Obviously, we wait a bit after the surgery. I don't think we started the IVF protocol until late July. I lost my calendar, that had all the dates in it. Which makes me a little sad.
I filled out the paperwork to see if the special IVF insurance would cover us, or how much it would cost. Since, while my health insurance covered the IUIs and ultrasounds and all, IVF was not covered on my plan. The insurance had the benefit of reducing the procedural costs, since the plan my doctor's office worked with had contracted [fixed] prices, so you'd pay a flat fee for the whole shebang, rather than line-iteming it, like an ultrasound here, a blood test there, etc. So if extra tests were needed, they wouldn't charge for those. And each cycle would include a retry, with frozen embryos from the previous attempt, if applicable.
For a very weak reason (they said it was due to my low FSH levels, but still within normal parameters) they said they'd only insure us if we did a 3-cycle plan. Meaning we'd have to shell out for 3 rounds of IVF (which would include the 3 retries.) Ugh. My grandma had given me $10,000, against any future inheritance, so that we could even afford this at all. And the estimated cost of just 1 cycle would be around $10k. So we couldn't do the IVF insurance. We would just have to hope for the best. Darn it.
2007
June or July: We decided to finally bite the bullet and do the big expensive semen analysis. Not just a volume count, like the $100 test we'd done in 2006. No. This baby had all the bells and whistles. Morphology. Motility. They even determined what percentage had the caps that could dissolve, so the sperm can even enter the egg. For one easy payment of somewhere over $700. Oof.
They told us percentages. Average percentages, and his percentages. They recommended an additional procedure called ICSI.
Now. Let me tell you something. Something I'm a little ashamed of. Something that I hope my husband, or anyone we know never, ever reads. I cried. I cried with a profound sense of relief and joy [and a little shame at my joy] when we got the results. Because finally, finally, there was some indication that the problem wasn't just with me. It wasn't my fault! It wasn't all MY FAULT. Until you've been there. Until you've peed on too many sticks to count. Until you've watched, month after month, as your body betrays you. You cannot possibly understand the guilt, the shame, the disappointment in yourself for not being able to do this one. simple. thing. This ONE thing that every other teenage girl seems to be able to do, without even trying. This one thing that so many people can not only do effortlessly, but accidentally. And complain about it! This one thing that both your sisters have done, by accident. This one thing, that every single female in your immediate family has done. This one thing, that out of the 2 grandmothers (6 total,) 1 mother (5 total,) 2 aunts (4 total, maybe more,) and 2 sisters (4 or 5 total, at that point) have done (making an average of 2.71 to 2.85 per person) you just cannot seem to do. You cannot create life.
So to find out that maybe it wasn't all me. Well. You cannot even imagine the relief.
But, to be fair, chances are good it's not all him either.
Late July (or maybe Early August): This facility uses a unique protocol, that is apparently longer and more carefully regulated than most other practices. I spent a month on birth control, to suppress my egg production (and to get me on the schedule they wanted.) As an added bonus, they wanted a specific brand of birth control, and not the generic. Not only did my insurance pay nothing, my copay was more than the drug cost at the pharmacy for a "cash" patient (not billing insurance.) Whuuuuuuck?! I got that fixed quickly. [Working in the pharmacy has some advantages! It was easy to look up the price without insurance!] Since my prescription plan policy stated in our packets that this special higher non-preferred brand-name copays is when "the patient chooses the brand instead of getting the generic equivalent," I read that to mean that since my doctor chose the brand-name-only, that I should get the lower, preferred brand copay. I spent a year fighting my insurance. They stopped answering my calls, emails and faxes. Jerks.
I got most of the rest of the medications through a mail-order pharmacy, since they were by far cheaper than Costco or my pharmacy's cash prices. Since this mail-order specializes in infertility drugs, they have all kinds of coupons and discounts from the manufacturers to apply towards the prescriptions that aren't covered by insurance. I got all the oral medications and the progesterone injectible from my pharmacy, since they were covered, and I happened to know which pharmacy locations had some rotting away on their shelves, so I got them filled at various places to help them use them up, rather than losing money when the drugs expired eventually! :)
My mail-ordered drugs were Follistim. Menopur... and a third one. Plus oodles of syringes, needle tips, pen needle tips, a Sharps container, gauze pads, and more. I was kind of annoyed that the shipping box didn't mention that the contents needed refrigeration, since I let the box sit around for a week or so until I opened it closer to when I'd be needing them. Argh! Luckily, they said they could be left out for up to two weeks. But still. Argh. $500 not down the drain!
We got an injection clinic, where they showed us what each of our meds would look like, which syringes and tips to use, which ones we needed to mix, how to mix them, what to do if our Follistim pen ran out of drug in the middle of a dose (which came in handy several times for me!) and more. I was kind of appalled at some of the basic stuff they didn't talk about. Silly little questions people were too shy to ask. But I could see their lost little lamb faces. So I asked loads of questions that I knew the answers to, and totally annoyed the nurse giving us the tutorial. But really. You tell us to use this needle to draw out the drug, then take that needle tip off and put on another one to use for injection... people will wonder why. Why that extra step? Why risk messing it up and jabbing yourself with the biggest needle you have ever seen in your life? Well, because the act of putting the needle into the rubber of the vial lid dulls the needle a little. Making it harder and more painful when trying to bust into your skin. See? Worth the extra effort. (Although, then why not get extra drawing needles for all these other meds too? But I didn't want to confuse things too much!)
As my protocol went on, I'd start looking up random stuff. Usually in the middle of the night. Supposedly I could log onto their site and look all this stuff up, since they don't post their protocol publicly, so it can't be copied. But we could never remember our logins or passwords, and you had to talk on the phone to the IT guy to get them, which doesn't help at 3AM. So I found stuff on other clinics' sites. And they only had 2 weeks of gonadotropins (the follicle stimulants.) We were doing 4 weeks.
Since I'd be injecting myself with various medications throughout the day, obviously my husband couldn't do them all. And since they said that I needed to inject them 12 hours apart, but that the actual time I chose wasn't as important, as long as I stuck to those times the whole protocol, I opted for 7. 7AM - not too early, even if I didn't have to work until 1PM. And 7PM - not in the middle of a busy time at work, or a commute home, or whatever, depending on my shift. So when I worked 9 to 5, I'd inject when I'd normally be getting up, and then after I was already home. An 11 to 7 shift would see me up, shot, back to bed for a snooze, then work until my last shot on my way out the door. The tough days were my 1 to 9PM shifts. I'd have to get up 4 hours early, but could go back to sleep. But I'd have to do my evening dose at the tail end of dinner rush, when people are getting off work and picking up their drugs and groceries. All without the benefit of a smartphone with a handy-dandy timer to remind me. I can't even tell you how many times I just hid in a corner at the back of the pharmacy to pull my pants down in front enough to jab myself before rushing back to help the next customer. (We would often opt to come in half an hour later or leave half an hour earlier and skip our lunch break, but smoosh together our two 10-minute breaks into a lunch instead of clocking out. Technically against the rules, but hey. The downside was I wouldn't have a break left to wander off to leisurely do my injection in private.)
I think I started with the Menopur. I can't remember if it was once or twice a day at the beginning. So the first time I had to get up and inject myself... I almost passed out going back to bed after. The second time went better. But the next morning, I got a bad needle. It hurt pretty bad going in, and when I ripped [Yes. Ripped] it back out, I saw that the needle had some kind of jagged line along it, like flash. Oh. My. God. Needless to say I got a little dizzy, what with the pain and bleeding and all. And I had a terrible bruise there for days.
Later in the protocol they introduced the Follistim, and whatever the 3rd one was. At the peak, I was injecting 3 medications for a total of 5 jabs a day. But that overlap only lasted a day or so, if I recall.
At this point my tummy flab was one big bruise from all the injections. I'd routinely bleed out of an injection site and need a Band-Aid. It wasn't until the last week that they told me I didn't need to stay within that specific area (they initially showed me how to use my fingers to measure over and down to where I should be injecting, so I had stuck to those general areas.) Thanks for nothing, guys.
At the tail end of a Follistim vial, I'd just take it out and get a fresh one, to avoid risking running out and having to do a second injection for the rest. At one point I hadn't been paying attention, and did run out with a vial. Doh! Luckily they had shown me what to do and I had written it down! [Thanks again guys. A sheet with all those tips already on it would have been a great hand-out. FYI.] Don't touch the dial. Remove needle from flesh. Remove needle tip from pen. Remove vial. Replace vial. Replace needle tip. Re-inject. Finish releasing dose dial. Ta-dahhh!
Since they decide the specific protocol, doses, strengths, etc at the beginning, they'd have me come in every few days for a blood test and/or ultrasound, just to see how things were progressing. Apparently my follicles or hormones weren't performing as expected, since my dose wasn't lowered when the schedule said they'd probably be lowering it. So I kept going in, getting my tests done (at the office not near me, since they could do the tests in-house and get the results within hours, which they needed in order to determine what does(s) I'd be taking next. So I went without complaint,) doing my doses as instructed. As we neared the end, they had on my schedule that on this visit, [named after a specific test they'd be doing at that point in the protocol. The date was determined by how I was progressing] I'd be getting my next schedule, now called a 'calendar.' This would have my projected retrieval and possible transfer date(s.) Plus the final doses of medications. But on the day of that visit, they didn't have my calendar ready for me. What? Seriously? But since I'd be coming back in two days, they'd give it to me then. Well... okay.
So. I go back in for the next round of tests and to [finally] get my calendar. And I read it over, later at work, to familiarize myself with what's in store and whatthefuck? My husband was supposed to start an antibiotic TWO DAYS AGO?! The day I was SUPPOSED to get my calendar, so I would have KNOWN he was supposed to get a prescription?! Are you kidding me? Not only that, but they didn't even have a prescription called in for him anywhere from 2 days before. Nope. I cannot even emphasize enough how much oversights like these eroded my confidence and trust in this office. But too fucking late [and expensive] to turn back now! I just loved having to be the one to even spot this lapse in their protocol, and have to call and harass them. Never mind all the fear that this might mess the whole cycle up and we'd have to do it all over again. Over some stupid little detail. ARRRGHHH!
So. My retrieval is scheduled for a Tuesday afternoon. (1pm, to be precise.) I had had to juggle shifts around at work to get that day off work, since it had only been decided late the week before. So. On Friday night, mere days before my retrieval. Business is slow. I'm fiddling around. Looking at all my Follistim vials, and seeing that I'm on my last one. And it's getting low. All the rest are the low ones I had set aside to avoid having to do a double-shot. It doesn't look like enough for Saturday, Sunday, Monday and Tuesdays doses. 7 more doses. Hmm. So I go back through all my schedules on the protocol, where I've recorded the doses I was instructed to take. And I count all the fractions of milliliters I'd used each dose. Subtracted from the total volume of medication I got. And... don't have enough to last. I can barely last through Saturday, and to squeak out the last dose, I'd have to do 3 shots to get the last bits from 3 vials. And it's after business hours on a fucking Friday night! I call my doctor's office, and ask for a call back. I call all the pharmacies in the area to see if anyone has this medication, in any size (although I only need the lowest volume.) I find one pharmacy that happens to have this uncommon, and freakishly expensive, medication (over $500 from them for this one box. Naturally they don't have the smaller package size.) But beggars can't be choosers. But - they're only open until 1pm on Saturdays, and closed on Sundays, so I'd need my doctor to call in a prescription ASA-fucking-P! [Sorry for all the swearing. Normally I try to filter it out, but I am using it now to evoke the sense of emotional and hormonally-driven stress and frustration and distress I was going through at the time. And let me tell you. This is nothing, nothing, compared to the vitriol that spewed forth while experiencing all these snafus and miscommunications throughout my time with this office.]
And, for that matter, why was it me, at 7PM on a Friday night, doing the math to determine that I wouldn't have enough medication. I mean, they had a team of doctors and nurses, checking my charts and determining my doses practically on a daily basis. What? No one there can do math? It never even occurred to anyone there that Hey, her ovaries aren't doing what we want. Let's keep her on a high dose. Oh and hey, will she even fricking have enough? What? I was supposed to discover that I was completely out of medication halfway through a dose?! I cannot even believe the ineptitude. I mean, it's not like these people are racing out in the middle of the night delivering babies. No. This is all they do. And they get paid a shit-ton of money to do it.
So finally the doctor deigns to call me back, after I called his office multiple times, shrieking like a crazy person at the answering service. Almost 3 hours after my first call. "Oh, no big deal. We have the medication in stock. Just pop by the office tomorrow morning and we'll get you enough to last you until the end." Thanks. For. Nothing. But at least I got my meds, and wouldn't mess the whole thing up and have to start over. And I wouldn't have to do the 3-shotter to squeeze out the last few molecules of medication! [So he gives me a box, then orders a box from the pharmacy to be mailed to them instead of me. But the bill was sent to me. Over $200. All the other medications together were only $500. *sigh* But they probably couldn't use the coupons again for me.]
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