Wake Up Call

As you may have been able to discern from the title, this is going to be less of an uplifting entry as compared with the others and before I get into it, I wanted to just step back and let you in on an exciting change you may have noticed. My partner, Rae, now goes by Rey. This is something I just began writing as I was updating the blog recently and I realized I never pointed it out or explained. In addition to going by "Rey" and "Reymond" in his personal life now, he has also petitioned for his name to be officially changed with the city so he can get a drivers license that matches his identity and as soon as that goes through (any day now), he'll be able to officially change it. Woo Hoo! So look to read more about Rey soon and know that I haven't broken up with the love of my life and begun dating someone of a very similar sounding name who also is trans and wants to preserve his fertility before starting T...it's the same old Rey! lol

With that said, here's your next edition of the Transgender Baby Steps Blog!

-----------------------

For people living in poverty and for people in the middle class alike, preserving fertility may seem like an unrealistic goal. After all, having a baby is expensive enough on its own - undergoing medications, examinations, treatments, and surgical procedures just simply to save up the little guys for later can cost anywhere from $9,000-13,000 and that just might seem excessive and fiscally irresponsible.

But after you start digging around for the information (and with the help of some knowledgeable health care professionals), you can find options for doing what needs to be done at a cost that is anywhere from nearly affordable to absolutely FREE.

Here are some ways we found that would provide a person with alternative financing options for this type of procedure. There are probably more so make sure you look into it!:

-Insurance Coverage - OK, this didn't work for us but it does work for some so check with your provider to see. However, one word of warning (passed along to you from someone in the biz) is that they only need to know what they need to know. This means that you should not offer up any information unless they ask you - you don't want to be disqualified because their company belief is that it isn't "essential" for you to do this because you're queer, trans, single, etc. Just tell them what they need to know.

-Other Clinic-Provided Discounts - Our fertility clinic was able to give discounts to people working for larger companies and organizations in the area who, although they had insurance, would not receive any coverage for the procedures.

-Research Studies - Participating in research studies may make you eligible for discounted or free medication and other procedures. Find out from your fertility clinic what programs they know of that are happening in your area.

-Compassionate Care Program - The pharmaceutical company making the medication most individuals take during this procedure (Gonal-F) gives the medication for FREE to those who meet their financial need criteria - Saving you around $9000 if you qualify.

-Donating your eggs to the clinic in a separate cycle - This may not be something you're comfortable with - the idea of your brethren being born to and raised by someone else entirely and potentially never getting to meet them (at this time, most legit egg donation clinics require donors be completely anonymous) However, if you think you can do it mentally and physically (there are also health-related criteria you must meet for donating), you will see sweet rewards up to $8,000-10,000 in the United States. Also, keep in mind that some clinics will not allow you to donate of you're only doing it to offset the cost of your own procedure as they don't want the reason for your donation to be wrapped up in the rewards themselves.

Of course, if you read the last entry, you know what happened when we tried to get insurance coverage. We also tried to get in on the research studies but there were none going on that we would have been eligible for at the time. So we set out to take advantage of the Compassionate Care program.

Rey filed all the necessary paperwork and sent along his proof of income. He received a call back within days - much faster than either of us had imagined. After asking questions to verify that he was the one who had turned in the paperwork, the woman on the other end of the phone asked if he would be the one carrying the child. In response to the question, he said, "I need to disclose to you the situation of why I am pursuing fertility treatments just to be clear so you are not confused. I am technically in a same sex relationship with a woman, but I am going to be transitioning to male. I identify actually as a transgender individual. My partner and I – we’ve been together five years and are engaged – are freezing my eggs because once I begin using testosterone as hormone replacement therapy, my ovaries will no longer be able to reproduce. So I will not be the one carrying the child, my partner will later carry the child through invitro."

The woman paused for a long time and finally said, “This program is not for you.”

At this point there was no further explanation of why, only silence on the line. Rey eventually said, “Ok…?” The woman finally explained that it is not their practice to provide free medication for someone who is going to be freezing their eggs for future use. The program is only for couples with infertility issues trying conceive now, UNLESS a woman has cancer or some other catastrophic medical event in which it would be considered medically necessary to preserve her fertility. While we of course knew that this procedure was medically necessary for us, we realized now that we had to prove it.

In the meantime, we had already been considering donating eggs as a way to compensate for the cost of our own procedure. After getting this news, we were more sure that this might be our last remaining option. At this point, we'd been knee-deep in the process for more than six months but without some way to help pay for the procedure, we weren't sure we'd be able to do it. I was nervous that we'd become attached to the idea that would never come to fruition.

We had already been on our fertility clinic's website for egg donation and Rey met all of the criteria. That, along with the fact that they had been amazingly supportive, understanding, and incredibly trans and queer-friendly all made us feel pretty confident that this would be as simple as just letting them know we were interested in donating. Here's the criteria they list:

Are you between the ages of 21 and 32 years of age?
Are you in good health and a nonsmoker?
Do you have regular menstrual cycles?
Do you have both ovaries and do you have no reproductive problems?
Do you have no current history of a sexually transmitted disease such as chlamydia or GC?
Do you have no history of HIV or hepatitis?
Are you psychologically healthy?
Do you have no current use of drugs or excessive alcohol consumption?
Do you have no family history of inherited genetic disorders or conditions?
Does your work or school schedule allow you to make it to daily doctor’ s appointments?
Are you willing to take hormone injections?
Do you have a car, a valid driver’s license, or reliable transportation?
If you have children, do you have a babysitter for when you have doctor’s appointments?
Do you have a normal height-to-weight ratio? Is your body mass index (BMI<27).  You can visit www.nhlbisupport.com/bmi/ to see if your BMI is less than 27.
Are you dependable, mature, and able to keep appointments?

The website also clarified that donors get paid immediately after having donated, regardless of how quickly their eggs are used by other individuals. So, excited and nervous, Rey picked up the phone and dialed their number. I sat right next to him for support. He was immediately put on the line with the director of egg donation, herself. The following are nearly perfect quotes from the conversation:

Rey: "Hello. My name is Rey Drew. I'm actually working with Main Line already. I'm preserving my fertility before I transition from female to male and I am interested in donating my own eggs to offset the cost of my procedure."

Egg Donation Director: "Um, so you're having a sex change operation?"


Rey: "Well, not exactly <Welcome to 2012 in America, lady>. I will be going on testosterone to produce secondary sex characteristics and before doing that and potentially destroying my ability to reproduce, we decided to go through this procedure to preserve my fertility. I'm thinking of donating in a separate cycle".

Egg Donation Director: "<LONG PAUSE> Oh. Well, that's a very unique situation and everyone wants something more ...normal. I would have to tell people about this and ...well, no one is going to want your eggs."

Swear.To.God.

That was essentially the entire conversation which was then followed up by our collective cussing and yelling and crying that went on for a good, long while as we realized we'd been discriminated against by the same clinic that had made us feel so loved. I felt so angry that our trusted health professionals who seemed to know so much about appropriate trans and queer vocabulary and etiquette really hadn't been schooled on the more complex array of transphobic issues they were apparently perpetuating.

This used up the very last of Rey's motivation. He had no desire to call and speak with her supervisor, much less start an effort to fight back! I, on the other hand, felt internally obligated to fight back! When I see the line clearly drawn between right and wrong, I just can't help myself!

I called Main Line the next day during my lunch hour at work. A gentle, truly caring nurse we'd recently spoken with answered the phone and I relayed to her what had occurred the day before with the director of egg donations. I also told her we'd been denied the Compassionate Care coverage because of their philosophy that starting testosterone is a choice and not medically necessary. She seemed genuinely apologetic and said she would pass the message on to our doctor. She said she was certain that we'd hear back something from him soon.

It was a week and a half and three phone calls to him later when I finally heard back from Dr. Glassner one morning at 7am as I was getting ready to go to work. He didn't seem like the same charming, gracious soul we met on our first visit. He said hello and quickly jumped into the mini-investigation he had launched after receiving the message the kind nurse jotted down. He had spoken with the director of egg donations and she had confirmed that what we claimed was truth but she stood by her statement that "no one would want (Rey's) eggs". This, apparently, was very important to them even though they always pay their donors immediately after donating, regardless of whether they'd be purchased.

I waited for him to let me know he had reprimanded her or that she'd even been fired for practicing against their open, welcoming, diverse philosophy of practice. But he didn't say those things. He stood by her decision, saying she was the expert in that particular field. I argued with him that this was discrimination and if Rey met the criteria posted online, then he should be able to donate. And, I protested further that by keeping trans and/or queer people from donating eggs, they were preventing trans and queer people from having the option to use eggs from people similar to themselves.

I was livid! How was it possible that we fell for this? How was it that we had been treated like gold by all of our friends and all of our family members throughout Rey's coming out about being trans AND  throughout this fertility process, and these people - who didn't even truly know us - were judging us based on their assumptions and on society's real fear and hatred of trans people. What if Rey had disclosed he was a Muslim? Or what if Rey disclosed he had had a car accident in which he acquired a brain injury or quadriplegia? Then what? Would anyone want his eggs then?

Dr. Glassner became a bit more empathetic after I shared this viewpoint with him. He then apologized that i was feeling the way i was (which of course really doesn't mean he's sorry at all) and closed out our conversation with a deal. Yes, a deal. He was going to give us $4,000 off our procedure since we were not able to donate. $4,000, remember, is maybe half of what we would have gotten if we had donated. I told him I had to think about it and talk it over with Rey since this was not what we had hoped he would say. This was generous, yes, but it was a response to a heinously discriminatory experience we'd had by one of his staff...and that was going to cost us around $4,000-6,000 in the end...close to the exact amount we needed to completely pay for our procedure.

Our Intake Experience - Part 2

We sat opposite a straight couple in their forties who seemed somewhat sad as we waited to be called in for my ultrasound. It hadn't occurred to me until then that people typically went to a fertility clinic because they were so frustrated with not having been able to conceive. And while this was a last ditch effort for so many people, this was our beginning. Among these upper class, straight socialites, we were the privileged ones.

As my balloon of excitement slowly deflated at the thought of these other couples and their emptiness, we were called back for my ultrasound. I was surprised to learn that apparently they do them intravaginally these days. I laid stiff as a board on the examining table while I waited for the ultrasound tech to prepare for the procedure. For weeks now, I had worried that I might find out during this ultrasound that I would never be able to carry children. It's not that I'd ever had any indications of that being the case; it just seemed like the most perfect punishment that life could offer. I had always known I wanted to have kids, but I had never been in the right place to do so. Now I was finally ready to find out what baby making potential lived in my loins, and at the same time, I was overwhelmed with the fear that I would get a dreadful answer to that question; that I would be back out there in that waiting room feeling the same pain and sadness as the empty, frustrated couple.

 The ultrasound tech was gentle and the procedure didn't hurt as much as I'd anticipated. She worked quietly, saying nothing as she snapped pictures with her machine. We had no idea what we were looking at on the screen - it looked like one blob after another; one big, one small; one black, one white. I hoped that the objects she was taking pictures of were intriguing to her because she liked what she saw, rather than the opposite, but I dared not ask. When we were done and my pants were back on, we were led to a third waiting room. We had barely sat down there when Dr. Michael Glassner walked out of his office and introduced himself to us.

We had seen wall mounted newspaper clippings and Philadelphia top doctor's awards which had his name on them in the office where we did the intake with the other doctor earlier in the appointment. He was a pioneer in cryo-freezing embryos. He had been on 20-20 and he was now shaking our hands. He had every right to be pretentious but with just his firm handshake and soft, gentle expression, we were put at ease.

We walked in and, to our surprise, the other doctor who'd conducted the intake with us at the beginning of the appointment was there. She smiled widely at us and I got the sense that everything was in very good hands. Dr. Glassner sat across the desk from us and said flatly, "I'm going to help make all of your fertility dreams come true". There was something generic about the statement that made me question myself and my prior feelings of ease and comfort, "Is this guy for real? Is this a commercial?" And that's when he said, "I read through your chart, I spoke with my colleague here, and it sounds like you're a committed couple who has worked really hard to get where you are- I know you must have a solid relationship. You deserve to have this and you shouldn't have to put your life on hold for it any longer."

I was staring at him and tears began falling uncontrollably onto his desk. He was the most compassionate doctor I'd ever spoken with. I had prepared myself for a doctor who would make insensitive comments and make us feel small for even thinking we could do this. Rae was stroking my back and smiling. I was shaking my head and wishing someone would pinch me! All of a sudden, I remembered that none of his compassion would matter if my uterus wouldn't carry a child. "Was the ultrasound ok?" I managed to get out. "Yes. It looked good", he replied.

I wept harder and someone passed me the tissues.  The question that was weighing on my mind came spilling out, "How much will everything cost?" He explained that the cost varies depending on the amount of medication Rae would need (which would be determined closer to the procedure date), but that it was between $9,000-$15,000. Although, that was much more money than either of us had at the time, that was the price of a cheap car. I didn't have a car, I reasoned in my mind, but if I needed a car, I would buy one. So, why then, would we not commit to spending the same amount of money to create a life? "And," he shared, "there are cost-saving measures we can take to significantly reduce the costs associated. He listed a few major ways couples can lighten the financial load and I was convinced we could do this!

He smoothly transitioned into a description of the procedure and our options. On the day of Rae's period, we would call the office and set up an appointment for the next day to come in, get another ultrasound and our instructions for the next two weeks. Rae would be taking a series of injections for ten to twelve days. The injections would overstimulate the production of eggs and also keep him from ovulating too soon. The grand finale would begin with an intramuscular injection of HCG which tells the ovaries to go ahead with releasing the eggs. Following that injection, we would head back to the clinic for the retrieval of the eggs. It used to be much more invasive but they now do it all lapriscopically. He stopped and said, "Now, some choose to retrieve and freeze eggs, but freezing embryos creates the best possible outcomes. Thawed embryos are much more viable than frozen eggs." I hadn't even considered that we would need to find a sperm donor so soon and the thought of it was quite daunting. I tried to quiet my mind long enough to find out what would happen next. He described that on the day of the retrieval, Rae would go under anesthetic, they would remove all of the mature follicles and inject the sperm into each one. They would let them grow and divide for three or four days and then freeze the most viable embryos.

I was in shock. Seriously dumbfounded. We had the ability to freeze tiny babies for later in life, when we were good and ready to be parents. I couldn't stop crying and so instead, I apologized for the continuing tears. "It's ok, Jen", Dr. Glassner said sincerely. The other doctor just smiled simply in my direction. You know that feeling you get when you're completely at peace? It might come when you're sitting on the beach with a loved one at sunset or when you're reading your favorite book on a cool autumn afternoon. That feeling was all around me. I felt like there was a warm blanket all around us and that we were protected from all the evils in the world.

As I stared at him blankly (still slightly shaking my head), I heard him say, "Rae, we want you to have an ultrasound today". I guessed he hadn't heard our plan. "Well," I explained, "We were going to wait to find out how much everything would cost and then I could call my insurance company to see if it would be worthwhile to get him on my insurance. After that, we could come back for the ultrasound. Would that be ok?" The two doctors looked at each other and said, "No, we want you to have it today, Rae". I took in a deep breath. And then Dr. Glassner gave us yet another gift, "It's on me," he said. The other doctor gave him a surprised look and said, "You're really trying to get the gold star today!" "Well, it's the first day of Hanukkah", and he smiled genuinely. "My son's not getting anything today because of this, but that's ok," he joked. We all laughed and Rae and I thanked him profusely.

They led us back to waiting room number two where we waited again with the sad couples. This time though, we couldn't hold back our ecstatic amazement. It wasn't long before Rae was in position on the examining table and the probe was in showing us what his fertility potential looked like. Again, the tech didn't talk while she clicked the mouse and moved the probe about. This time though, I wasn't worried. I felt like a million bucks! We headed to waiting room number three where Dr. Glassner met us with the ultrasound pictures in hand and said "They look great. You both look good - though I like these last pictures better, you both look good."