Gametes In Love

For every step forward it feels like we’ve been taking two steps back. We’re so far back, in fact, that we’re now at the beginning.

We spoke with FPNC’s contract negotiator today. She, as the one fully knowledgeable of what has been agreed with our insurance carrier, had the final say of valid information. During this conversation we confirmed the worst case scenario: the clinic’s major procedures are out of network for us, they will not be certified, and the clinic has no plan in the near term to seek coverage for their lab and surgical room facilities through any insurance carrier.

Then they proceeded to tell us that one of their former physicians is now working with Stanford Fertility Center, and they would like to recommend that we work with them and that they would be happy to transfer our records and initiate our appointments with them. We didn’t ask for this – they asked us to do this… in effect firing us as their patients.

The part that sucks is that we LOVE our doctor. She has been simply wonderful and I dread having to start the process over with the unknown of another physician. It’s hard to find someone that you ‘click with’ the way we did with her. We have not concretely ended our relationship with FPNC, but we’ve had to put an immediate halt on all procedures with them. For all I know, we could end up in the same scenario with Stanford. Given, however, the money involved it is worthwhile to at least investigate that option.

Since then I’ve called the cycle scheduling admin and had to cancel my upcoming SHG test as well as the injection training. I figured that the clinic that would be performing the IVF treatment should be the one conducting this test.
We also had a good chat with our physician as well. We explained the situation, she was very sympathetic and she’ll look into this whole situation on her end as well (esp. the part where the contract negotiators are encouraging her patients to leave the practice).

So that’s where we are: back to the beginning. We thankfully at least know what our diagnosis is, and what the methods of treatment are. Otherwise everything gets asked all over again: What are all the procedures that we’ll undergo? Who will be billed for each procedure and why? Is each facility performing each procedure in network with our insurance company?

I’m remarkably at peace with all this: maybe it just hasn’t hit me yet.

Meanwhile I’m going to remain on the pill. I figure at least this way we’re in a little more control over my cycles and can decide when to start a procedure, than just waiting for nature and having a bunch more rushed conversations.

A few good things have come out of this: for one, I can continue working with my personal trainer. I’ve been on a good track so far: I’ve lost 5 lbs, two inches off my waistline and an inch from each of my thighs. I can keep at it: being healthier will only bring on a healthier pregnancy (I hope). For another, we’ve had a remarkable outcry of support from friends and family. One of HIS friends works with Aetna and has been so generous in donating his time in helping us get us answers from the inside. All of our friends/family have extended us many shoulders to lean on. I’m also learning a great deal from the many experiences from other families in similar situations on the Nest.com. It’s truly an online support group.
I feel very fortunate to have all these in my life right now.

Our first appointment with Stanford is Nov. 9th. That’s two weeks away. See you then!

Ok, so now we have a new plan. It goes something like this:

I started my period today. I will begin the birth control pills at the assigned day 3 with the hopeful assumption that my insurance will kick in and certify the lab fees. This buys us until November 7th to see where the insurance situation is.
IF it is certified, we will continue the IVF route.
IF it is not, we will skip this IVF cycle, I will take the full set of pills and then convert the November cycle to a round of IUI.

The IUI cycle either works or doesn’t. If it doesn’t, we’ll begin IVF in January after we adjust our FlexMed for the uncovered lab fees.

We’re both at peace with this path. I’m still hopeful that Aetna will come through, so send us some positive vibes.

I don’t think I fully understood the meaning of that quote until last night.

These last two days have been some of the roughest in this process so far. Here’s why:

This week started off well, with the cycle planning, only to come crashing down on Tuesday morning when we spoke with the clinic’s financial advisor. As it turns out, all the “fortune” I believed we had with Aetna covering a round of IVF is no fortune at all. Our doctors are covered because they are in network. The clinic’s surgical room where the egg retrieval and transfer will be done is also covered, but the clinic’s laboratory, where I will be receiving daily blood work/ultrasounds and will perform the ICSI procedure is out of network and is not covered. The cost of the lab is over $6000. That’s no small peanuts!
And that is where things started unraveling.

My cycle is supposed to start at the end of this week. After that it’s pills, tests, injections in a row. If we don’t pay out of pocket, do we stop and wait? What does stopping mean and what are the alternatives?

HE and I have been in major disagreement about it. HE is now leaning towards trying IUI instead, and I don’t have the heart to pursue a procedure that in my mind would be us going backwards. This part is really difficult to explain, which is why communicating between us since Tuesday has been so difficult. I just have feelings and instincts that make me choose IVF over IUI. I can’t explain those. In my rational mind, I do realize that IUI is cheaper – thousands of dollars cheaper, but in my heart I fear yet another negative test and yet another emotional cycle spent waiting on a procedure that has much lower success rates.

I’ve been crying on and off for those two days.

So last night after work, HE made dinner. I opened a bottle of wine, and after 2 glasses each (which for me, def. means intoxication), some of the stuff we’ve both been keeping inside started coming out. We cried together, and talked together. I think we now know where each of us is coming from and what we’re thinking. Ironically, I don’t know that we agreed on what to do next, but at least we’re back to openly talking. We have had such an amazing relationship this far, and I thought that how we are with each other would get us through this process. I just never thought that it would be THIS hard!!!

There is a chance that the insurance will cover the lab, provided we certify it, but we won’t know for sure and the process for this certification is so abstract. My primary care physician has to initiate this process. She’s been out of the loop this whole time, and getting 4 parties to share information has been exhausting to orchestrate.

So how do I feel?

• Angry. Angry with the insurance company. Angry with the hoops that we have to jump through hoops for them so that they can stay profitable. Angry with the clinic in a way for not mentioning to us earlier that the lab is not covered, esp. since they’ve known all along.
• Exhausted. I don’t think I’ve been this emotionally wrecked in a long time. I can’t even talk about it with others. It’s honestly easier for me to write it down so that others can read, than having to share the story.
• Confused. The limbo state is driving me bonkers. I don’t know what procedure we’re doing, I don’t know what to schedule next.

I think all we know up next is this: once my period arrives, I will start taking the birth control pills and assume we’re following the IVF route. This buys us a few days to square things away with the insurance company. IF we know more at that point, we’ll go through with the next round of tests and order the injectibles for IVF (which will cost $1000+). If we don’t, we have three options:

1. Suck it up and pay for the lab out of pocket.
2. Continue taking the full month’s full of pills and then maybe try IUI in December instead.
3. Stop this IVF cycle while we continue to work with the insurance company on getting the lab certified so they will cover the lab costs with the hope of starting again in January.

I don’t know where we are on the decision between those three at this point.

So that’s the news today. It’s a long vent, so thanx for listening.

We had our cycle planning appointment today. Boy, are there dates to remember! Things are actually going to start happening pretty fast soon. Provided that AF (or my “relatives”, as hubs calls them) shows up on the 25th, the cycle will go something like this:

• Call the office to let them know the moment cycle 1 begins. They will then schedule me for an SHG (figures out how big my uterus is) test and then an injection training class. We need this – the injections, I think, will be the most torturous part of this process.
• Begin Birth Control pills on 10/28. Kinda funky that on the path of getting pregnant I need to go on birth control, but here’s why: IFV is the process of the Dr. controlling your cycle. We want to keep nature out of it… mostly :). The Birth Control tells the body to begin shutting down ovulation. Stio the pills on 11/16.
• Begin the Lupron shots on 11/10. Lupron will put me in temporary menopause. In effect it tells me to stop the natural cycle of hormone production to tell my body when to ovulate. These shots have tiny needles and go either in my stomach or my thighs. I’ve read online that I might want to alternate placement so I don’t get too sore. These need to go in at a very specific time every day. We’ll stop when the Dr. tells us to.
• Go in for an ultrasound making sure my ovaries are nice and quiet on 11/19.
• Begin the FSH shots on 11/22 (Yep, Thanksgiving day). The FSH now tells the body to begin maturing egg follicles. No more exercise for me at this point. From here until the day of the retrieval, I’ll be going in for ultrasound monitoring every day. At this stage it is important that my body doesn’t over stimulate egg production. Luckily, I can do these appointments on my way to work.
• On 12/1 administer the HCG shot, and this one’s a biggie (needle wise). This one tells my body to ovulate.
• 35 hours later (or 12/3) we go in for the egg retrieval. I’ll be under general anesthesia during this process and home recouping afterwards. Hubs also makes his contribution on this day as well.
• Begin the Progesterone shots (big needle that goes in my bum) on 12/4. This tells my body to begin preparing for pregnancy.
• Go back for the transfer on 12/6. This is get KNOCKED UP day!!! Again, this is stay at home and be on bed rest day. We get to see the embryos too. How cool is it that we get to meet my future kid(s) today?
• I go back for a post-op appointment on 12/10, and
• My pregnancy test is on 12/17!!!!

Huh… I just noticed – are there no shots between 12/1 and 12/4? Really???

After all this, I need to be around for 4 weeks to make sure that if I am pregnant things are going well (ie, no ectopic pregnancy) and that I’m not going into ovarian hyper stimulation. It means staying home for the holidays because I have to be close to the Dr’s office for monitoring. I know that Kelle and the kids will be disappointed. I feel bad about that, but hopefully a little niece or nephew will be a good gift in exchange.

So how do I feel?
Excited – I really have a good feeling about this. I just feel like THIS is what will work for us!

Well… it’s official. We’re trying IVF!

Some of you will feel saddened when you read that. Please, don’t be! I, for one am really excited about it. It’s good for a change to have a diagnosis and a path forward. As I’ve said before “It’s the engineer in me: find the bug, troubleshoot it and move on”.

We had our follow-up test review with our RE today (that’s Reproductive Endocrinologist for you non-baby obsessed types… also fancy speak for Infertility Doc). It was to go over the results of my blood test, hubs’ sperm and blood work, and my HSG exam.

We know that I have a good egg reserve (yey), I am clean of STDs (double yey) and my tubes aren’t blocked. From previous nine months worth of charting we’re also pretty certain that I ovulate. It doesn’t mean that there couldn’t be anything else going on, but the most obvious causes have at least been examined. We also know that HE is clear of STDs and has a good number of swimmers. Unfortunately, the motility (how long they live) and form (the shape) of said swimmers is not quite in range of what will help us naturally conceive. When the doc went over this I couldn’t help but think “Are you OK hearing this?”. Some guys don’t like to hear it. Luckily HE isn’t one of them, but I wonder if deep inside it bugs him.

We went over treatment plans. We have the following options:

1. Put me on Clomid and partner it with an artificial insemination attempt. The Clomid could help me ovulate more than one egg, which would increase the number of targets for the little dudes. The artificial insemination (or IUI) would take the good and strong sperm and deposit it close to the eggs.
2. In Vitro Fertilization (IVF) with ICSI. IVF includes taking medication to force my ovulation. It actually over-stimulates ovulation so I’ll produce multiple eggs (hopefully). These eggs will later be harvested. HE will also be making his deposit. The ICSI portion of the procedure would select a single sperm and inject it into the egg to increase the chances of fertilization. If the egg(s) fertilize, they’re reinserted.

… and we’re going with option 2. Here’s the reasoning:

• Success rates. Success rate with IVF is higher. I really don’t want to go through cycles of IUI only to continue being disappointed and end up at IVF anyway. Also if we need ICSI (implying that just surrounding the egg with sperm is insufficient), wouldn’t it imply that IUI will also be unsuccessful? Maybe it’s my rationalizing.
• Cost. I don’t think the people at Aetna are as clear on what they cover. We’ve heard two separate stories from them. Story A has Aetna covering 6 IUI attempts and then 15K towards IVF. Story B has Aetna covering a total of 15K, where the IUI attempts and Dr visits are part of the 15K. Given that a single IVF round will be around 15K, I really would like to have the insurance company cover as much as possible.
• Twins. For years it’s been my wish for the longest time to have twins. Yes, some people think I’m nuts, but I can’t help my fantasies. Given that I’m not the right age group, family predisposition or ethnic background I’ve known its almost impossible and I’ve become quite accepting of a single healthy baby, but a girl can still dream 🙂 In a weird way I feel that knowing that we’ll have to go through treatment, this is Nature’s way of at least giving me a glimpse of hope to see a dream realize to makeup for months of unsuccessful trying.

The Dr. didn’t advise us against IVF. She really wasn’t suggesting one approach over another (I think their office explicitly asks them not to), but hubs and I both walked away thinking that if she didn’t think we needed to consider that option yet she would’ve said something.

So… on Monday we go back to talk about the IVF cycle. I will need to have another test of my uterus this time to check how big it is and see where the eggs would need to be re-inserted. If it’s anything like the HSG test (which I expect it will be) it won’t be pleasant. Then I go on birth control for 2 weeks, then start the injections. If all goes to plan, we’ll be doing the egg retrieval late November, early Dec. Wouldn’t it be a great Christmas gift to know we’re pregnant? Ok, now I’m getting ahead of myself. Let’s get through Monday first!

So between now and then I need to start making a list of detailed questions about the process: Can I still work out with my trainer? Do I need to stay away from certain foods/drinks? How much weight will I’ll be gaining through the meds, and will it go away? How do I store the medication? Ugh… I really need to start writing these down!

And that’s that — for now at least 🙂