Land Of Fruitfullness VII

It has certainly been a little while since I updated about the fertility journey we are on. My last post left on a sour note and although this one is one of hope it too ends on the sadder side.

After finally getting all the insurance in line and knowing everything was all set and ready to I patiently waited for Aunt Flow to arrive. Ironically enough she came right on time January 1st to be exact. What I was to start 2014 huh? I don't think I have ever been so excited to have gotten it as I was on that day. Then the ball started rolling...

I called the fertility center and let them know. I was nervous though and having never done this before had no idea what I was doing. When I didn't get a call back I called them and ended up bothering the doctor on call for no reason other than I thought something wasn't right. As it turns out nothing really happens until day three, whoops! So I would be going in January 3rd for my first blood work and ultrasound to tell me what my dosage would be for my shots. I had order the shots which was strange to me but I got it all taken care of. Then I began the some what short waiting game.

However the weather had other ideas for me. You see Thursday night into Friday was when we had that lovely snow storm. Luckily the fertility center was accommodating and all I had to do was take an at home pregnancy test on Friday and then give myself my first Gonal-F injection of 150UI.  I ended up having to drive to the UPS pick up site in Shrewsbury because they couldn't deliver it in the snow. When I finally got home it was time to face the needle.

It was packed inside a huge Styrofoam case with ice packs. It also came with a sharps container and alcohol swabs.

After I watched this video I was all set to go. I was facing my fears on having to give myself a shot on day one, Woohoo!

It was a small needle and didn't hurt. I was able to successfully give myself my first shot and was ready for my blood work and ultrasound Saturday morning. I went in got everything all done and  they called me later in the after saying to continue my 150UI for the next three days and I was to return at 7am for more blood work and ultrasound on Tuesday.

Everything went well for the next three days. I went in bright and early Tuesday for blood work and ultrasound, they called that afternoon to double my dose for the next two days. So now I was giving myself 300UI. Lewis was extremely helpful in giving my shots. It made it easier to not have to do them myself.

I headed back out to Boston on Thursday at 7am for an other session of blood work and ultrasound. They called again in the afternoon and this time they increased my dosage to 450UI for the next two days. I was concerned at this point because it was day 9 and I was still bleeding. They seemed unconcerned about it though and told me to continue as directed. So I continued!

On Saturday 1/11 I headed back out to Boston for Bloodwork and Ultrasound, I was awaiting their call because depending on what they said I was going to have refill my injection pen and I knew there was no way I would get for the next day. Sure enough they called at 2:45pm and told me I would be doing 450UI for the next two days and that Monday night I would be giving myself the "Trigger shot" of Ovedril and come in Wednesday for our first insemination. I was thrilled but that also meant I was driving out to Waltham to pick up more meds. I got everything I needed and was ready for this part of the journey. I again asked if I should be concerned that I was still bleeding and they said nothing about it.

I will admit the higher dosage did a number on my I felt really bloated and it just made me feel BLAH for a good hour or so after injecting it. I could definitely feel the difference being on these follicle stimulating drugs. It was like nothing I had ever felt before. But having never done this before I had no idea what to expect.

On Monday night at 10:45pm I gave myself the trigger shot and that was it. Lewis and I went back to Boston on Wednesday January 15th for the insemination. He went in first and made his deposit. They took his swimmers, cleaned them, counted them, etc. Then it was my turn. They told us that they typically want 10 million swimmers and his deposit had 62 million so that was a good thing. They explained what they were going to do. Basically they take a small catheter and put through your cervix and then inject the sperm. One of the nurses was doing it, after three attempts and not being able to get it they put Lewis's swimmers back in the incubator and called in a doctor.

When the doctor returned she got to work and had some slight difficulties herself. After the third time she got it. I could feel it as soon as she got it. She injected the sperm and then I had to lay there for 20 minutes. I didn't mind except I wasn't very well covered. After 20 minutes I got up and got dressed. We made our way out, we got our discharge papers. I have never gotten anything that said they encourage you to have intercourse during the next two days. We made our follow up appointment for January 31st to get the blood test to see if it worked, provided aunt flow didn't return before that.

There really wasn't anything special after that. I had minor spotting for a day or two and then everything was normal. But that's just it it was normal there was nothing that made me feel any different. I never really believed people that said they know their body etc. but I didn't feel any different.

So as I said this ends on a slightly sad note only because Aunt Flow returned today and so I must begin another level of this journey. I am sad but it was almost as though I already knew. I am very hopeful that the doctors have learned more how my body reacts to Gonal-F and will adjust my dosages accordingly and we will have success with this time around.

Our time to announce a baby will come, it just isn't today.

Thanks for reading and continuing to send your positive thoughts our way. I really appreciate it!

Until next time...

Land Of Fruitfulness VI

I am beyond frustrated mainly because in my opinion there really is no reason for this frustration as everything could have easily been organized and avoided.

Needless to say I am at the very beginning of this journey despite the fact that it has already been occuring for 6 months and I fully understand that this has the potential to go on for years and many people have done what I am doing for a long time.

I have done everything everyone has asked, I have done what my oncologist has told me which was basically just to jump through the hoops. I had an echocardiogram done which I knew I didn't need, I have faciliated commincation between multiple doctors offices when they really should have been able to do it themselves considering they are not only with the same hospital but in the same building and use the same medical record system. Now when I finally think I am all set there come yet another bump in the road but it appears to have the possiblity of being an even bigger obstacle deoending on the outcome.

Since I completed the preliminary testing months ago the plan has been to move forward trying artifical inseamination because I am so young and it seems as though everything should respond well to fertility drugs, etc. If that didn't work then of course there would be the plan B of invetro. but that would be later on down the road.

After I had the echo and got everyone all connected to be cleared to start fertility treatsments we then just began the waiting game of a new cycle. Which for me is always an unknown so that was fun. I was elated Wednesday when I discovered I had started a new cycle (or in laymens terms my period arrived) I called as soon as I had a second and tried to get things moving. There was a minor miscommunication that resulted in my speaking to the on call doctor that night around 6pm because I thought I need to start the shots that night. Only to discover that doesn't happen until day 3. Whoops, hopefully I am not being noted as a diffiicult patient cause I am not trying to be.

So then Thursday I awaited another phone call to get evrything setup. The nurse called and told me I needed be in Fridat at 8:30am for all the baseline testing and then I would get a call mid afternoon to start the shots. I would also be getting a call from the pharmacy about arranging the shots. I was so excited thinking maybe this was actually happening FINALLY!

Then I got another phone call from MGH I can't for the life of me remember her name but she is the one submitting the authorization to my insurance company for all of this. She informed me that based on my medical record I didn't meet the criteria for this to be covered by BCBS because of one hormone level being at 12 and their cutoff is 10. She proceeded to tell me that there was a very good chance they would deny me. So I needed to decided if I wanted to go ahead knowing I could be denied in which case I would have to pay for everything which would be a couple thousand dollars. For some people that might not be an issue but for me I don't have a couple thousand dollars laying around if we did need to pay. So basically the only option was for me was to wait until they get the approval or denial back next week and then hopefully try again for my next cycle (whenever that will be). 

I of course asked if I was denied then does that mean I could never get any kind of fertility treatment without having to pay for it? She said there would a good chance I would approved for invetro. I explained how that didn't make sense to me because inseamination was pretty much entry level to all this therefore it is less invasive, less expensive, etc. so why would I be denied for that but approved for invetro which highly invasive and very expensive? Her only response was that because with the slightly elevated hormone level the success rate of inseamination was lower but invetro would have a higher success rate. I would say I could agree with that if they tried it once and it didn't work but otherwise I don't get it at all.

The part that brings about my frustration is this has been the plan for months and even if they were waiting to get clearance from the echo and such, all that was done at least two weeks ago so why didn't they submit an authorization before today? They have my medical record, they know the qualifying criteria for the insurance company. If there was even a question that it might not be covered (which would seem to be a concern for most people) they should have been organized enough to have this all set. I feel like I have been jumping through all their hoops and getting nothing in return. 

I feel lost as though I am supposed to just know all of this. It's not like there is an orientation to this process we are basically flying by the seat of our pants.

So I am frustrated in having to postpone even longer with high possibility of not begin able to proceed as planned which in my opinion would be like starting from the beginning.

If there is anyone out there who would like to be our fertility sponsor please let me know. I really wish there were more resources for fertility post cancer treatment!

Land Of Fruitfullness Part IV

I was supposed to have an appointment at MGH with my doctor. The morning of I got a call saying she was home due to an injury (she was/is ok) and that they needed to change my appointment to a phone appointment. I was actually thrilled about this due to the fact that meant I didn't need to drive all the way into Boston!! 

She called right on time and we chatted. After reviewing all the info that the obstetrician had sent her about his concerns regarding my health and exposure to different chemo drugs she decided that she agreed with him about getting an echocardiogram done before we start any fertility treatments. For those of your who are not familiar with an echocardiogram it is basically an ultrasound of your heart to make sure it it working properly. I was/am not at all concerned about this. I have done numerous races which include triathlons as well as months and month of training involving high impact cardio workouts. So I know if there was a problem I would most likely know by now. But based on some good advice I have been given, I decided it was just another hoop I needed to jump through. 

That spawned my adventure of trying to get not only an appointment but the orders out in for the echo. I called the obstetricians office where they informed me it needed to be ordered through the fertility center and transferred me there. I had wait to the next day to get a call back from them. Where they informed that was not something that was part of their normal protocol that I needed to talk to the obstetrician's office. After much go around about having already talked to them and getting sent back to fertility. They then told me I needed to have my PCP order it at MGH. So that would have involved another lengthy conversation with her office. I was quite frustrated at this point that these two offices couldn't communicate with each other and get it done for me vs. having me go through all this. 

My lymphoma nurse practitioner makes fun of me because I do just about everything  through email. Well in this instance the email succeeded again. I tracked down my OB's email and asked for some help. Despite an awful time I had when I met him he responded quickly and was very pleasant. By the next day they had called with the appointment all setup and ready to go. I was thrilled!!

So I went in for my echo which was very uneventful. The man doing it was extremely nice! I was even more thrilled that this time around I didn't need any contrast to help with the image. He said it was most due to the fact that I had lost so much weight! The only down side is that in order to get a good picture they have to press the ultrasound wand into your body with A LOT of pressure to try and get a good view in between and around your rib cage. I still have spots that are sore.

I haven't gotten the final report yet but based on what the echo tech said everything looked great so hopefully we will see. 

Now I'm just waiting to meet with my fertility doctor and see what she has to say and what the next step is. 

I continue to to play the hurry up and wait game!

Until next time...

Land Of Fruitfullness Part III

I decided that I needed a little time before I wrote this. Yesterday was a rough day and instead of writing out of pure emotion I needed to take the time to process. Despite giving myself the time this post will most likely be informative yet also a venting session at the same time.

I went to Mass General to have a consult with an OB doctor that deals specifically with Medically Complicated & High Risk Pregnancies which once I am pregnant I will apparently be considered due to my history of lymphoma. I was interested in what he had to say mainly because even I don't know the specifics of how my chemo could have affected me. 

Here is my first vent. If you are seeing a new patient it would be nice to take the time to at least glance at my chart before seeing me. It is very disconcerting to sit and watch you read everything and your reactions to it. I lived once already I don't need to relive it every time someone needs to look at my chart.

Anyway we went through my chart talking about the effects having cancer had on my body, what chemo drugs I had, etc. There were only two drugs out of everything I had that he was concerned with. Considering everything I got that was some what reassuring. The first one is Cytoxin, because it is known to have the potential to be very hard on your ovaries. He is going to look into what my total dosage was so he would have a better idea how much that could be a playing piece in this game. The other drug he was concern about is Doxirubison which can have an effect on your heart. So at some point in this I have to have an echo-cardiogram to make sure my heart is strong and isn't showing any signs of weakness.

After hearing this I am not very concerned about my heart. The way I look at it with all the cardio I do I would think if there was an issue with my heart something would have come up by now. So I figure that is just a precaution.

I am more concerned about the cytoxin. Because judging by the issues that I have had which have lead to me going down the fertility path I feel as though there has been some affect on my ovaries but only time will tell. 

My issue with why this was a rough appointment is that I am not a person that lives in a fantasy world. I am fully aware of what this journey could bring and that there is always the possibility to not be able to have children using my own eggs. However while sitting listening to what he had to say I think he was trying to making me understand all the possible outcomes. He told me that the cytoxin could have zapped my ovaries but even with that I would be able to use an egg donor. He told me that people tend to worry that because I had all these toxin drugs in my body the likelihood of them having affected my eggs making them abnormal is not any greater than a "normal" women.  That 90% of miscarriages are caused because the egg has a chromosomal defect. So basically the bodies way of natural selection. These are all things that I feel don't need to be fully addressed until it comes to light they are an issue. You know the whole we'll cross that bridge when we get to it saying that pertains to this very well. As if all this wasn't enough it gets worse...

He proceeded to tell me about how my weight is an issue as well. That being obese can lead to developing diabetes while pregnant, it has a higher rate of miscarriages, and can be attributed to both under weight deliveries and larger weight deliveries. I wish there was some way to have a neon banner that pops up across my chart saying something along the lines that I am active, have lost almost 90lbs and am trying to live a healthy lifestyle. I (not being a shy person when it comes to this) informed him of my already huge weight-loss, my active lifestyle, being a triathlete and trying to eat healthy. to which his only two replies were, well if you are doing triathlons then I would think the doxiruison hasn't affected your heart. His other was that although my current weight-loss is significant I still need to work on lowering it to be closer to the normal range. He looked up what the normal weight for someone my age and height which would involve me losing another 70lbs. So to start with he would like me to lose another 50-70lbs. I think that was the biggest slap in the face. That I have tried so hard and done do much work to get to where I am and it still isn't good enough. I have no idea how I am going to lose that much more weight but I will give it a shot.

So I guess my real issue is that although you need to make sure your patients are informed it also doesn't help to try and address things that are not an apparent issue. All that does is create more stress and worry about things that you can't control or even know about.

However luckily I have my amazing NP from Lymphoma and she is so awesome that she called me after 6pm yesterday to talk to me about what happened. She made me feel A LOT better. I told her about all of the above and she said that although Cytoxin can be hard on the ovaries I only received 3 doses while some people have 6 so that is in my favor. Also that I am the abnormality (I know shocking) when it comes to patients because if he is dealing with high risk based on hypertension or diabetes most likely he has patients that are not very compliant. Where as I am very compliant and try my best to do what I can to be in a better situation. So that he probably works on the side of scaring his patients into compliance. Looking at it from that point of view made it a little more acceptable. So I decided that I will do what I can to work towards what they have told me but I am not going to starve myself to do it. I really can't thank Bri enough for taking the time to call me after an already long day when she easily could have just gone home!

So now I have to look forward to eventually getting an echo-cardiogram. Oh did I mention that when I had this done before I started chemo they had to use IV contrast and forgot to close one of the tubes and spilled my blood all over the floor? Hopefully we can avoid that this time. And I will see what Dr. Souter has to say about the OB's notes/concerns and where we go from here.

After all this the only thing that kept running through head was..."Cancer the gift that keeps on giving!" I am very lucky to have the outcome I did from having such a progressed disease but I guess the saying is right once you have had cancer it will forever affect your life.

Until next time....

Land of Fruitfullness Part II

We went today back to Mass General Fertility Clinic to meet with the Doctor. It was a very good appointment with a positive outlook and everything seems to moving forward.

The results of my HSG were just as the radiologist said, both Fallopian tubes are open with no blockages or abnormalities!! That was very exciting to hear! Lewis's testing came back saying that it seemed artificial insemination was going to be a good route for us to go vs. Invetro at least at first so that was also positive!

The extra good thing about this appointment was that it just so happened to fall on my cycle day 3 which is when they do some hormone testing. I had already had all this done but it was a random sampling because of the spontaneity of my periods. So it was prefect to be able to get a true reading this time.

As it stands right now I have to go see another OB/GYN that deals with High-Risk Pregnancies and Medical Complications so that I can be cleared to proceed. Basically I am going to have to talk about what chemo meds I was on what the potential was for that to have cause a medical complication and I am sure there will be some level of clearance received from my oncologist as well.

Once all that is complete the plan is to hopefully start with my next cycle which is very exciting! I will be giving myself (or most likely Lewis will be doing it) shots of FSH to help the ovulation process. Going in very frequently for ultrasounds and blood work. Once everything looks good  we will go in together. Lewis get's the fun job giving the sample and then I go through the insemination process.

so although this is a much shorter port then the first, this is currently where we are in the fertility process. I am very hopeful that things will go smoothly from here. Although I am aware of what a process this can really be!

Here's to hoping my positive outlook helps us through all this!

Find The Land Of Fruitfulness!

So I have debated with this for sometime about what I wanted to do, if I should blog about this particular "adventure" in my life or not. But the more I thought about it the more I came to realize it is highly unlikely I am alone and therefore my experience will hopefully someday help someone else.

This is where the disclaimer comes in. From here on out this becomes very personal. There may even be some mention of female body parts and reproductive organs so if that isn't for you please stop reading. For everyone else here goes...

For anyone that truly knows me knows that the love I have for children is profound. One of the immediate first questions/concerns I had when I found out I had cancer and would be undergoing chemotherapy was, "Will this affect my chances of being able to have children?" Aside from wanting to remain alive being my #1 concern/objective, I have to say children/fertility was #2 on my list from Day 1.

Because of the nature of my lymphoma there really wasn't time to waste before I needed to start treatment. There also weren't many option discussed as far as fertility preservation. So due to the time constrant my only option was to get a shot of a drug called Lupron. Lupron is a hormone therapy drug that causes the female body to stop making estrogen therefore stopping ovulation. The idea behind getting this before treatment is that it will help protect the ovaries from the harmful effects that chemotherapy can cause. In my case one shot lasts approximately 3-4 months and since my treatment only ended up being slightly more than 4 months I only got one shot.

So I completed my treatment and at my first 3 month check what do think was one of the first things out of my mouth? That's right I was asking when my periods should be returning. My oncologist told that it was very luckily to take up to about 6 months for anything to return to normal. Well I was giving him exactly 6 months. If things weren't progressing by my 6 month check up he was going to hear about it. Lucky for him my cycles returned two weeks before I was scheduled to go see him so I was thrilled about that!

Everything continued pretty much like clock work for another 4-5 months. I honestly could've set a calendar to it. However this is also the time that I started changing everything about my physical person. Changed my diet, changed my physical activity, etc. I had lost a significant amount of weight. After about the 5 month mark things start to go haywire. There were times were I would go for 2 months with no cycle or when I would get a period it would be for weeks (yes I said weeks as in 14-20 days). It got to the point where I told my primary care doctor that I wanted to go see an actual gynecologist.  During this time I also became even more concerned about my fertility so I also convinced her to do hormone testing, which came back normal for someone my age, etc.

All this continued for quite sometime. There were times where I was put on progesterone to stop the bleeding it had been going on for so long. After talking to my GYN it was decided that I would start taking the pill in an effort to help regulate things. So I did.

While all of this was going on I made it a point to keep my oncologist in the loop and voice yet again all of my concerns with what was going on. A lot of it was attributed to the recent weight loss and not so much my treatment.

I stayed on the pill for about 6 months. When my prescription ended in March 2013 I decided I wanted to see what was going on and if this had helped at all. Well since March of 2013 I have not had a single period and no I assure I am not pregnant. This has obviously been quite concerning to me as this irregularity had now been going on for almost 2 years.

So when I went for my 2 1/2 year check up with my oncologist I explained what had been going on, after a very lengthy conversation he said, "Well intially when we started your treatment the likelyhood of RCHOP affecting your fertility was very slim. However having to change your treatment to R-CODOX-M/IVAC which is a more intense treatment could have possibly had some effect." At this point I had to control myself as this has been a topic of conversation since day 1 like I said earlier. We both decided it was in my best interest that I should go to the fertility clinic!! Finally I was hopefully going to get some answers and hopefully some good news!!

I was setup with Dr. Irene Souter who is the director of perimplantation genetic diagnostis program
 with the fertility center. She was absolutely amazing!! Of course the first meeting was like pretty much any other medical meeting, lots of bloodwork and going over the plan. She explained that lots of times with cancer patients their oncologists see the return of periods to mean that fertility was unaffected. However you can have periods return and still have some affect to the ovaries and hormones. I was some what relived to know I wasn't crazy!! We did all the bloodwork before we left the office and the ultrasound was scheduled for a few days later.

In fact I had the pleasure of doing an olympic triathlon and then waking up at the crack of dawn to drive into boston on a busy Monday morning to have an ultrasound done. Let me tell you how excited I was about that! I luckily had a friend go with me which was nice support. During the ultrasounds they were amazing at explaining exactly what they saw and what it meant. Oh yea and I forgot to mention that this was an internal ultrasound, that was a fun first time experience. There were a few things to note, 1.) There was a simple cyst on my right ovary which are apparently quite common, usually come and go and are certainly not cancerous. 2.) My left ovary was very difficult to view so they made a note that it was smaller then it should have been. 3.) The lining of my uterus was still quite thin which meant that even though I hadn't had a period since March there didn't appear to be one coming in the near furture either. I left there feeling concerned about the cyst and the small left ovary.

Fast forward SIX WEEKS later (yes I did have to wait 6 weeks). I finally get to meet with Dr. Souter. The good news is that all of bloodtests including genetic testing and hormone testing came back good. The hormones were slightly off but nothing that can't be helped and I am certainly not in early menopause which was my biggest fear! However Dr. Souter did say the size of my left ovary was abnormal and that she believes based on the ultrasound and bloodwork that my chemotherapy treatment did have an affect on my ovaries. But that she also thinks with some fertility treatment I will still be able to have my own children! That was a huge relief for me!

Then she told me about what was next. I needed to have more bloodwork and what they call and HSG (hysterosalpingogram) which is basically a live x-ray of your uterus and ovaries where they inject some dye to watch the picture and make sure everything looks the way it should, there are no blockages and the fallopian tubes are working the way they are supposed to. This one scared me a little!

To prepare for this I had to go in the day before and get bloodwork done to make sure I wasn't pregnant. I also had to have another internal ultrasound. Luckily this showed that the simple cyst was gone, however my left ovary couldn't be seen. That night I had to take an antibiotic because the HSG is considered to be invasive and they use that to prevent any possible infections. While at home there were two things going through me head. First being, aside from my oncologist who has never seen any part of my body other than what isn't covered by clothing, I have never had a male doctor so I was hoping the Radiologist was not a man. and second I never thought I would be having the conversation with my husband about how the situation was down there. Did I need to shave or something of that nature.

Now on the day of the HSG I arrive in Radiology ready to do this. I get changed and then they take me down. They go over the procedure, how it will work and all the potential side effects. I sat there calm as could be as they told me they were going to be inserting a small catheter through the cervix into the uterus so the dye could be injected for the x-ray. All without any kind of pain medication, now doesn't that sound fun? So as if I wasn't nervous enough in comes the doctor who I am sure you guessed by now was a man. I was just about mortified. However I kept my cool and just told myself, "well it needs to happen and the likelihood of ever seeing this person again was slim so just deal with it." They have me lay on the table with my legs in the lovely knee stirrups 100% spread eagle for a long time. Finaly everything is ready to go and they start. They sterilize everything and insert the speculum. Then comes the fun part the catheter. He tells he is going to insert that and proceeds, surprisingly enough it wasn't as bad as I imagined slight discomfort but nothing over bearing. Then they have to slide you down the table to be the right position for the x-ray. Well while this was going on you will never guess what happened. The catheter came out. So I got to start the process all over again.

Same thing new sterile dressing, new catheter, everything. This time when he was done he had to hold my legs while they slid me down so I didn't engage any abdominal muscles which would make the catheter come out again. This slide was a success! They started the live x-ray and injecting the dye. That was more painful but I think it was due to the speed at which the dye was being injected. About 5 minutes in he left the room and came back with another doctor. Explaining the image he was seeing was a little unusual. That comment made me nervous. You also guessed correctly if you said this second doctor was also a man. They continued to inject to dye but by doing that caused some hardcore cramping/spamism and again the catheter came out.

So this is now the third time we are doing this. Now I get the pleasure of not only doing it again but with an entirely different male doctor poking and prodding down there, FANTASTIC! after I was all set up again and had been slid back down the table they again started taking pictures. He injected the dye much slower so there really was no pain/discomfort which was a relief. When all this was said and done he told me it appeared both my fallopian tubes were open and that there didn't seem to be any abnormalities. That was very good news and I suppose worth all the anguish I went through. A normal 15-30 minute event took me an hour and half! At least I got many praises of being an excellent patient during the whole thing!

That is where I am at right now in my adventure to find the fruitful lands. I decided to write about this in hopes it will some day help someone else who finds their fertility has been affected by chemo. I am currently waiting for my follow-up appointment to go over all the results and see what the next steps are. I assure that my later posts will not be this long. I welcome any comments, questions or just general support that anyone would like to share.

My one thing to leave you with is when faced with something that could affect your fertility or sexual healthy be your own advocate, ask questions and push for what you want! :)