you know your life continues down surreal (or perhaps pointless) lane when you fall asleep reading the IUI instructions included in the REI¹ welcome packet interspersed with reading the instructions to the one-step ovulation predictor kit, even though you’ve been using the clear blue easy fertility monitor for nearly a year now.

and it’s further evidence of insanity when you find yourself telling your husband that HE needs to figure out whether frozen or fresh sperm are preferable for IUI, given the results of his semen analysis.

TMI? probably. but i’ve just finished my cycle of clomid for the month and my hormones are raging and my moods are swinging and it’s getting to the point where i’m just gonna steal the first baby that comes to my door on halloween.

no, i’m kidding. i’ll take the second one. the first ones are always the greediest.
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¹ for those not in the know, REI in this context is not the recreation sports equipment store, but rather Reproductive Endocrinology and Infertility.

i’m about to start a digression here about whether or not having had 3 miscarriages qualifies as infertility, but that’s just going to be a long, drawn-out mess and i have things to do today. like sit by pool and talk about adoption with my aunt. so toodles!

so, the interesting thing about repeat miscarriages, it seems, is that there’s not a whole lot to be done if there isn’t some sort of chromosomal or clotting factor issue. when there is such an issue (about a third of the time) there are medical and surgical interventions that can happen. the other two thirds? the medical advice is to keep on truckin’.

or really, keep on fuckin’.

the RE visit today wasn’t too helpful; the resident (who had done a rotation on the psych ward when g was the attending – she recognized him and started to stammer a bit) was scattered and unnecessarily timid. i don’t think a case history should be taken with “um, so you don’t have a history of…?” questions, but maybe that’s just my survey instrument training talking. after 50 minutes of that (and a brief conversation with her attending), she sent us off to the lab, where they promptly relieved me of what felt like half my blood volume. going vasovagal was a distinct possibility. i’d post a photo of the needle site, but you’d just nod at the lovely bruise.

the upshot of all this is that if i don’t get pregnant this cycle, i get to do the clomid challenge next cycle (not as fun as it sounds, but it radically increases the chances of a multiple pregnancy) and have a hysterosalpingogram (i’ll spare the details, mostly because i don’t want to think about them right now – but it’s about as unpleasant as it sounds and will require the heavy painkiller artillery before and after).

w00t.

on tuesday, one of my docs asked me how bad this whole process would have to get before i gave up. i looked at him, and said “hunh? i’ve decided to get pregnant. until someone tells me i’m categorically unable to carry a pregnancy to term, i’m going to do whatever’s necessary. “hard” and “give up” do not compute.”

so, we begin again. with the knowledge now that i’ve a 50% chance of miscarrying – unless the tests tell us otherwise.

in other news, i’m sleeping in a lab tonight to see if the docs can determine a cause of my insomnia.

laloca: a one-woman effort to keep the DC-area medical establishment humming.

in the next few months, i am going to have a crash course in the work done by reproductive endocrinologists.

funny, i never thought that this would be my life. but miscarriage #3 seems to be concluded, so we’ll see what happens. i may or may not blog about this, or anything else much. the urge to stick my virtual head in the virtual sand is strong.

(and it just struck me that when i created the category “women’s reproductive health” i never thought i’d be talking about me…)

[this is a recovered post from the great data disappearance of 2009. links, comments, and other html may have been lost permanently.]

(before launching into my outraged diatribe, i’m going to stipulate that safe abortion access is an integral part of not only women’s reproductive health, but our ability to exercise self-determination. many other individuals have written more coherently and persuasively on the subject than i could, so i’ll leave any interested readers to the googles for the specifics.)

with that out of the way, on to the diatribe.

in a press release celebrating the 240-194 approval of his odious abortion restriction amendment, bart stupak exulted,

Now that those voices have been heard we must move forward and pass a bill that provides quality, affordable health care for all Americans.

he’s also said, “All Americans deserve the right to quality, affordable health care coverage.”

all americans? really? apparently stupak doesn’t think that abortion access has any place in women’s “quality” or “affordable” reproductive health care. his amendment (couched in “this just [just! - ed] continues the hyde amendment’s prohibitions on the use of federal funds for abortion” logic) will have the practical effect of denying abortions to any women participating in the health insurance exchange.

how? right off the bat, it prohibits exchange-participating plans that offer abortion coverage from accepting any federally-subsidized customers (estimated at 80% of exchange participants)¹.

oh, but wait. apparently women will be allowed to purchase separate “abortion riders.” that’s great, provided a) women will think to insure against unintended pregnancies (or better yet, pregnancies with complications necessitating an abortion either due to risks to the woman’s health, or abnormalities with the fetus); and b) that there are insurance companies willing to offer those riders in the first place.

and it’s b) that’s really the kicker. via NARAL,

According to the respected National Women’s Law Center, the five states that require a separate rider for abortion coverage, there is no evidence that plans offer these riders.²

so. we’ve got a health reform plan from the house that is intended to create universal coverage by requiring individuals to acquire health care coverage through a national exchange³. and that exchange will effectively reduce women’s access to abortion services. fantastic.

i really, really hate washington right now. a meteor could demolish the entire hill, and i’d only mourn the architecture. okay, i’d feel sad for the families of the members of congress, but the representatives? not so much.

particularly not bart stupak or nancy pelosi, who facilitated the introduction of stupak’s amendment. because of those two (insert foul adjective of choice here… oh, hey… choice!)s, women are going to remain second-class citizens when it comes to health care.

(and finally, because i’m pissed off at the pro-choice democrats who folded and voted for the bill with stupak’s amendment: there’s a niggling voice in the back of my head trying to convince me that perfect should not be the enemy of the good, and that this reform bill is better than none. to that voice i say – there are far fewer anti-choice democrats than pro-choice ones in the house. if the pro-choice dems couldn’t get the antis in line and force a vote without restricting abortion access, they’re a useless political machine. if they’re going to allow abortion to be a political football, they should play the damn game to win.)

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¹ how ironic that the democrats have brought us our own version of the mexico city policy.
² i’d link directly to the national women’s law center on this, but i can’t find anything on point on their website.
³ it will also expand medicaid access, but that doesn’t help low-income women access abortion. see the hyde amendment.

the fourth circuit court of appeals has upheld virginia’s (previously overturned) “Partial Birth Infanticide Act,” which apparently criminalized a specific abortion method.

although it isn’t clear to the layperson (read: me) which procedure was banned, the wp describes this:

Although the Virginia law permits women to choose various abortion procedures, it specifically makes it a crime for doctors to perform a rare midterm abortion that involves partially delivering the fetus before crushing its skull to ease removal.

i haven’t yet had a chance to read the opinion myself, but the post’s coverage indicates that the majority’s opinion essentially reasoned that doctors’ criminal liability for performing this type of procedure is so unlikely that the fact of the criminal liability isn’t enough to invalidate the law.

the entire purpose of the law is to criminalize that abortion procedure. if it’s exceedingly unlikely to fulfill its purpose, the law is unnecessary legal accretion and has no reason to be cluttering up the books. taking the majority’s assertion (as interpreted by the post; as i mentioned, i haven’t yet read the opinion) at face value, if doctors are unlikely to actually face criminal prosecution for performing the procedure, and yet there’s substantial pressure to retain the law, there must be some other reason driving the decision.

hmmm. i wonder what it could be.

abortion opponents are apparently very willing to criminalize doctors’ therapeutic decisions. they seem to ignore the fact that if the doctor is committing a crime, then the woman is an accessory to the crime, and guilty of conspiracy as well. abortion opponents should be honest about their intent, and attempt to hold the woman criminally responsible as well. let’s see how far legislative efforts would go then.

despite having a startling similarity in appellation, i’m pretty sure that janet napolitano is no relation to johnette napolitano. which kills any chance of hearing the DHS secretary sing joey anytime soon.

###

in reproductive health news, it’s looking likely that the FDA will be making it easier for 17-year-olds to buy plan B. the u.s. district court for the eastern district of NY has told them to, at least. (PDF of the memo & order in tummino v. von eschenbach)
i like the judge’s straightforward approach:

…the gravamen of plaintiffs’ claims is that the FDA’s decisions regarding Plan B – on the Citizen Petition and the SNDAs – were arbitrary and capricious because they were not the result of reasoned and good faith agency decision-making.

Plaintiffs are right.

…

Indeed, the record is clear that the FDA’s course of conduct regarding Plan B departed in significant ways from the agency’s normal procedures regarding similar applications to switch a drug product from prescription to non-prescription use, referred to as a “switch application” or an “over-the-counter switch.” For example, FDA upper management, including the Commissioner, wrested control over the decision-making on Plan B from staff that normally would issue the final decision on an over-the-counter switch application; the FDA’s denial of non-prescription access without age restriction went against the recommendation of a committee of experts it had empanelled to advise it on Plan B; and the Commissioner – at the behest of political actors – decided to deny non-prescription access to women 16 and younger before FDA scientific review staff had completed their reviews.

somehow i don’t think the rank & file up in rockville are too broken up about the district court’s decision.

the colorado senate recently passed a bill, 32 to 1, requiring pregnant women to submit to HIV testing. the lone dissenting vote came from a republican who believes that the measure would “remove the negative consequences that take place from poor behavior and unacceptable behavior.”

apparently the senator believes that living with the consequences of untreated HIV appropriately punishes poor behavior. on the other hand, the rest of the state’s senators apparently believe that a fetus’ medical needs outweigh a woman’s right to privacy. according to one of the bill’s sponsors, “What this bill will do and why it’s so important to test the woman when she is pregnant — if she is HIV-positive, treatment is started immediately to protect the baby, the unborn baby.”

now, don’t get me wrong – i think HIV testing is a good idea. it’s a good idea if you’re sexually active and if there’s a possibility you could be exposed to HIV. it’s a good idea if you’re a pregnant woman who wants to make the most informed choices about health care for yourself and your fetus. so it’s a good idea to require doctors to offer the test, and to either require health insurance to cover it, or to pay for it out of government coffers. but requiring women to get tested – which is the likely outcome of an opt-out system – bothers me. interjecting the government anywhere in a woman’s reproductive health care bothers me, because in this country, it’s a quick jump to measures that limit reproductive choice, and that impinge on a woman’s right to conduct her life as she sees fit.

i believe the wording of the bill is highly problematic, even though it’s basically the existing syphilis law with HIV tacked on:

25-4-201. Pregnant woman to take blood test. (1) Every licensed health care provider authorized to provide care to a pregnant woman in this state for conditions relating to her pregnancy during the period of gestation or at delivery shall take or cause to be taken a sample of blood of the woman at the time of the first professional visit during the first trimester for testing pursuant to this section. The blood specimen obtained shall be submitted to an approved laboratory for standard serological test for syphilis and HIV. Every other person permitted by law to attend pregnant women in this state but not permitted by law to take blood samples shall cause a sample of blood of each pregnant woman to be taken by a licensed health care provider authorized to take blood samples and shall have the sample submitted to an approved laboratory for a standard serological test for syphilis and HIV. A pregnant woman may decline to be tested as specified in this subsection (1), in which case the licensed health care provider shall document that fact in her medical record.

(2) If a pregnant woman entering a hospital for delivery has not been tested for HIV during her pregnancy, the hospital shall notify the woman that she will be tested for HIV unless she objects and declines the test. If the woman declines to be tested, the hospital shall document that fact in the pregnant woman’s medical record.

25-4-203. Birth certificate – blood test. In reporting every birth and stillbirth, physicians and others required to make such reports shall state on the certificate whether a blood test for syphilis and HIV has been made upon a specimen of blood taken from the woman who bore the child for which a birth or stillbirth certificate is filed and the approximate date when the specimen was taken. In no event shall the birth certificate state the result of the test.

first, they’re requiring a sample of blood to be taken for the purposes of the HIV test, whether a woman agrees to be tested or not. then, the bill allows women to opt out, rather than requiring affirmative assent to the procedure, which would provide more protection for the woman. nothing will prevent a provider from taking the blood and “oops!” either “forgetting” to give the woman the option to decline the test, or “losing” any documentation of her refusal. finally, if they do offer her the option to decline, and she does, the fact of her refusal must be documented. why? and how will that information be used down the line? will providers be allowed to refuse to treat women who decline the test? will health insurers refuse coverage to women – or their infants – who have not tested negative? and what is the purpose of recording the fact or absence of the test on the child’s birth certificate?

the legislation is broadly written to cover all providers treating women for “conditions relating to … pregnancy.” this would require that a woman seeking an abortion must go through the HIV rigamarole. and to what end?

while this legislation might have evolved from good intentions, the potential for abuse seems very high, and the rationale behind requiring the testing, flimsy at best. i can only hope the house shows better sense than the senate and defeats it.

almost two years ago, a good friend and mentor died of pancreatic cancer. she’d managed to beat the odds for awhile, enrolling in a treatment study out of california that seemed to knock the tumors back and raise the possibility that she’d be able to get a whipple that, it was hoped, could extend her life. in the end she didn’t, but at least she was able to leave on her own terms, in her own house, with her family around her.

and now wapo is telling me that ruth bader ginsburg, author of one of the most well-mannered tongue-lashing dissents¹ i’ve had the pleasure to read, lone remaining woman on the supreme court, has been hospitalized with the same disease. it appears the cancer was caught early, and she’s undergone surgery (although what type is unclear). but still. it’s an ugly cancer, and has a very poor prognosis.

i hate pancreatic cancer.

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in related news, obama is apparently trying to reframe the abortion debate. or, perhaps as the wapo put it, “appease both sides.” (yeah, like he tried to appease the house republicans by persuading the dems to drop a number of provisions in the stimulus bill, including expanded access to contraception for poor women? and how did that work out for him?) he seems to be trying to walk the “reduce unwanted pregnancies” tightrope with the establishment of a white house office on faith-based and neighborhood partnerships², but i’m wondering if he realizes that the antiabortion side also trends heavily toward anticontraception as well? if he starts pushing abstinence education as part of his agenda, i’m going to hurl.

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¹ gonzalez v. carhart. it should be required reading for anyone concerned about how the supreme court has consistently eroded abortion rights since roe.

The Court offers flimsy and transparent justifications for upholding a nationwide ban on intact D&E sans any exception to safeguard a women’s health. Today’s ruling, the Court declares, advances “a premise central to [Casey’s] conclusion”—i.e.,the Government’s “legitimate and substantial interest in preserving and promoting fetal life.” Ante, at 14. See also ante, at 15 (“[W]e must determine whether the Act furthers the legitimate interest of the Government in protecting the life of the fetus that may become a child.”). But the Act scarcely furthers that interest: The law saves not a single fetus from destruction, for it targets only a method of performing abortion. See Stenberg, 530 U. S., at 930. And surely the statute was not designed to protect the lives or health of pregnant women. Id., at 951 (Ginsburg, J., concurring);cf. Casey, 505 U. S., at 846 (recognizing along with the State’s legitimate interest in the life of the fetus, its “legitimate interes[t] … in protecting the health of the woman” (emphasis added)). In short, the Court upholds a law that, while doing nothing to “preserv[e] … fetal life,” ante, at 14, bars a woman from choosing intact D&E although her doctor “reasonably believes [that procedure] will best protect [her].” Stenberg, 530 U. S., at 946 (Stevens, J., concurring).

² headed by a 26-year-old, no less. wtf?

in what’s become the most common left-v-right policy pendulum in washington, obama will be repealing the mexico city policy. and not a moment too soon.

update from O’s statement on rescinding the policy:

It is clear that the provisions of the Mexico City Policy are unnecessarily broad and unwarranted under current law, and for the past eight years, they have undermined efforts to promote safe and effective voluntary family planning in developing countries. For these reasons, it is right for us to rescind this policy and restore critical efforts to protect and empower women and promote global economic development.

For too long, international family planning assistance has been used as a political wedge issue, the subject of a back and forth debate that has served only to divide us. I have no desire to continue this stale and fruitless debate.

while i’m not crazy about the “protect and empower” language (it rings a bit too close to patriarchal patronizing, if i may regress into undergraduate mode for a moment), i’m thrilled the policy is toast for the next four years. i also particularly like the “it’s gone, that’s it, it’s not open for discussion” tone of the second paragraph. the other particularly heartening bit is the good news for UNFPA:

In addition, I look forward to working with Congress to restore U.S. financial support for the U.N. Population Fund. By resuming funding to UNFPA, the U.S. will be joining 180 other donor nations working collaboratively to reduce poverty, improve the health of women and children, prevent HIV/AIDS and provide family planning assistance to women in 154 countries.

i’m still giddy.

the “pro-life” position generally holds that abortion should be illegal in the u.s. (made so on a state-by-state basis, one would expect) because it is the murder of a human being. indeed, if their reasoning holds, abortion is the willful, deliberate, and premeditated murder of a human being.

in illinois, punishment for first-degree murder (which covers willful, deliberate and premeditated murder) includes the death penalty. as the perpetrator of murder for hire, a person who performs an abortion would be eligible for capital punishment. as the solicitor of murder for hire, the woman who has an abortion would face 20-40 years in prison.¹

seems pretty straightforward. and yet, these abortion protesters in libertyville² were hard pressed to come up with any appropriate penalty for a woman who had a hypothetical illegal abortion. most hadn’t even considered the question of what should be done to those women. (the young woman at 4:08 has the most reasoned response, however even she is visibly uncomfortable with suggesting an appropriate penalty.)

interesting. perhaps they believe abortion should be illegal, but decriminalized?

hat tip: justin
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¹ 720 ILCS 5/Art. 9 and 720 ILCS 5/Art. 8
² i’m assuming that’s libertyville, IL