Monday, March 31, 2008

odds and ends

1. I am feeling a lot better. Thank you all so much for your support. It makes such a difference to have people out there that get it and can remind me I'm not crazy when I need that most.

2. I struck out this morning with my PCP. She refused to run the CF screen and said that she always refers out to a genetic counselor for things like that. M and I talked briefly after my appointment and on one hand, I feel like it's irresponsible not to do the screening when we're spending so much money to get pregnant, but on the other hand, why am I so preoccupied with CF? Neither KD or I have any history of it in our families and there are probably a hundred other equally devastating diseases I could be pre-screened for, but I'm not sweating those. CF is just the one the doctor recommended, and I now want it on principle because of the insurance mess, but really, this might be something worth letting go of. You can't fight all the battles all the time, and I am pretty darn fatigued.

3. I have made peace with the reality that we may not get on the clinic's schedule for this cycle. We're still hoping to be able to pay the clinic this week, but that's leaves us just over one more week until Lupron would need to begin, and it may just be too short of notice. I'm okay with it. Of course I'm anxious to start sooner than later, but if I'm totally honest with myself, next cycle would probably be better from a timing perspective. If we start this cycle, my ER/ET is likely to fall right on top of M's graduation and all 4 parents will be staying with us - not much of a low-stress environment! I can see the pros to both outcomes - starting right away v. waiting one more cycle - so whatever happens will be okay.

4. Orientation is on Thursday. I can not wait to have that final checkpoint behind us.

Thanks again for all of the kind comments and encouragement. What did people do before they had the internet to turn to during these types of things?!

Wednesday, March 26, 2008

introducing: the end of my rope

Yesterday was a Very Bad Day. Very Bad. As I said to M on the phone this morning, I'm pretty sure we can call that rock bottom.

I went in for my CD3 bloodwork yesterday. It was supposed to be Estradiol and CF screening (FSH was tested about a year ago and RE said the level was low enough that we didn't need to retest). Well, the CF screening was out because of the insurance BS I wrote about the other day. When I sat down in the lab, the woman said "Just Estradiol and FSH today?" I was about to correct her but then I decided to let it go. My FSH test was a year ago, they were taking blood anyway, and what do I care if they want to run one more basic test through my insurance? Maybe it'll even give us useful information. So I said yes, she opened the vein, and I went to check out. Usually when I go to the lab at my RE's office, I just drop the slip and dash - no co-pay or anything. This time, the cashier did some quick math and asked me to turn over $162. I asked why and she said that since my last visit, they learned I have an insurance exclusion on all infertility coverage and I would have to pay everything up front and out of pocket from here on out. They will not submit another claim on my behalf, no matter what the service is for, and I will have to pay for all future services up front and at the fee-for-service rate (which is usually about 2 to 3 times the insurance negotiated rates). So I did what any hormonal, stressed person would do - I burst into tears.

I asked if it was too late to cancel the FSH test ($90-something of the total cost) and the cashier said she'd check. She got the nurse who explained to me (slowly and condescendingly) that the test would give them important information about how my ovaries are functioning and they need this to make good decisions about my treatment. I told her through my kleenex that I understood and wasn't trying to cut corners, but that my doctor had told me specifically she was comfortable using my old FSH results and I'd rather not pay out-of-pocket for tests I don't need. What I should have said, had I had my wits about me, was this: "No YOU listen, I know all about your freaking tests as I have been getting them regularly for the past year and a half. The reason I'm contesting an unnecessary charge is because I'm preparing to write your clinic a check for $16,000, so I resent your implication that I'm being cheap or neglecting my healthcare in any way." I did muster the presence of mind to look at the chart she was waving in front of me and I saw right on it that my doctor had written "WNL" (within normal limits) next to my FSH on their IVF prep checklist. I asked the nurse about it and after reading the notation, she admited that it did look like we might be able to skip it but she couldn't say for sure without talking to the doctor, who was unavailable at the moment. She said she would follow up and reverse out the charges if I happened to be right about the FSH not being needed. (She called 15 minutes later to say they'd cancelled the FSH test, btw.)

At this point, I was late for work and not in any state to go in anytime soon. I called my boss to say I'd be in eventually. I then called M and sat in my car in the parking lot getting strange looks from the security guard who was ticketing cars on either side of me. (My clinic has reserved parking for IVF patients - I guess they probably all do? - so here I am, sitting in the "green circle" parking with tears streaming down my face. The security guard probably knows better than to approach the hormonal women who park there.) M and I talked for a while and I tried to figure out if there was any, any, ANY way not to go in to work. I'm so far behind this month because of our vacation and some extra meetings I've had, and there were just things I had to get done, mental health crisis or not.

I've made this story longer than I should have. The bottom line is that I made it in to work, eventually, and limped through my day feeling the most fragile I've been since this whole thing started. I couldn't stop crying or focus on anything I needed to. Fortunately, the woman that sits in the cube adjacent to mine was out yesterday so there weren't any witnesses to my pity party. M took off work early to take me to lunch but of course, the sight of her just opened my floodgates all the more. Am I the only one that happens to? When I was younger, my mom had that effect on me. Now, it's M. It seems that no matter how well I've pieced myself together, there are certain people I'll come undone with upon contact. I think it has to do with a feeling of safety. Anyway, I simply couldn't pull myself together, and it didn't seem to be getting any less acute as the day went on. I knew it would be a bad decision to go home to our empty house for the evening, so I invited myself out to dinner with a friend and her fiance. I felt like I was maybe 15% there most of the night, but she's a good friend and knew what was up, so it was okay.

It wasn't the $162. I know that. I think I finally just broke. I hate that we have come to IVF at all. I hate that one single try is going to cost more than half of my annual take-home salary, and more than I spent on my first brand new car, and our chances of success are still only 52%. I hate that people around me continue to get pregnant without having put in 1/2 or 1/8 or 1/965 of the effort, emotion, and money that we have. I continue to grieve the fact that I will never be one of those women who floats blissfully through their easily-acheived pregnancy. I envy their untarnished spirits and the sense of control they have over their bodies, their futures, and their destinies. I used to think I could do anything I wanted if I worked hard enough, but this experience is showing me how naive that was. I feel so powerless, and so sad. The clinic is totally screwing me on the insurance situation, and I hope to have the strength to fight them on it somewhere down the road.

I am unbelievably, desperately terrified that this IVF won't work. I would feel so differently if this were covered by my insurance. It would just seem like the next step. I mean absolutely no disrespect to those who are fortunate enough to have coverage - I think we should all be in your shoes, not vice versa - but covered v. uncovered cycles are simply horses of a different color. We all have the heartbreak of our past failures behind us, the desire to be pregnant sooner rather than later, and the desperate want to have our children in our arms, but in one case, there is also the desire not to have spent $16,000 dollars in vain and in the other, that isn't a factor. I know in some people's worlds, $16,000 isn't a lot of money, but it is in mine. It's unfathomable, really.

If this IVF and any subsequent FETs do not work, we'll be taking a long break to regroup and relocate. This means I'll be job-hunting, and I'm sure you can guess what my #1 criterion will be. I'll take my Masters degree to the Gap if they have infertility benefits, which I believe they do. I'll have no shame. I was thinking about this the other day and if IVF was covered by my insurance and if we did only three cycles per year, that would be like adding $40,000 to my annual salary. I could do just about anything for that kind of a raise, couldn't you? I'm not saying we won't try at all during that time, but it will be a long time before we can afford anything but unmedicated ICIs again.

I'm doing much better today. I just keep looking around me and wondering how I got here. I never dreamed I would have this much trouble getting pregnant. Never. I think it all just caught up with me yesterday.

We've run into another delay with the home appraisal and the loan application, so it looks like we have a while longer to wait before we can finalize our IVF calendar. I know I will feel better once that is in place. And in the meantime, one foot in front of the other, right?

Monday, March 24, 2008

bless you, dear Julie

Anyone who was at my house over the weekend would have witnessed me scowling repeatedly at this month's issue of People magazine. I picked it up in the check-out line on Friday evening because J-Ho was pimping out her new twins on the cover and I was just dying to see if she'd 'fess up to any infertility treatments. She didn't. Surprise, surprise.

I've found that infertility brings the gift of a gaydar-esque sensor for picking up others in like circumstances. While their strife may remain invisible to the untrained eye, we voluntary pincushions who haunt the waiting rooms of Reproductive Endocrinologists and are on a first name basis with the cryobank staff know better.

Anyway, I've had a scathing response to the article bouncing around in my head for a couple of days and, as luck would have it, Julie beat me to it, with her usual grace and eloquence. Check it out!

the paperwork plague

I've decided that "paper" should be the universal winner when it comes to rock, paper, scissors. It is immeasurably powerful; able to trounce all opponents in a single bound. Paper, along with it's partner in crime, Red Tape, is giving me a significant amount of grief at the moment.

I've been on the phone with our clinic four times today. They currently have room for us to start IVF this cycle, but can't guarantee anything until we complete our checklist and pay our bill in full. Ah yes, let's take these things one at a time, shall we?

(A) Complete our checklist: CD3 bloodwork is tomorrow, orientation is on April 3rd. The only other thing remaining is the Cystic Fibrosis screening we've decided to complete. I called my insurance company a few weeks ago and they said it would be covered. Today, I requested that it be added to my lab requisition for tomorrow and they said they'd have to get pre-authorization because the test is over $1000. I told them I'd already verified my coverage, but of course they have to check for themselves. Fine - I'd rather have two confirmations than one as well if it really costs that much! They called back a few hours later. My insurance company stated it wouldn't be covered. I called my insurance company again and learned two things: (1) They have a record of my first call and the determination that was made. Yes, I am in fact covered for the screening. (2) They have no record of my physician's office making an inquiry today. Their last call was on 3/6 and referred to infertility coverage as a whole. WTF? Were they so sure my insurance wouldn't cover it they didn't even bother to check? If so, what else have they made similar decisions on? I called back and left an extremely friendly message (more flies with honey, right?) suggesting that perhaps they call again as I have now been told twice that the test will be covered. They call me back and say that they did and they have now been told twice that it will NOT be covered. *sigh* I asked what I should do since this obviously isn't going anywhere. Should I call from their office and hand the financial advisor the phone? Should I ask that they send me written proof of my coverage? Unfortunately, the woman calling me back didn't know anything about anything - she was just returning the call on behalf of their insurance liaison, and she said she had no idea what to tell me, except to call back tomorrow and talk to the insurance liaison directly. She did say something that made me think the denial might be because the test is coming from an RE rather than my PCP, so it looks like it is infertility related, even though it obviously isn't, and don't they have freaking doctors on staff to figure crap like that out?? Stop. Breathe. Anyway, I conveniently have an appointment with my PCP next Monday for my annual physical, so I'm going to ask her about doing the CF screening there. Maybe if it comes from her, they won't argue as much. Or they will. Whatever. I feel like I'll have more energy to fight this battle in it's appeal state down the line than I do right now, if it comes to that.

(B) Pay our bill: We're just waiting for the home equity line to come through on this one. Of course, our application, like everything else, has required us to jump through hoops we didn't know existed at the outset. First, the loan officer copied the wrong page (or something, I'm still not clear what went wrong there) so we had to take our paperwork down again for re-processing. Then, the lender decided they couldn't accept the full appraisal we had done less than two months ago. They'd rather schedule their own drive-by appraisal, 'cause that's likely to be more accurate. Um, okay. We think that happened today, judging by the random man we saw taking notes from his car across the street from our house. We were either being appraised or cased for an upcoming burglary. I guess we'll know when we do or do not have a tv by tomorrow evening. Once all that is processed, we still have to sign something and wait another 3-5 business days for the money to actually be usable. Tick, tick, tick.

I'm definitely feeling like I'm at the end of my rope. If this IVF doesn't work, I may actually be ready for a nice long break. If M and I were a heterosexual couple, I'd be 110% happy to stop actively ttc and just "see what happens." And then, of course, it would work. But we're not, and my patience with a break might not last as long as my current frustration level predicts, so our ttc holiday may end up being shorter than longer. Right now though, I feel done. We'll do this IVF (if we survive that long, that is), because we've already taken so many steps, but my tolerance for jumping through hoops is wearing very thin and I'm ready to give it up for a while - with or without a baby on the way.

Monday, March 17, 2008

dollars and sense, or lack thereof

Today was spent running errands and trying to get things in place for our upcoming IVF. I transported the samples to the appropriate lab and will return the tank to the first lab tomorrow. I called the shared-risk IVF program and got all the details about what they offer, but it really doesn't make sense for us financially. We didn't see much savings until we got to the 3 fresh + 3 frozen cycle plan and (1) who knows if we'll even have frozen embryos to transfer, so the 3 frozen might be a moot point and (2) it isn't transferrable to another physician and we're planning to relocate if we are not successful with IVF #1 (or FET #1, if we're lucky enough to have one).

That decision made, we explored financing options for paying our clinic directly. Our clinic only works with one provider of healthcare credit so I applied and was denied! I was totally shocked. My credit isn't spectacular, but it is on the high end of average. We applied under M's name - same outcome. The only thing I can think of is that we just refinanced our house in January and the dust must not have settled from that yet. This caused me to have a bit of a freak out. The financing was the one part I wasn't worried about (silly me!) so to have a road block thrown up there was really surprising and, if I'm honest, humiliating. M pulled me back together and reminded me that we have a long list of other options and this was nowhere near a dead end. I blew my nose and made a half-hearted attempt at dusting off my tarnished ego and we headed for the bank. We are now the proud owners of a home equity line of credit. *sigh*

In the end, this is a better way to go. It's where we should have started, honestly, but my ability to think outside the box has become a little threadbare lately. The interest rate is less than half what we would have paid on the commercial healthcare loan and it's a good thing to have in place anyway. As M pointed out, we can also use it to get the new computer she so desperately needs.

Of more concern to me is how easily I lost it this afternoon. That I have become that fragile; that something so small can shake me so... that makes me feel sad and scared. I have to think it's an issue of cumulative impact. As much excitement as I have about moving toward IVF, there is that much and more trepidation. And I am so completely tired of jumping through hoops and dotting Is and crossing Ts. I feel like all I do anymore is call various offices, fill out paperwork, transport samples, have things faxed... managing our ttc journey is a full-time job, and we're supposedly on a break! Never mind all the lengths I'm asking those around me to go through as well.
I'm just very teary for some reason I can't put my finger on. I think it's a combination of hormones, stress, and disappointment that our vacation is over and we're right back on the rollercoaster. Several of our loved ones are going through trying times, and my heart hurts for them as well.

M and I talked last night about how we're both feeling going into this IVF. I have come to rest on a delicate blend of excitement, optimism, and pure, cold, heart-stopping fear. I'm most nervous about the PIO injections which I hear are a PITA, literally speaking, and the possibility of a BFN. I feel like I will be able to cope with a BFN okay if we have embies to freeze. If not... I dunno. It might get ugly!

Friday, March 14, 2008

We're back...

...and timidly trying to reintegrate into our normal lives, which seem to be moving at about 10 times the speed of the vacation life we just wrapped up! Disney was awesome, and I'm so, so, so glad that we carved out some time and money to get away together - hard to do during this process.

Not one to waste a moment, I had my trial embryo transfer this morning. All went brilliantly but the RE said she'll still request ultrasound for the actual transfer, just to let both of us see exactly what's going on and put our minds at ease. Sounds good to me.

On Monday, I'm picking KD's vials up where they are currently stored and transporting them to the IVF lab. CD3 bloodwork will be sometime during the week of March 24th, and we're booked for our (5 hour and $100/couple) IVF orientation on April 3rd. Around that same time, we'll pay our bill and get our official calendar. It looks like Lupron will begin roughly one month from right now. So that's our plan**, best we can predict it.

**Subject to reworking, revising, and complete and total overhaul at the whim of our RE, our clinic and my finicky-at-times-especially-lately cycle. :-)

Monday, March 3, 2008

the IVF consult

The short version:
I feel good. It went better than I expected. We're on track for an IVF cycle sooner rather than later. I'm feeling optimistic and ready to go.

The long version:
We're definitely going forward with IVF. The RE talked to us about our options (IVF or laparoscopy/injectibles) and made it clear she felt IVF was the best choice for us at this point. Her reasoning for not recommending injectibles is that it is a significantly larger expense that is not accompanied by significantly larger odds, and she frequently sees patients go through 3+ injectibles cycles (same cost as IVF or more) with no success. We asked a lot of questions about my medical history and the likelihood that there could be something wrong with me that we haven't found that could interfere with IVF working. She reassured us that people with ttc histories just like ours ("unexplained infertility") have success with IVF every day. She was baffled as to why we weren't already pregnant, but had genuine high hopes that IVF could be our answer. I asked specifically about endo and she said the worst case on record wouldn't interfere with the success of IVF.

They will only transfer two embryos per cycle because of my age and medical history, which is fine by me. The clinic's pregnancy rates for my age group are 52% with 46% resulting in live births. Of those live births, 32% were multiples (133 sets of twins and 7 sets of triplets). Their FET success rates are much lower, but I guess that is typical? She did recommend ICSI (ker-ching!) for half of the retrieved embryos because of us having tried 12 times with KD with no luck. I wasn't expecting that, but whatever she thinks will give us the best shot sounds good to me. I would so love to be able to do this once, if at all possible. She said she hasn't seen enough research on acupuncture to say for sure that it helps, but she knows it can't hurt so she supports me in continuing with that.

I had a much better experience with the RE this time. She was warm and friendly and informational. I think she was probably that way last time too, but I was too overwhelmed to absorb or appreciate it. She was remarkably sympathetic about our lack of insurance coverage and said that we'd be first in her mind for assistance if they get any samples or donated drugs. She said we shouldn't count on getting a full cycle's worth, but she'd surely be able to help us a little.

Because we've already had so much fertility testing done, and because we're not heterosexual and won't have any accidental pregnancies messing things up, she said we could get started right away without having to take BCPs or wait for a new cycle to start. Our checklist includes: Attending their official IVF orientation, getting an updated STD screen, deciding if we want to do cystic fibrosis screening (and doing it if we decide yes), and having a trial embryo transfer. I'll call tomorrow to schedule these things, and then we'll be off and running.

Aaaand, the fun part: We also have to figure out how we're going to pay. They don't offer any financing or shared-risk plans of their own, but they contract with Advanced Reproductive Care to offer payment plans and 1-, 2-, and 3-cycle plans with refund guarantees. So that will be our next question - do we want to pay a cycle at a time or invest in one of their multi-plan programs? Definitely have some thinking and talking to do there. The single cycle cost directly through the clinic is a little more $$$ than we were expecting, especially since we have to add the ICSI, but not totally out of the ballpark. It's crazy to have reached a point where the difference of a couple thousand dollars seems reasonable.

The bottom line is that I'm feeling cautiously optimistic about this move. We both are, actually. Thank you to anyone out there that may have shared a little birthday goodness with us - we definitely felt it. ;-) It's crazy expensive, yes, but it is the appropriate next step - simple as that. If the RE did one thing today it was put my mind at ease about that. It was obvious that she genuinely feels this is a good decision and that it can work for us. On we go!

and now: today

I don't quite know where to begin with this post. I am positively filled with _________ (anxiety? sadness? nausea? jealousy? anticipation? grief?) as I approach our IVF consult today. I have felt pretty numb since I made our appointment a week ago, and I know it's because I'm too overwhelmed to process what we are embarking upon. While I have many online friends that have crossed this threshold, I don't know anyone personally that has done this. I don't know anyone personally that has had to do this. I know of a friend of a friend - that's our closest connection.

I'm working on questions for the RE. We plan to ask about what schedule they'll put us on, how they decide how many embryos to transfer and on what day, their prognosis given my medical history, what the chances are that some yet-undiagnosed medical issue (endo, lining issues, etc.) could prevent this from working, and of course, how much all this is really going to cost us. I'm interested to know how open they are to working with my acupuncturist. I know a nearby clinic allows her to come to the transfers and do a session before you even get up off the table. This clinic hasn't allowed that in the past, but I want to at least know that they're in support of me continuing to work with her on my own. I've also been advised to ask what their criteria is for freezing embryos and when they make that decision. Being the caring partner that she is, M has some questions about what all this is going to do to me - how we can minimize the discomfort of the shots, how much pain I'll be in post-retrieval, what kind of hormonal free-falls I'm in for, how many days of bedrest I'll be subjected to, etc.

I'm trying really hard to get excited about this next stage of our journey. It is devastating to me that we've come to this point, but the reality is that we're 18 months in no matter what our next step is, so why shouldn't I be thrilled that our next step is to the intervention that will give us the greatest chance of success available? I think I'm just terrified that it won't work - in fact, I'm hardly expecting it to at this point - and then it will just be one more way in which we put ourselves out there, gave it our all, and ended up with nothing to show for it except more debt and heartache. I know, I know - I've got to get a better attitude about this, and I really am working on it. It won't stand a chance of working if I can't calm my nerves a bit. Hopefully this afternoon's appointment will help.

Thanks for all the good luck and kind wishes you've sent our way. I'll update again after our appointment!

ahh, child-free living

Disclaimer: I am forcing myself to write this entry. It was bubbling up all weekend but I never took the time to put pen to paper. Er... fingers to keyboard, that is. I am SO not feeling this post right now, but it deserves a spot in this blog and I'm the only one that's gonna put it there, so here we go.

I had one of those weekends where I took very little for granted. On Saturday morning, I had to go to a special event for work. I usually only work Monday through Friday, yet I did not have to arrange for childcare. I took a long, hot shower and took my time getting dressed and out the door. No diaper bags to pack; no favorite stuffed animal to forget and run back in for. I went to Starbucks and decided to go in because the drive-through line was long, and I peacefully surveyed the community bulletin board while waiting for my order. No small person tugging on my sleeve, eating something off the floor, or demanding some forbidden treat at full volume. Then I drove downtown, listening to NPR rather than Baby Einstein, enjoying the peace and quiet of the city before the rest of the world was awake.

The rest of the weekend followed a similar pattern. M and I made an impromptu decision to seek out some peace and quiet in the form of a hike so we threw the dog in the car and went. We didn't pack snacks or water or baby carriers or anything. That night, we ate haphazard and non-nutritious meals at staggered times and fell asleep early. Really early. On the floor and in street clothes. Yesterday I spent the better part of the day in my pajamas, reading a book between trips downstairs to change loads of laundry. It would have bored anyone under the age of 12 (or perhaps 25?) to tears. Last night we went out to dinner and then to a casino, and we didn't give a second thought to when we would get home or how much we owed a babysitter.

Now, the reality (that probably goes without saying) is that I would rather have a baby in my arms than any of the above, but that's not to say the above wasn't pretty darn nice too. And I know I will miss it desperately when I'm a new mom, struggling to keep up with my triplet boys. ;-) I feel like this process makes it all too easy for me to focus on what I feel is missing in my life - this person we're working so hard to bring into existence - but does little to remind me how good I have it now. I have the luxury of relatively carefree day-to-day functioning, and I know there are parts of my life that are as enviable to those with children as parts of their life are to me. Behold the dilemma of the greener grass!