting. Tøff dag.

I går kom tanta på besøk også. Vet ikke helt hva jeg føler om det. På en måte er det godt at kroppen fungerer som den skal, det gikk 5 uker og 4 dager etter fødselen, og 5 uker akkurat etter utskrapingen. Men på en annen måte så er det så utrolig feil også, for jeg skulle ikke hatt mensen på lenge lenge ennå. Og når den nå engang er her så betyr det ikke at vi er i noe babylagingsmodus. For vi må vente, vente og vente.

Har skrevet og fått nytt svar fra Dr. D igjen. Han er favoritten så langt, ikke bare pga økonomien, men også pga lang erfaring, svært god statistikk, lettere å reise til geografisk av legene i USA, vil gi meg 17-P-sprøyter, og i det hele tatt. Jeg drømmer om å reise dit i ferien min i august, men for å få det til å gå tror jeg at jeg må ta ei ekstra uke ferie (som jeg har fått vite er OK fra ledelsen) og Mannen må be om å forskyve ferien, evt ta ut litt avspasering i slutten. Så det er litt avhengig av det egentlig. Ellers så får vi reise senere, og det går sikkert også an, men jeg er rimelig utålmodig. Jeg kommer til å være over 35 år neste gang jeg er gravid, om vi lykkes igjen, med alt det innebærer. Så håpet er at vi får kommet oss avgårde og gjort operasjonen 20. august....

Limer inn det siste svaret fra Dr. Davis.

Hi esmeralda,
In the mean time I have some more questions I hope you can answer.
You say that you would recommend doing the TAC pre-pregnancy,- in what method would you do it then (trad/lap)? I'd really prefer the method that gives the absolutely best results in terms of keeping a future pregnancy. The traditional approach would be the best on two accounts: First, it has the best track record in terms of results. It is the approach that has been done the longest and the one for which we have the most imformation. To the best of my knowlege, our success rate (assuming you don't have an early miscarriage) for the pre-preg TAC by traditional approach is 100%. Second, it is the least expensive.
Also, with the TAC in place and if I get pregnant again, do you think I should keep working as normal? When you get pregnant (no "IF's" please), you should be able to be like any other normal pregnant woman. I do not advise bed rest if the cervix is your only issue. I have had many. many patients who have continued to work throughout their entire pregnancy, right up until the day before their cesarean. What level of activity you maintain will, of course, depend upon how you feel, whether or not there are other issues, and on how anxious you might be.
Is there a specific time during the menstrual cycle it should be done? I have had irregular cycles after the previous losses, so it might be difficult to plan ahead. During or right after the menses is ideal but it really doesn't matter much. I would not use this as a criteria in making your plans.
What complications do you see most often, and what would happen in my case (with no american insurance) if there were any? Also do you know if some american insurance companies would sell insurance against complications from just this one procedure? In addition to the 5000$ would there be any other medical expenses at all (except the aprox. 250$ for the P17-shots which I think I would like to try)? There is always the potential for complications but, to be perfectly honest, my patients just don't have problems. The biggest "complication" we have is that their obstetricians want to restrict their levle of activity because they can't believe that this really works. I cannot remember the last time we had any kind of a complication other than things like nausea, post-operative pain and constipation. I have heard of companies that sell international health insurance plans. I don't know names off the top of my head and I don't know if they have plans that would kick in after a certain level of expense, but I think that may be possible. The costs I have given you assume a two-day hospiutal stay. If you are able to go back to the hotel a day sooner, the cost would be about $1300 US less, if you have to stay an extra dya, it would be about $1300 US more. More than 50% of my patient are able to leave the next day, which would save you that $1300.
In connection with the procedure, how many days would I have to stay in the hospital, in hotel close by, and how many days should we wait until we fly back home? Assuming your surgery is done on a Friday, you should plan on arriving in the US on Wednesday (earlier if you prefer). You would stay in a hotel Wednesday and Thursday nights. You would be in the hospital for one or twi nights (Friday, Saturday). Your husband or a companion may stay in the hospital with you. We would send you back to the hotel upon discharge from the hosptial. I would see you on Monday and you would be free to travel home Monday evening or Tuesday morning. Given the length of the flight, I would suggest travel home Tueday or Wednesday - or later if you prefer. So, all in all, a trip of about one week.
I see that some of the other women on abbyloopers who's had IVF after the TAC has been told to "rest the cervix" for a couple of cycles first, is there any reason for this? If I choose to do it as soon as possible, in the first cycle, can I start with GnRH-analoge from day 20 in the same cycle as the TAC, or do you mean the cycle after (which would give 2 menses after the TAC)? I do not recommend getting pregnant the same cycle as the TAC. But there is no reason or advantage to "resting the cervix". I have no problem if you want to start GnRH on day 20 of the same cycle, provided that we can do the TAC no later than day 9 or 10. Most reproductive endocrinologists prefer to wait until after you have had your first period after placement of the TAC, just because it fits better into what they know and are familiar with..
I have still not had my first menstruation after our last loss, but are coming up on 6 weeks soon and am expecting it to return around then. Will there be a long waiting time before you would have time to schedule the procedure if we decide to come to New Jersey? Pick a date (any Friday) and I'll add you on. The only dates that are out are July 2nd, July 30th and August 6th. So that leaves June 25th, July 9th, 16th and 23rd, and any Friday from August 13th on. We could also do any Wednesday beginning with July 7th, except for August 4th. If we do your surgery on a Wednesday, you would need to arrive Monday, etc.
Sorry for the bombardment with questions, there's just so many things to think about! No problem. Ask as many questions as you want.
Dr. D
esmeralda