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Virginia’s doctor’s advice was to give it a year before they worried.They gave it a year while they worried.There was testing, different conclusions, more testing and more trying.Three years into their marriage they started seeing specialists, something they later wished they’d done sooner.They were referred to a reproductive endocrinologist. They finally had answers, which meant they finally knew what might be needed to get pregnant.Virginia had endometriosis. A condition in which the tissue normally lining the uterus or the womb grows outside of the uterus. Endo, as it’s often called, is a painful condition which affects about 11% of women. It is known to cause infertility.Dusty was diagnosed with varicocele, an enlargement of the veins within the scrotum. The condition occurs in about 16% of males. It is usually harmless, but can be associated with infertility. Varicocele can contribute to lower sperm count and decreased sperm quality. “It’s disheartening thinking that I might be the problem,” said Dusty, glancing at his wife.First attempts with IUIThey started what’s called intrauterine insemination, or IUI, a fertility treatment involving placing sperm into the woman’s uterus to help with fertilization. The goal is to increase the number of sperm reaching an egg. During this treatment, the woman takes hormone injections.“You're emotional. You’re already emotional from having to go through this and then you have all of that added on top of it,” said Virginia of the extra hormones from injections.“It really messes with your hormones. Basically, you feel like you’re pregnant, and maybe more like the harder parts of pregnancy,” she said.A cycle of IUI is performed once a month at ovulation. It’s done in a clinical setting at the doctor’s office.“The actual process itself is uncomfortable. They have to insert into your cervix and into your uterus. It’s quick but it’s just not ideal. Not as pleasant as the natural route. It’s awkward with the doctor and the nurse,” said Virginia.IUI cost the Merritt’s about ,000 a month and they did three rounds, or three months of treatment, before having success. They were pregnant, and were both nervous for the pregnancy to last.“It’s hard to be hopeful. At the same time, you have to have hope,” said Dusty about the pregnancy.Their son Macsen was born happy and healthy. They thought they were done having children, but the urge built over time. They wanted Macsen to have a sibling and they wanted another baby. The desire built in them to the point they started feeling all of the emotions of their earlier attempts.The couple went through four rounds of IUI, some of them painful and all of them unsuccessful. The cost was about ,000 a month, which they’d been covering with odd jobs and cuts from other places in the budget. It was decided, the best option for pregnancy was in vitro fertilization, or IVF.It would have to be IVFIVF is a much more labor-intensive process, and much more expensive.An IVF cycle is a series of procedures to assist with conception of a child. Mature eggs are collected from the woman’s ovaries and fertilized with sperm in a lab. Then, the fertilized egg (or embryo) or eggs are implanted in the woman’s uterus. A cycle typically takes two weeks, and depending on personalized details, can cost between ,000 and ,000, sometimes more. Virginia and Dusty weren’t sure how they were going to afford IVF. They were selling their house and knew they’d have some equity from the sale. They worked extra. They saved.They started making appointments here. They were growing more discouraged, but remained determined. “We were feeling really lost for a while. Like, how are we going to come up with this money? Are we in the right place? We were frustrated and unhappy,” recalled the couple.The textA text from Virginia’s sister one morning changed everything.“She said, had we considered treatment outside of the US for IVF?” Virginia immediately started looking up information online. “I spent the entire day researching medical tourism,” she said, her husband chuckling.Virginia found the Barbados Fertility Clinic, even emailing them to ask questions. They responded almost immediately.“She’s looking up all this stuff,” said Dusty, “and then she’s springing it on me, sending me text messages. I get home and she’s like, I’m serious! Look at this, and look at this. Showing me all the research she’d done,” said Dusty.The couple learned the difference in price was significant. A full round of IVF for everything they wanted here was going to run ,000 at a local clinic. Total price for IVF in Barbados was to be about ,300.The Barbados clinic had a travel guide who helped them figure out details and pricing for travel. Airfare for four (they were taking their older son and Virginia’s mom), a condo for two weeks, a car, and food totaled up to about ,000. The total trip with everything, including IVF, was to cost them about ,500.(Note, the Merritt’s say they were originally quoted ,000 to ,000 for IVF in the states, but didn’t know the quote did not include medication. That piece of information significantly changed the financial commitment for which they’d need to be prepared. They share so other couples will know to ask about including that in expenses.)The decision to goAfter more research and more discussions, and further communication with the clinic in Barbados, Virginia and Dusty made their decision. They were going to Barbados.“Worst case, we have this amazing vacation with our son. Best case, we come home pregnant,” said Dusty.They did get a little nervous as they were about to go.“Flying out, it was like, we’re going on a vacation. This is nice. And then it was, okay, we’re going for medical treatment. This has all been built up and it’s all so wonderful. Is it actually going to be what we think it is,” said Virginia, recalling her feelings as they left for Barbados.The couple was in Barbados for two weeks. The clinic was across the street from the beach; the couple’s condo was a short walk to both. They were there two weeks, and report a very comfortable experience and a wonderful vacation.They left Barbados unsure if their efforts had worked, although Virginia said anyone struggling with fertility is to act as if they’re pregnant until they know for sure they’re not.“It’s called PUPO, or pregnant until proven otherwise,” she explained.The babiesSix days after returning from Barbados, Virginia and Dusty found out they were pregnant.“Oh my goodness! It worked!” she remembered saying.It was twins. Baby boy, Wells Coen Merritt, was born a few moments before his sister, Isla Lawrence Merritt. Wells has the distinct honor of being the 2000th baby born with the assistance of the doctors at the Barbados Fertility Clinic.Barbados Fertility ClinicDr. Juliet Skinner opened the Barbados Fertility Clinic in 2002. “I’ve been a qualified gynecologist since 1998, qualified for medicine in 1992,” she said, stating how long she’d been practicing medicine.She and her staff get inquiries regularly from couples exploring options for fertility treatments, and the clinic is reportedly very quick at responding to questions, something Virginia Merritt told us was a huge plus in her opinion.Most women want to know success rates, cost, length of time and safety.Success rates are difficult to verify when dealing with clinics because different variables lead to differing success rates and many clinics choose what’s best to market. It’s important for couples considering IVF to ask questions about their specific circumstances to learn the most likely chance of success. As for cost, that’s easier to quantify. As mentioned earlier with the Merritt’s, cost in Barbados was about a fourth of what the couple was quoted in the states. A typical stay for treatment is two weeks. The typical length of a woman’s visit for treatment in Barbados is two weeks, at which time she leaves and will learn if the visit was successful at producing a pregnancy within a week of returning home.As for oversite and regulation?“It’s always a leap of faith for someone to leave their home country and go to another country to have healthcare,” said Skinner.Barbados is a very small island and doesn’t have a regulatory body like the United States does.However, the clinic is accredited by Joint Commission International, or JCI.41 Action News reached out to JCI to learn what an accreditation from them entails. Dr. Paul Chang, Vice President, Accreditation, Standards and Measurement, for Joint Commission International, e-mailed back this statement: 8659

Vincenzo Gelsomino, who lives in Clairemont, said he can see the system working for those who plan ahead. "I think if we know we will change our behavior, it will be better," said Gelsomino, noting his bill has increased over the years to average more than 0 a month.There are already 150,000 San Diegans transitioned to the time-of-use plan.SDG&E will transition about 75,000 customers each month to the plan through mid-2020. Residents can opt out. SDG&E is promising to credit customers the difference if they pay more for electricity on the time-of-use plan after the first year. 595

Updated Lyrics[Verse 1: Kelly Clarkson & John Legend]I really can't stay (Baby, it's cold outside)I've got to go away (But I can call you a ride)This evening has been (I'm so glad you that you dropped in)So very nice (Time spent with you is paradise)My momma will start to worry (I'll call the car and tell him to hurry)My daddy will be pacing the floor (Wait, what are you still livin' home for?)So, really, I'd better scurry (Your driver, his name is Murray)But maybe just a half a drink more (Oh, we're both adults, so who's keepin' score)What will my friends think? (Well, I think they should rejoice)If I have one more drink? (It's your body and your choice)Ooh you really know how (Your eyes are like starlight now)To cast a spell (One look at you and then I fell)I ought to say, "No, no, no, sir" (Then you really ought to go, go, go)At least I'm gonna say that I tried (Well, Murray, he just pulled up outside)[Chorus: Kelly Clarkson, John Legend & Both]I really can't stay(I understand, baby)Baby, it's cold outside[Verse 2: Kelly Clarkson & John Legend]I simply should go (Text me when you get home)Oh, I'm supposed to say no (Mm, I guess that's respectable)This welcome has been (I've been lucky that you dropped in)So nice and warm (But you better go before it storms)My sister will be suspicious (Well, gosh your lips look delicious)My brother will be there at the door (Oh, he loves my music, baby, I'm sure)My gossipy neighbor's vicious (I'm a genie, tell me what your wish is)But maybe just a cigarette more (Oh, that's somethin' we should probably explore)I've got to get home (Oh, baby, I'm well aware)Say, lend me a coat (Oh, keep it girl, I don't care)You've really been grand (I feel when you touch my hands)But don't you see? (I want you to stay, it's not up to me)There's bound to be talk tomorrow (Well, they can talk, but what do they know)At least there will be plenty implied (Oh, let their mind their business and go) 1957

Weaver said, however, that the lessons of 2016 should be taken to reform the party's approach to the grassroots and behavior during primary seasons. 148

Wednesday, March 27, is American Red Cross Giving Day. The organization describes Giving Day as "an opportunity for local communities to come together on one day to help the families who have been impacted by a home fire or other disaster and who urgently need Red Cross services to get back on their feet. "If you would like to donate, visit www.redcross.org/donations/ways-to-donate/giving-day.html. 401