Our “Little” Adventure

Well, this month marks one year since we received our foster care license and entered the Illinois Adopt Waiting Children program. Aside from a couple of nibbles last summer, we have (sadly) had no movement on the adoption front. This was likely also influenced by the departure of our agency caseworker in mid-November. Her replacement starts tomorrow, so we look forward to getting to know her ASAP!

Meanwhile, we stumbled into a little unexpected adventure. We were asked to provide rides to medical appointments for a couple who was expecting a baby and did not have a vehicle of their own. Their doctor decided to induce a few days before the due date, and they delivered a healthy baby girl.

I don’t know exactly how or why, but the Illinois Department of Children and Family Services got involved with this couple. It turns out they both have DCFS records in other states and had lost or given up custody of their children from previous relationships. Thus, there was some question as to whether it would be safe for the baby to go home with her parents.

Rather than taking the baby into custody immediately, the DCFS investigator proposed implementing a Safety Plan, which simply means that with the consent of the parents, the baby is put into a safe situation for a limited time while the background investigation is completed. Matt and I were asked to be the responsible parties for a seven-day Safety Plan. When it was time for the baby to be released from the hospital, we all signed the agreement and the baby came home with us.

Over the next six days, the parents visited periodically with the baby at our home while the investigator gathered the needed information. This was an interesting time for us! I have never been responsible for a newborn, so Matt helped me get into the rhythm of feed – diaper – sleep, and we learned to decode the baby’s various noises and expressions. She was a good baby, and by the third night was sleeping four hours at a stretch! Matt and I took turns with night duty, and everything worked out just fine.

On day five, the DCFS investigator contacted us to let us know the baby would be going into foster care for a while. On day six, she invited the foster parents to our home to meet us and pick up the baby. They are a younger couple who just completed their foster training in November, and this was their first placement. They were very excited and very sweet, and we believe they will do a great job.

The next day the birth parents, the foster parents, and the investigator attended a hearing for a judge to grant temporary custody to the foster parents. (We did not attend, but we gave the birth parents a ride to the courthouse.) The birth parents have nine months to take advantage of services provided by DCFS to get themselves and their home ready so that their baby girl can return home.

Since Matt and I will not be having any children of our own, it was a great blessing for us to have a few days with this sweet little newborn. We were able to get to know her, care for her physical and emotional needs, and cherish her unique spirit. Unlike a fostering situation, which usually has an indefinite outcome, we knew we had just a limited time with her before she either went back home with her parents or into actual foster care. This made it easier to commit to the Safety Plan and to work with parents until the decision was made.

We can’t say for sure why Heavenly Father granted us this special responsibility, but we are very grateful for the opportunity to help out some of His children for a little while. We are praying for all the parties involved, and trust that whatever happens will be the right path for this sweet little angel as she commences her journey in mortality.

 

 

 

 

The Waiting Game

It has been six months since my last blog entry, and I am sure many of you are wondering why. Our adoption trainer warned us last October that there would be plenty of waiting during the adoption process.  At the time we didn’t quite believe her . . . well, we didn’t want to believe her.  But (not surprisingly) she was exactly right. Sigh.

One of the steps in preparing to match adoptive parents to waiting children is deciding what kind of children are desired. We are planning to adopt a sibling group, because we have plenty of room, resources and love, and we know that is it hard to find families for siblings. We feel very strongly that siblings should not be separated by the courts if at all possible. Due to our age (we are both in our 50s) we also decided that school-aged children (5 to12 years) would be a wiser choice than babies or toddlers. We would love a boy/girl pair but are flexible on that, as well as number of siblings . . . although if we get more than two kids we’ll need to invest in a larger vehicle.  So you can see why it may take a while for the perfect sibling group to cross our path!

Here’s how the matching process goes:

Ashley, our caseworker, contacts us with the names and ages of the siblings who are looking for a forever family. She also forwards us, electronically, a written report detailing information about the children, the situation that led them into the foster care system, their current status, and any emotional/medical/developmental/educational issues they are dealing with as a result of the challenges they have faced.

We look over the information and make a decision whether this sibling group is one we could take into our lives and provide the needed love and support for.  Then we contact Ashley with a yes or no. If we say yes, Ashley puts us “in circulation” for consideration as a family for the sibling group in question.

We didn’t receive our first call until May.  Ashley had a brother/sister sibling group, ages 10 and 11, for us to consider. There were some pretty heavy issues these kids were dealing with, so we took a little time and prayer before making the decision to be circulated. About ten days later, Ashley let us know that only two families (us and one other) had circulated, and the other family had been chosen for placement. It sounded like a very good match, and we were thankful these siblings had been given a good and safe home.

Our next call came in July, again a brother/sister sibling group, this time ages 8 and 5. Their challenges were not as severe as those of the kids in the first sibling group, and we were able to give Ashley a yes pretty quickly. About ten days later, Ashley informed us that the siblings had been placed with another family.

So that’s how it goes! Each time we get some names from Ashley we get very excited and thoughtful. Each time we are notified that we are not the “chosen family” this time, we get rather sad and thoughtful. We pray regularly both for the children looking for homes and for those workers who are involved in the matching process, that they will be guided to make the best decisions for each child and sibling group that enters the adoption pool.

Being theatre people, it helps us to think of each contact as an audition. We are auditioning to be the parents of these siblings. Often an actor is not right for the part, and so will not be cast. But ONE DAY we will be right for one of these sibling groups, and we will get the phone call from the caseworker, asking us if we are ready to meet the children who will be coming to live with us and be part of our family.

It is possible that I will not blog again until that day finally arrives . . . we’ll see how many more NOs we get to work our way through! Meanwhile, thank you for sharing this journey with us, for all your prayers and love and support. We are so looking forward to being parents, with all the adventures and challenges that will bring!

P.S. If you are aware of any school-aged sibling groups who are looking for a forever family and would be willing to live in rural Illinois, please contact me.

The Home Study – how hard can it be, really? HA!

The home study is a humongous document, assembled by the case worker, of detailed information about us which the agency has decided is relevant to our desire to take children into our family.

Some of the required information is simply forms, as you might expect: proof of income and various kinds of insurance, driver licenses, marriage certificate, etc. We also got fingerprinted so a background check could be done. (Don’t worry – we passed!)

However, the bulk of the information was in the form of worksheets full of questions which we had to answer in writing. We were somewhat overwhelmed by the number of questions and the variety of issues. By my rough count, we answered approximately 180 questions each! Here’s a sample of what we were asked about:

• Values
• Tastes and Preferences
• Intentions
• Family of Origin
• Couple Relationship (2 worksheets)
• Previous Marriage
• Parenting
• Relationship and Adoption Issues
• Grief Work
• Adoptive Parents Personality Characteristics
• Employment
• Household Responsibility Checklist
• Childcare Plan
• Floor Plan (also home features and neighborhood)

We were also required to take an online “couple evaluation” to determine in what areas we needed counseling. (We aced it. No counseling required, thank goodness!)

I must admit this was a major emotional roller-coaster. Sometimes it was interesting and fun, delving into memories and figuring out what and how much to commit to paper. Sometimes it was sweet, as we recalled our courtship and wedding. Sometimes it was hard, discussing challenges and failures we have encountered. Sometimes it was humorous: “If you have been tremendously effective as parents, how will your kids turn out?” (yes, that is an actual question.)

Ultimately, while I am sure the agency has a justification for every single question we were required to answer, we found it to be a significant invasion of our privacy and personal lives, and there were more than a few tears of frustration shed during the process. How ironic that any two hormonal teenagers can hook up and produce a baby without the teensiest bit of training, counseling, income or stability, but we, mature adults who happen to be dealing with infertility, are grilled like criminals before we can be granted the privilege of taking in a child.

But, being optimists, we assume that all this detail will qualify our caseworker to come up with a perfect (or at least awfully good) match for us!

PRIDE Training

As we are adopting IN the state of Illinois and FROM the state of Illinois (children who are wards of the state), we were required to take 27 hours of training in Foster PRIDE/Adopt PRIDE – nine weeks of 3-hour courses. This training is offered all over the United States to foster and adoptive parents and is highly respected.

Why, I wondered, if we are going to adopt children, would we need to be trained as foster parents? Since we are participating in the Adopt a Waiting Child program, the kids we adopt will most likely have spent a good portion of their lives in foster care and have emotional and developmental issues that will need to be addressed.

In addition, any children we take in with intent to adopt will be in our care as foster children for six months before adoption proceedings may commence, so although they are not being prepared for reunification with their birth families, they are still in the foster care system for that time.

Some issues that PRIDE teaches about:

• An overview of Child Welfare Services and the personnel and offices involved
• Practical issues such as health care, safety, privacy, chores and allowance
• Issues of loss, attachment, continuity and permanency
• Issues of maltreatment, abuse, and trauma of all kinds
• Possible disorders of conduct, mood, attachment, etc.
• Physical, emotional, developmental, and learning disabilities
• Issues of personal, cultural, and racial identity
• Behavioral issues, discipline, and punishment

We also had eight hours of training in educational advocacy. The state provides educational services for children from birth through school age, and continues support into the school years through the local school system. Children with special educational needs are entitled to an Individualized Education Plan. The state also provides counseling and therapy as needed for children in foster care.

We were officially licensed as foster/adoptive parents on January 13, four months and two days after our first PRIDE training session on September 11, 2014. I will be writing more about the completion of that process in my next blog entry. Meanwhile, please keep us in your thoughts and prayers as we happily wait for our children to join us.

A New Beginning

If you have been following our story, you know that in June we completed our final attempt at in vitro fertilization. Since we are quite sure that we want to have a family, we have been exploring options and requirements for adoption in the state of Illinois.

We are working with personnel at the Center for Youth and Family Solutions, a statewide agency that licenses foster and adoptive homes and also places children who are wards of the state through the Department of Child and Family Services (DCFS).

We are required to take 27 hours (nine 3-hour classes) of preservice training in Foster PRIDE/Adopt PRIDE (Parent Resources for Information, Development, and Education), which is provided free of charge. At the completion of this training, our home will be licensed for foster care, which is required for adoption even if we do not provide foster care. Fortunately, these classes take place right here in Macomb, so it is very convenient for us. Our teacher is a foster care and adoption veteran as well as having her own birth children, so she has many stories to tell!  Our course will be completed on November 6.

In addition, we have completed two of three required training sessions for adoption.  These sessions are fee-based and we get to drive a long way, in our case, to Bloomington (103 miles/2 hours one way)!  Once we have completed these sessions and a LOT of paperwork, our CYFS worker will collect our documents and create our Home Study, which is required for adoption.  The State has several kinds of adoption pools; we are working with Adopt a Waiting Child.  These are children whose birth parents no longer have parental rights (they have either surrendered their children to the State or the State has terminated parental rights because of conditions in the home) and thus are in need of permanent homes.

The issues brought up in these sessions require a lot of thought and introspection. Why are we adopting? Are we willing to take children with disabilities? Children of biracial heritage, or of another race entirely? Sibling groups? What ages? What kinds of issues might these children be dealing with from their pasts, which usually will have involved foster care? What resources are available for the adoptive family to succeed?  Etc., Etc!

We are pleased with the quality of the training we are receiving and are looking forward to preparing for placement of a sibling group in our home.  We appreciate your thoughts and prayers as we approach parenthood together!

The Rest of the IVF Story . . .

. . . as it might have been!  We did have two cycles which produced viable eggs, and these were fertilized and implanted, although none of them resulted in pregnancy.  However, this is a fascinating sequence of events which I would like to share with you, just in case you were wondering what happens!

So all those medications are designed to stimulate the preparation of as many eggs as possible (controlled ovulation, remember?).  When the follicle openings reach 25mm or so, the eggs are considered mature and ready for retrieval.  At this point the doctor gives a specific time at which the patient is to have the hCG (also known as the trigger shot) administered.  This is timed at 36 hours before the actual egg retrieval surgery.  All other medications are discontinued at this time.

The surgery is performed transvaginally (through the vagina), with the patient under general anesthesia.  The doctor uses an ultrasound probe to locate the follicles, and then uses a needle to gently aspirate each egg.  The procedure takes 20-30 minutes.  At the same appointment, the partner provides a sperm specimen.  The lab technicians examine the eggs to determine which are viable candidates for fertilization.  They then use a process called ICSO (intracytoplasmic sperm injection) to inject one sperm into each viable egg. At this time progesterone suppositories are prescribed to prepare the uterus for reception of the fertilized eggs.

The fertilized eggs are monitored in the laboratory for three days.  As implantation time nears, the eggs are evaluated to determine which are developed enough.  The technician photographs these eggs and show them to the patient prior to implantation.  To facilitate the process, the patient drinks a liter of water during the hour before the procedure!  This relaxes the uterine wall and allows for a clearer ultrasound image.  In addition, the patient is given Valium to help her relax, so as to avoid any contractions in the uterus that can be caused by stress.

Compared to retrieval, implantation is fairly quick and easy.  Dr. Horowitz’s team ran like a well-oiled machine, of course.  The doctor inserts a speculum, followed by the ultrasound scope.  The lab team brings in a catheter loaded with the embryos, and the doctor threads the catheter through the cervix and injects the embryos into the uterus.  After a few minutes of recovery time, the patient is sent home to enjoy 24 hours of bed rest.  Blood is drawn on days 10 and 12 after the implantation to determine if any of the embryos have resulted in a successful pregnancy.

For us the most difficult part of the procedure was not the injections or the surgery.  It was the wait time between the second pregnancy test and the phone call from the nurse with the results.  Our first (five eggs) and third (three eggs) cycles both resulted in two fertilized eggs being implanted, none of which resulted in pregnancy.  Our second cycle was the hardest emotionally, because six eggs were retrieved and five were fertilized, but none of them developed enough for implantation.

Although it was a difficult journey, we knew at the outset that our chances of success were pretty low.  We wanted to give Heavenly Father every opportunity to bless us with a child of our own, while at the same time understanding that, due to our age, the probability of achieving pregnancy, even with Dr. Horowitz’s expertise, was statistically against us.  However, we still wish very much to have a family, and will be pursuing adoption in the near future.  I plan to keep this blog going so that you may share this NEW adventure with us!

 

Journeys

Matt and I visited the SIRM clinic on Friday, May 16 for the ultrasound that would determine the timing of the trigger shot and egg retrieval. Dr. Horowitz explained that none of the follicles had increased beyond 13mm. If my estrogen levels were found to still be increasing (as they were on Wednesday), we could go ahead and administer the trigger shot in hopes that the eggs would be ready. However, if estrogen levels were not increasing, it would be best to cancel the cycle, as the eggs were not going to mature sufficiently for fertilization.

The nurse contacted us a couple of hours later to let us know that estrogen levels had actually gone down rather than up since Wednesday’s ultrasound, so the decision was made to discontinue the cycle. Needless to say there have been many tears shed this past weekend, as this was our last opportunity for IVF conception using our own genetic material. (We will, of course, continue to strive for pregnancy through the traditional method!)

As it is still our intention to have a family, in a few days we will begin discussing what other options will be viable for us.  Egg donors are of course still a possibility, although chances for success hover around 60% and all costs would be out-of-pocket. We will certainly consider adoption, and have seriously discussed adopting a child who is a few years old, rather than an infant.  Considering our age, this seems like it might be a wiser route to take.

Although we will not be participating in egg retrieval, fertilization and implantation at this time, I do plan future blog entries on these topics based on our previous experiences, as the science and the process are both quite fascinating.

We thank you all for your love and prayers throughout this process, and hope that you will continue to send good thoughts our way as we explore new and unexpected paths in our quest for parenthood.

Halfway there . . . or not . . . !?!?!

Monday’s visit to the clinic went well.  First, blood is drawn to check estrogen levels. Dr. Horowitz then uses the transvaginal ultrasound to measure the depth of the endometrial lining, which is an indication of the uterus preparing for pregnancy. Next he locates and measures any follicles that are opening, indicating that eggs are being prepared. He found two follicles on the right ovary measuring 13mm each, and four follicles on the left ovary measuring 11mm each, so we were off to a good start.

Follicles will reach approximately 25mm before releasing a mature egg, so at my next visit on Wednesday the doctor would expect to find that the follicles had progressed to a larger stage.  However, in my case he discovered that the follicles had not grown during the 48 hours since the Monday ultrasound.  He asked me to wait until we received results from Wednesday’s blood test to determine if my estrogen levels were increasing as they are supposed to.  So after some tense waiting, the nurse called midday to let me know that the estrogen had increased (whew!) and that we would have another ultrasound Friday morning to see how the follicles are doing.

Once the follicles have reached the stage that they are ready to release the eggs, the doctor will control the timing of the release using a special “trigger shot”, which Matt will inject into my upper arm.  Egg retrieval is scheduled 36 hours after the trigger shot is administered (which is usually in the middle of the night so the surgery can take place midday)!

This reluctance of the follicles to increase in size is a bit of a setback for us, so we ask for your good thoughts and prayers that the eggs will develop as they should over the next few days.  Thank you all for your love and support!

How Much Does That All Cost, Anyway?

This post is going to be about the financial aspect of the IVF cycle.  As I posted earlier, we are very fortunate to live in a state which mandates health care coverage for fertility treatments.  For both financial and scientific reasons, a patient may only have up to four IVF cycles covered.

The Sher Institute for Reproductive Medicine deals only with fertility treatments; all of the procedures of each cycle are bundled together and submitted to the insurance company in one package per six-week cycle. Services include: office visits, blood work, lab work, ultrasounds, egg retrieval (including anesthesia), fertilization, implantation, and pregnancy tests. It takes about three months for the cycle paperwork to be submitted and processed, and coverage is 90%. One cycle bills $7594.00 to the insurance company, which pays $6859.63; our portion is $734.37.

Medications are purchased from Mandell’s Clinical Pharmacy in New Jersey, and they are billed separately. Tablets, suppositories, antibiotics, needles and syringes are all pretty cheap; we pay for these out of pocket for a total of $93.11. Alcohol swabs and a sharps disposal container are included for free. Plus FREE overnight shipping!!! Insurance covers all the injectable drugs. From lowest to highest, these are the costs per dose:

• Progesterone              $    2.26
• Delestrogen                $    9.75
• Lupron                       $   23.49
• Menopur                    $   60.23
• Ganirelix                    $   65.70
• hCG                          $ 225.05 (only once – this is the trigger shot)
• Follistim                   $1172.00

The medication total for this cycle was $16,456.95, and our copay was $170.00, so you can see that the insurance coverage is excellent. The vast majority of the cost is for the Follistim, which accounts for $14,000 of the $16,500 drug total. Follistim is a highly specialized medication. Originally derived from the urine of menopausal women, it is now created in a more highly bioactive form via genetic engineering.

For this typical IVF cycle, the total cost is $24,404.06, of which the insurance company pays $23,406.58 and we pay $997.48.  If we are not able to conceive during this (final) cycle, we could opt for future cycles using an ovum donor, but all costs would be out of pocket for us. The SIRM Clinic offers discounts on IVF packages for patients paying cash, but it still would be a major investment with no guarantee of success. Also, how do you ask someone to put themselves through what we’ve gone through, physically and emotionally, to get those eggs prepared for retrieval, with only a 60% chance of a successful pregnancy? Tough questions, and a lot to think about.

Thank you for joining us on this crazy journey!  We appreciate your continued prayers and good thoughts on our behalf.

 

 

The Big Week, Part 2

So the Follistim injections began Monday evening, May 5, in the upper outer thigh: two injections of 450IU and 300IU for a total of 750IU. This left 150IU in the (900IU) cartridge for Tuesday’s injection. Tuesday required three injections: 150IU from the first cartridge, then two doses of 300IU each from the second cartridge for a total of 750IU. Tonight (Wednesday) we were thankfully back to two injections: 300IU from the second cartridge, and 450 IU from the third cartridge. Tomorrow will be the same in reverse: 450IU remaining in the third cartridge, then 300IU from the fourth cartridge. Friday will be another Follistim three-injection day! (300IU & 300IU from cartridge four, plus 150IU from cartridge five.)

Thursday we add in another evening injection! This is a human menopausal gonadotropin (menotropin) called Menopur. It provides FSH (follicle-stimulating hormone) and LH (luteinizing hormone) as well as hCG (human chorionic gonadotropin). Its job is to stimulate the tissue surrounding the ovarian follicles to produce testosterone. Yes, you read that right! This is then carried to the surrounding follicles, where the FSH converts it to estrogen. This promotes optimal follicle, egg, and embryo development and enhances development of the uterine lining in anticipation of implantation.

Friday then becomes our crazy medication day! In the morning, a prenatal vitamin, a Dexamethasone tablet, and a Ganirelix injection (tummy). In the evening three Follistim injections to make up one dose (thigh), plus a Menopur injection (tummy) and Delestrogen injection (hip), and the estrogen suppository at bedtime. This regimen will continue, minus the Delestrogen, through the weekend.

All this in preparation for Monday’s appointment (May 12) at the clinic! Dr. Horowitz will conduct a transvaginal ultrasound to evaluate how many eggs are developing. I will visit the clinic at least two more times that week, probably Wednesday and Thursday, for the same evaluation process. It takes about a week for the eggs to reach the point where the doctor will instruct us to “trigger” ovulation with a special injection. In the past we have had a Saturday retrieval, a Monday retrieval and a Sunday retrieval. We’ll see what happens this time around!