Thursday, February 17, 2011

Drug Dealer

My medications arrived this morning. Several thousand dollars of medications. Last time, neither of us were able to be home for delivery, and I fretted all day at work that they wouldn't be on my porch when I got home. But they were. Since I didn't want to risk losing or misplacing anything, we left the box sealed until just before I was to start using them.
No one had told me that some of the medications should be refrigerated. Yet another thing that slipped through the cracks at that place. Yet another "FUCK! Does this ruin EVERYTHING?!" moment. Luckily, Folli.stim can be left out for up to 4 weeks. But still. I thoroughly resented not being given the information, so that I could have chosen to keep them refrigerated or not. I would have chosen to refrigerate them, since absolutely any effort I could make to ensure everything would be in ideal conditions, I would do. And I put them in the fridge this time, even though we have way less room in there now.
I still have butterflies in my stomach from seeing that box on my doorstep this morning, after hearing the doorbell ring. Just another sign that this is really happening. Who knew one could be so excited over prescription medications? Squeeee!
And, for more delight and glee - they were covered on my insurance. So what probably would have been around $5,000 worth of medications were only $242.49. A lot easier to stomach if something got ruined, or we stopped mid-cycle and I had to try again another time with medications.

Sadly, since I started my birth control last night for suppression, I wasn't able to fully enjoy my glee at my meds arriving. Apparently the BCP make me nauseous. They prescribed the generic Ortho.Cyclen for me this time, which I've never had. But when I was (much) younger, I had tried OrthoTri.Cyclen, and threw up every Sunday for a month before I figured it out. So I called to leave a message for my nurse, since it was 7am when I had woken with the feeling I wanted to vomit. I know that BCP and other hormones can cause nausea, but other than the Ortho product I'd had before, I've never had a problem. Since I was concerned that perhaps they both use one of the same hormone variations, maybe my issue was with the specific ingredient.
I got a call-back from the on-call nurse, telling me to take it with food. I told her that I took it with all my other medications the night before, and that I've never ever had a problem with "take with food" medications when I take them all together at night. (I take a prenatal vitamin, a biotin supplement for hair and nails, acid reflux medication, an anti-depressant (BCPs trigger depression in me,) and a allergy pill. Quite the handful.) She just said to slowly take the birth control earlier and earlier in the day, until it's with a meal. But she said she'd have my nurse call me back. Excellent. Done with you.
Then my nurse called (actually, it was the one I hadn't met yet. Two nurses job-share, but they are "my" nurses, and try to be the ones to call me back.) She said they don't normally like to switch pills this early, in case the nausea is related to something else, but she listened and took me seriously and looked up and verified that the BCP that had made me sick in the past was the same ingredient as this one, so it was likely that this was the issue, but she'd consult the doctor. I love being taken seriously. Plus she listened when I explained about my compliance issues. I have learned from past experience with pills taken multiple times per day, that I forget the daytime meds half the time. So it's just easier to take them all at bedtime, even if the acid reflux one is best taken 30 minutes before the largest meal of the day, for example. And it's not like Mommy Brain is going to help matters any!
She said they recommend taking the pill at bedtime anyway. Take THAT, on-call nurse!
Obviously, if they wanted me to stay on this one, I would, but at the seminar last night, the doctor said that the BCP wasn't really essential, if you didn't want to or couldn't take them for some reason. So it shouldn't matter which one! I told my nurse which ones I had used for suppression at the first IVF cycle, and to control my period for the polypectomy. The doctor ended up switching it to the same one I used last IVF cycle. So hopefully that goes well!

Talkin' Shop

So last night we went to an IVF seminar, put on monthly by the clinic. I kind of wanted to go, since it's been over 3 years since we last did IVF, and I remembered looking up a lot of the terms online in the middle of the night, so hoped that maybe they'd explain more.
I didn't view it as a waste of time, but my husband kind of did. He said he's glad he went, in case there had been anything new, but he didn't feel he heard anything new. I was glad I went, since they did go a little more in-depth, plus showed pictures of some of the procedures, like ICSI. They showed a picture of embryos at Day 1, Day 3 and Day 5. I hadn't realized how crappy our embryos were until I saw that beautiful Day 3 picture. Eight clear little cells, happy as could be. Mine were jumbled messes, with all the fragmentation. I was kind of surprised at some of the stuff they left out. Like one of the reasons to recommend ICSI is if enough of the sperm don't have the enzyme on their heads for getting into the egg, or if the caps don't come off to expose the enzyme (I forget which they're looking for.) That was one of the reasons they wanted to do ICSI with us the first time.
And it was kind of neat (and scary terrifying at the same time) to see the needle depositing a sperm into the egg too.
And the embryologist at the seminar mentioned fragmentation a few times, but never explained what it was, so I asked, even though my husband and I were probably the only ones in the room, other than the medical experts, who actually knew.
There were a lot of stupid questions. A LOT. And I didn't like how the doctors answered several of them, but I kept my trap shut. My husband doesn't like me butting in at stuff like this, plus I didn't want to wave it in everyone's faces that we'd done this before and had a child.
Stupid questions, like, should they do ICSI if it's not deemed necessary. Is there an advantage to using assisted hatching if they aren't over age 38 or have thick egg walls?
But I knew where those questions were coming from. From the fear that this wouldn't work. I remember being there. I remember being supremely pissed off and terrified that it had all been for nothing every time I realized they had let some detail slip through the cracks. I remember wanting every. single. advantage we could get. Will this procedure make it more likely? Less likely? If we do this, do our chances increase...?

Plus questions that were financially based. Do I have to do ICSI with frozen sperm? Can we 'collect the sample' at home and bring it in that day? This 'flat fee' for IVF, what if we've paid and you decide to stop that cycle, or do fewer checks along the way? Or more checks? What if we do ICSI and there are tons of eggs? Will it cost more?
Since we had the benefit of partial insurance help the last time around, and 80% coverage this time, it was hard to be patient with these questions, since really, 'saving' on these types of things are just nickel-and-diming it. The IVF retrieval, fertilization, and transfer are the big costs. Around $10,000. ICSI is only a few grand, varying by around $500 whether they are fertilizing more or less than 10 eggs. All the other stuff is peanuts. But it is daunting. Seeing this $15k price tag, plus $3-5k in medications. Each peanut becomes a bigger deal.

Money, Money, Money

Now that we got the ball rolling, it's rolling pretty fast. My insurance company finally called back and said that IVF is covered if IUI hadn't work. So we should be good, as long as the prior-auth process doesn't take too long. Luckily, the lady I talked to on the phone in the finance department understands the urgency and has seemed very understanding and supportive. She was off the day we went in for our initial consult, and I wasn't wowed by the financial counselor subbing for her. And I was almost feeling hatred for the person I was initially transfered to when I called to tell my financial counselor what the insurance company had said about the PA requirements. She was all "looks like she's working on it." "Next time you can just punch in her extension." Look lady. They transferred me to you. No need to get all snippy! And I don't exactly have confidence in their financial counseling team, who first told me that my insurance didn't cover IVF, then, when I said it did, she actually read the info in their computer and told me we wouldn't need a prior auth. I had urged them when I first made the consult appointment to be getting on my insurance. And again at the consult visit. But when I finally got to speak to the regular person at this office, on the phone, she told me she would start the PA process as soon as we did my Day 3 labs. She took me seriously, and seemed empathetic and supportive. Phew.
One of my issues with the previous clinic was the financial stuff. They were so used to IF not being covered, I had to nag them for each. visit. to bill my insurance before billing me. At the time, the IUIs were covered, as were the ultrasounds and bloodwork. When we finally went with IVF, the IVF procedures themselves weren't covered, but the ultrasounds during the ER and ET were covered, as was all the bloodwork and U/S during the medication cycle, and the anesthesia was covered for the ER. But it was like pulling teeth to get them to bill my insurance. And they wouldn't even bill for the labwork. They made me pay them and submit for reimbursement. And then, at some point, they were able to bill my insurance, so there was a bit where they were getting paid by me and the insurance, which they credited later. Supposedly. I'm still not 100% sure I didn't get screwed on the bloodwork somewhere. And then there was an issue at the end, where months later I get a notice from a collection agency that I owe the clinic money. Whuuuuck? They made us pay in full before they did the IVF procedure, and then I went in and paid more for the extra bloodwork and U/S that they added as we were nearing the retrieval date. But they said I was paid in full. Turns out they had double billed my insurance, since my insurance was slow to pay. So they had sent some claims twice, gotten PAID eventually for the first set they sent, then the second requests got declined for obvious reasons, so they then pooped all over my credit rating by sending those to collections. ARRRRRRGH!

Tuesday, February 15, 2011

Counting Chickens

Normally I'm good at keeping my expectations low, so I'm rarely disappointed. Normally I'm good at assuming something good WON'T happen, so that I don't tempt fate into ruining my plans.
But for some reason, I just can't right now. Part of me wants to start buying "Big Sister" shirts for Z. I mean, I'm just ASKING to be sucker-punched in the gut by the Powers-That-Be for that! My husband keeps trying to gently remind me that it may not work. And I know this. I mean I KNOW that IVF may not work. Especially since we don't really know what the issues are, other than a slightly lower % of ideal "swimmers" and a high fragmentation rate of the embryos (probably due to sub-par eggs, but since there's no way to test the eggs, who knows?)
We decided to sign the waiver and get started on IVF right away. Now, this wasn't a decision taken lightly. I spoke with my family practice doctor, who told me that since I had antibodies from contracting chicken pox as a child, rather than from a vaccine, that I should be fine. He also said that my chances of getting chicken pox again were so slim, and then the chances of damage to the fetus is so small (2%) after that, that he didn't see any reason not to start IVF right away. Plus Z has been vaccinated, and if I were to catch it, I'd be more likely to get it from her versus getting it from one of her friends at school or wherever. And then, the same day as my doctor's appointment, I get an email from my nurse at the IF clinic saying that the doctor herself recommended signing the waiver, giving the same reasons as my doc. Well. Great!
My period started yesterday, and now we start the ball rolling. Today or tomorrow I need to go in for labwork, then start BCP tomorrow for suppression. I'm scared. I'm terrified that this won't work. Or that I'll mess it up somehow. Last time, I had nothing to distract me from doing this. Just work and the snooze button to delay my daily shots until I remembered and got them done just a little later. But now, I can totally see myself leaving my meds at home when gallivanting off to my sister's house (I frequently forget my REGULAR daily meds when visiting my sister.) And how can I wake myself up at 7am to do shots without also waking up my little co-sleeper? I plan on using the calendar app in my iPhone to help, but the alarm is sooo hard to hear from in my pocket.
But despite my fears, I'm blissfully hopeful and borderline certain that it will all turn out okay. I'm tempting fate to come and destroy my bliss.

But I can't help myself. I'm totally counting my chickens before they're hatched.

Thursday, February 10, 2011

A Pox On Both Your Houses!

Well. Maybe bad news. Some of my labs came back. My STD testing all came back normal (not really a shocker there,) but my Varicella (chicken pox) screening came back equivocal (meaning I do not demonstrate full immunity.) "Non-Immune" status is a test result less than 0.91. Between 0.91 and 1.09 is considered equivocal, and a result greater than 1.09 is considered immune. My level was 1.07. In 2007, the last time we did IVF, my result was 1.96, but apparently immunity can wear off over time (hence Shingles later in life.)
So I can get immunized again, but that would be 2 shots, spaced a month apart, with another 30 days before they'd want to start the IVF process, since the chicken pox vaccine is a live virus.
So we can either wait another 2 months, and risk having to pay out-of-pocket because we no longer have the IVF insurance, or sign a waiver and plow ahead.
Another fucking blueberry!
The chances of me contracting chicken pox while pregnant are slim, but not non-existent, as we go to preschool and gym class and whatnot. And the chances of a fetus in the first 28 weeks getting damaged by the virus is only around 2%. But the risks include death, malformation, mental abnormalities, and lots of other fun stuff. After 28 weeks, they appear to be safe, unless they are born within 7 days of the mother contracting the chicken pox. Before then, they have enough antibodies provided in the womb.
But my results are so close to immune status. Sooooo close. What are my chances of contracting the pox while pregnant, when I might be immune? (Equivocal just means you're not necessarily immune, but you might be.) If you asked me whether I would let my child be deformed to save $15 grand, I'd say "Hells no!" But this is just a teeny tiny miniscule chance that something could happen if I don't get vaccinated versus risking having to pay around $15,000 out of pocket to get pregnant.
Now, if we choose to do the IVF now, and something does happen, I'll never ever forgive myself. Ever. But I also don't want to spend our entire savings on this either. I want a baby so bad. Sooooo bad. But bad enough to risk deformity or health issues? Because of our ages (35 and 41) we're already at higher risk for a whole host of fun things to inflict upon our child. Do we dare add another risk factor?

Friday, February 4, 2011

New Beginnings

Our first appointment at the new IF clinic was at 9am, with an 8:45am check-in, and bringing children is somewhat frowned-upon, (understandably!) So rather than waking up before the sun and then waking up the sprout to drop her off at Grandma's, we opted to spend the night at my mom's house and just wake her up before leaving. So naturally, Little Z refused to fall asleep before midnight. Argh. And woke me up. A lot. All. Night. So we opted to leave without waking her and hope for the best, since chances were good that she'd sleep until 10 or 10:30, and we should be back by then.
We met with the doctor, who I liked, and she kept asking if we have any questions. Like what? We've done this before. And I'm normally just waking up around now, so I need a little help jump-starting my brain here, lady. She suggests that we can do an ultrasound today, and some genetic testing and the FDA-required bloodwork for IVF (Hepatitis tests and such.) Wow! Moving things right along! Love it already!
She checked out my uterine lining, since I have been a little concerned due to my relatively light periods since my polypectomy a year ago. Looks good. She checks out my ovaries to see if I have been ovulating (looks like I have) and how many eggies are in the works (3-4 on the left, 4-5 on the right.) She says they wouldn't recommend IVF if the numbers had been lower than 5 total, so we're good. Whoop! And since we aren't going to fart around with Clomid or Femara and timed intercourse, or IUIs and other stuff, she says we can start with my next cycle! Holy crap, that's fast! They bang out a preliminary calendar, based on a projected cycle start of Feb 15, in a little over a week.
Start BCP on Day 4, 4 weeks of BCP before suppression check, 2 days after that, start injectibles! We could be doing an egg retrieval as soon as 7-8 weeks from now! FROM NOW! Part of me is super excited to finally be proactive again. And part of me is resistant, because it's all happening so fast! And yet a third part of me is frantic that we get this done, and that it's successful, since we don't know how long we'll have this IVF-coverage insurance plan, since they've been laying off a bunch of my husband's department.
After talking to the doctor and being whisked in to get an ultrasound, we wait for our blood draws before talking to our personal nurse (we get 2 actually, since they job-share. But they are the ones who will be contacting me and answering any questions. Which is a large part of why I chose to switch to this clinic. Already more personal service!)
My one concern is that this clinic only has a 2-week protocol with the medications, and my previous clinic had done a 4-week protocol. And I hadn't been developing as expected, so my dose stayed high. Hopefully this clinic will stay open-minded about trying it, if things aren't looking good.
Since the U/S and bloodwork has made us stay later than expected, and my mom has an appointment of her own at 11, we have them take my husband's blood sample first, then he goes to pick up Z, so my mom can leave. Then he comes back for me. So I get my blood draw, talk to the nurse and get a preliminary calendar, and such, then I'm told that they need another blood draw, since they didn't take enough for all the tests. Urk.
Then off to the financial counselor, who tells me that infertility isn;t covered on my insurance, and that my projected out-of-pocket will be around $15,000. Whoa, hold up, lady! I would have bee panicking here, except that I personally called my insurance, even though my husband already had, just to be clear on my coverage. So I told the financial counselor that my insurance does cover infertility, but that ours is the only plan they have that does. Ah. She looks at my actual file and sees that they, to, called and verified my coverage, and rattles off the same information I got, about it being covered at 80% after my $200 deductible. Whew! So then I ask her about the IVF coverage, since all the insurance could tell me was it's covered if I "can't get pregnant by other means." So I ask her if they'll be calling to get a prior authorization or whatever, since I don't want to be scheduling IVF appointments if the insurance is going to want me trying something else I haven't done yet first.
Apparently, they can't be bothered to call for me to find out. She says that since IVF is covered, it doesn't need a prior authorization. I don't know about you, but if something is only covered under certain conditions, that's usually what a prior auth is for. To determine that those conditions have been met. Argh.

So I call my insurance after I get home, to talk to the PA department, and they say they have to call my husband's employer to find out what they mean by "can't get pregnant by other means." Well. Finally. At least someone is willing to find out what I need to do to get this done! I wonder if that means that his employer pays the 80%...

Catch and Release

I just found out that my old IF clinic has merged with the new one I'm seeing. But their computer files aren't linked yet. And I will still need to sign a records release form. Whuuuuck? How stupid is that. The new clinic can't just call and ask for files to be faxed. And since I dicked around too long lost track of time, I had to drive out to the old clinic to get a hard copy of my file to bring in for my first appointment. But could they print it up and have it waiting for me and my release form? No. Which is bullshit, since I shouldn't even need a release form to release my records TO MYSELF!
My husband had faxed over his release form, so they could fax his motility and morphology report, and since we had our appointment the next day, I just told them so that they could fax it that day, rather than waiting until after our crack-of-dawn-o'clock appointment the next morning. So the guy at the office prints it out and lets me have it. Which I'm totally fine with, since as I'm flipping through it, I notice that his motility and morphology test results aren't even there. I mean, yeah, it's nice to know that he didn't have Hepatitis 3+ years ago, when these tests were done, but really, I think the fancy semen analysis which prompted the first clinic to recommend ICSI is somewhat more crucial information. So the receptionist prints that out for me. Thanks, bub.
But... my husband hadn't signed a release to allow ME access to his information. I wasn't going to bitch about it, but really. This new clinic had us each sign a form releasing our information, test results, and permission to leave messages with the other partner.