Wednesday, March 21, 2007

Drama, RE clinic waiting room style

So I think I've finally gotten my insurance issues straightened out, and I am extremely thankful that I did not have to sell the car, the dog, or my body in order to pay out-of-pocket for my cycle when I went to the RE's on Saturday morning. The financial coordinator took pity on me and gave me a free pass on Saturday, with the understanding that I'd straighten everything out on Monday, when my insurance company would finally have all of my info in their systems. Which they did, and I did, and now all's quiet on the insurance front, as far as I know.

But this morning was full o' drama at the RE's office, let me tell you! First of all, let it be known that I'm the grumpiest asshole in the morning you've ever seen. R can attest, I'm just not nice to deal with, at all. I hate, despise, detest, and abhor getting up early in the morning. Especially on mornings when I have to get up extra friggin' early to fight the MONSTROUS metro DC-area traffic to get to the RE's office by 7am (ish). So here I am, swinging into the ridiculously miniscule parking lot of the RE's office this morning, which is a ONE WAY deal - all the parking spaces are angled for people coming from the southerly direction - and suddenly I'm nose to nose with a hugantic bright red F-150 type pick-up truck. The truck jams on the brakes, I jam on my brakes - most indignantly, might I add, because I AM IN THE RIGHT, and red-truck is waaaay in the wrong, as he is GOING THE WRONG DIRECTION IN A ONE WAY PARKING LOT, for Chrissakes. Instantly my blood pressure sky rockets, my face turns bright red, and as we're stopped there, front end to front end, I mouth (scream) the words, "What the FUCK are you doing you IDIOT??!!" Now mind you, red-truck driver can see me plain as day, but I can't see who is behind the wheel of this monster truck because of the illegally dark tint on the windows. Which makes me even more angry. Finally red-truck backs up and pulls around me, and as I'm pulling into a parking space I realize the truck is turning around in order to park too. Uh-oh. It dawns on me, too late, that the only other establishments in this office space/retail area - the Sally Beauty Supply store, Acupuncture Clinic, and Quick-Cash-A-Check joint are all still closed at this hour of the morning. (I just realized how funny it is that all of those particular establishments are in a building anchored by an infertility clinic!) Hence, the red-truck driver is more than likely about to make her or his way to the same waiting room to which I'm headed. At this point I'm starting to feel a little embarrassed at my outburst, and I decide to fiddle with my purse, keys, cell phone for a minute so as to avoid an unseemly confrontation in the parking lot. Yeah, prolong the awkwardness until we're actually IN the waiting room together! Great idea! I scrunch down squirming in my seat as red-truck driver, who turns out to be of the gentlemanly persuasion, walks past. Curiously, he seems totally unfazed, doesn't even glance my way, to get a look at the woman who just cursed him out. Hhhhmmmm...

Once I actually get into the waiting room I realize why - he's got bigger fish to fry. He's the guy in the corner of the waiting room trying to comfort an hysterical, sobbing, inconsolable wife. I felt like the world's biggest schmuck, let me tell you. I have no idea what was actually upsetting this couple, but I can vividly imagine a number of failed infertility treatments, or deliveries of bad news, that would make ME cry like that. Oh, it was awful to sit in that waiting room with them, oh LORD, I have seen the error of my ways and I will endeavor not to fly off the handle for petty reasons because you never know the heavy burdens being carried around by the strangers you encounter. Amen.

THEN, just after red-truck driver and red-eyed sobbing wife finally get shuffled off to the back to meet with Dr. D.............. a Woman-To-Be-Reckoned-With comes striding out of the back, presumably having just met with Dr. G, or maybe one of the nurses, God help her. I mean, the look on this woman's face, I can't even do it justice. Every person in the waiting room paused mid-magazine, riveted to the spot, and this woman, long black hair flying out behind her, eyes blazing, nostrils flaring, goes flying up to the 'check out' counter at approximately 98 miles per hour. Without so much as a sidelong glance, not even so much as a flicker of a look at her wide-eyed husband - WHAPPAP - she whips a sheaf of papers with laser accuracy into her husband's lap - WHAP - slaps her 'check out' sheet onto the counter - WHIRR - spins on her heel and is out the door in a flash - WHABAM. Not a word to the receptionist, nary a credit card produced, not a syllable for the astonished husband or even a gesture to follow-me - nada. The poor bastard husband is sputtering and spinning and snatching up papers and finally goes stumbling out the door behind her. Good Lord, the entertainment factor. Never have I wanted to be a fly on the wall so badly - to be privy to the conversation that went on in that elevator ride from hell back down to the parking lot! Alas, I supposed I shall never know, but I'd sure hate to be the Dr. that had to deliver bad news to that bitch on wheels. I was agog at the whole scene - I understand that everyone reacts to the hell of infertility in different ways, but I would no more treat my husband like that, or even my dog, for the love of was really unbelievable, you shoulda seen it.

Anyhoo, so, rather anti-climactically, here's what's going on with me: the same old shit! Can you believe it? I know - shocking, right? The old ovaries are still scoffing at the puny amounts of Follistim I'm shooting up every night. No cause for activity on their part, heavens no! Much more fun to float around in there like bumps on a log, flouting authority and FSH at every turn., we're upping the dose to a whole 150 IUs of Follistim, and the next chance for the ovaries to prove themselves fucntioning members of society is Saturday morning. Of course, Saturday morning! Because did I mention how I LOVE, LOVE getting up early in the morning?

Yeah. Well, that's all for now soul sisters - peace out.


Tuesday, March 13, 2007

On top of everything issues!

Lordy, lordy ladies, have I got a complicated earful for you. (I'm sure you're all on the edges of your seats out there, huh???)

So, the basic udpate is this: we did not, as I suspected, come to any conclusions over the weekend as to whether or not to continue down the IUI road, or put a halt to this looooong-ass cycle and just kick it into high gear by jumping into IVF. R and I discussed, but just went around in circles, never coming to a conclusion with any real conviction either way.

So, I went back for a monitoring appointment this morning, and wondered if I'd receive any information that would sway our decision either way?

The basic outcome was as I suspected: no change. Still loaded up with immature follicles, still no growth. They just called with the RE's reccommended protocol, which shockingly includes the direction to increase my dose! By a whole 25 IUs! I know you IVFers are cackling hysterically at this puny and wimpy dose, but every IU counts when you're a PCOSer doing IUI, I tell you!!! So, I go back on Saturday morning to see if the extra 25 IUs will make a difference.

BUT, here's the new problem: Wait - allow me to digress for a moment (what's that you say? you have no choice but to allow me to digress, as usual? yeah, yeah, tough cookies..) to say that I can't remember whose blog I read this on - maybe you, Watson? Or maybe Kellie?? but I remember reading someone's post that said that she can't EVER seem to leave the effing RE's office without being saddled with yet ANOTHER obstacle, problem, hurdle - be it physical, emotional, administrative in nature. I SOOOOO agree. Two steps forward, one step back....This is what drives me to drink at 8am on a Tuesday morning. Well, not really, because you know, the drinking and driving is bad, bad - BUT, I was having explicit THOUGHTS of Johnnie Walker Black while sitting in traffic on rt. 66 this morning.

OK, SO, back to the new(est) problem: as you know (i think) I left my job at Major Cell Phone Company three weeks ago. I started working at Major Financial Institution two weeks ago. My health insurance provider will be EXACTLY the same - my IF coverage will be EXACTLY the same. So, former insurance expired at the end of Feb. New insurance coverage begins on March 1, AFTER I enroll. So, I just enrolled today, and as soon as the insurance company receives my enrollment info, coverage will be retroactive to 3/1.

OK, are you still with me? Or have your eyes rolled back in your head and drool started coming from the corner of your mouth? I'm getting to the root of the problem now, trust me....

So, my insurance provider, both past and current, require you to call a certain phone number to get advanced authorization numbers for all IF treatments before they begin. I called them today to explain what was happening with the old job, new job, same insurance company situation. The woman I talked to told me in no uncertain terms that I'll really be causing them a lot of administrative headaches by having the nerve to change employment in the middle of this cycle, and in fact, had I told them when I started this cycle on 2/11 that I was going to be taking a new job before the cycle was over, they never would have agreed to cover it in the first place. I calmly and sweetly told her that I AM INFERTILE, and I HAVE PCOS, and therefore I HAD NO WAY OF KNOWING THIS CYCLE WOULD LAST SO EFFING LONG. For the love of God, people, I could have smacked her. THEN she told me that my insurance through my old job is now terminated, so as far as they are concerned they aren't paying for anything right now. IF and WHEN they receive my information on enrollment through my new employer, they certainly are not going to agree to pay for a cycle of treatment that began on a date in the past when I wasn't covered. She suggested that I prepare to pay for the rest of this cycle out of pocket.


So, this being the case, unless I can convince my RE's office to let me continue this cycle, but report it to my "new" insurance as a new cycle that began on 3/1 or later - I have 3 choices:

1) Cancel this IUI cycle, take progesterone to induce a period, and Start. All. OVER. AGAIN,
2) Continue with this IUI cycle, and prepare to pay out of pocket for wandings, bloodwork, and God willing, the actual insemination,
or 3) Cancel this IUI cycle, and begin an IVF cycle.

I've left a message for the financial coordinator at my RE's office, but of course haven't heard back from her yet today. I will continue hounding her tomorrow, and depending on what she says the policy is about LYING to my insurance company, I'll guess we'll have to make a decision.

I tell you, if it's not one thing it's the other. Madness!!!


Friday, March 9, 2007

Never ending IUI....or move on??

So I neglected to post after my monitoring appointment this past Monday, because, well, there just wasn't anything to report. Same story, different monitoring appointment: plenty of follicles, but no growth happening yet. I went for another appointment this morning, and got the same exact news.

But then, my RE said something that at first really sent my spirits plummeting, but over the last hour has really caused me to rethink the course we're on right now. Here's an exerpt from our delightful mid-wanding, over-the-stirrups conversation:

RE: "Well K, have you been talking to your ovaries, asking them to get on board with what we're trying to do here?"

Me: "Yes, I've been giving them nightly pep talks, but they are so stubborn!"

RE: "Yeah, well, as you can see there's still not a whole lot going on in here {wand, wand, wand}..."

Me: "Yeah, as usual."

RE: "You know K, you would be a perfect patient for a new IVF-type procedure that we're working on introducing later this year. It's called IV*M - in vitro ma*turation. Basically we extract immature eggs and then mature them in vitro, then fertilize them, then transfer them back to your uterus. I mean, here you are, absolutely loaded up with follicles, but obviously it's proving difficult to get them to grow. We could extract plenty of immature eggs from you, no problem.....I don't want anyone in this practice to be a "guinea pig" though, so we're waiting until later in the year when there will be more data available - if the data shows above average success rates, we'll start offering IVM here. You'd be a perfect candidate."

Me: {slightly bug-eyed} "Soooo, are you saying that IUI is not going to work for me? Are you canceling this cycle?"

RE: "No, no, we're going to keep trying here for a while longer. But if we cant get you to ovulate, I just wanted you to know that IVM would be a possible option for you."

Me: "Uh? OK? Um...thanks?"

RE: "Haveaniceweekendwe'llcallyouthisafternoon......." on his way out the door....

So, at first I was crestfallen. All the hope I had been holding that it was only a matter of time, that at some magic future wanding session the RE and I would be high fiving over a sonogram screen showing 2 or 3 huge mature follies....all of those feelings departed suddenly like air out of a popped balloon. All of a sudden that nasty dark voice in the back of my head reappeared with it's familiar refrain: "did you REALLY think this was going to work? you idiot! you're not going to have any children! why do you persist with this pathetic hope of yours? it's futile!! futile!! you aren't good enough! you don't deserve this! give up now!"

I walked out of the office in a fog, trying in vain to shut down the nasty voice. I had a good cry in the car before getting on the road to head to work, repaired my makeup, then called R to tell him the latest development. And as I was relaying the RE's words to R....I suddenly thought - well, this really only applies to the protocol for trying to make my ovaries produce one or two eggs at a time - for IUI, right? If we were to move on to IVF, they could blast my fucking stubborn-ass ovaries with obscene amounts of FSH, and they'd be overcome - they'd HAVE to fucking do their jobs and produce eggs, right? And that would be a good thing, bc with IVF the more the merrier.

So, I said to R that I wondered if we should abandon this IUI cycle and make the decision to--da-da-dunh - move on to the mother of all infertility treatments - IVF? It is one hundred percent a financial question for us, you see. Looooong ago when my OB/GYN diagnosed me with PCOS, he told us that our best bet, most sure fire, quickest way to pregnancy was going to be IVF. He said, if you can afford it, you should do it right away. Money definitely BEING an object, we decided we'd try everything and anything before moving to IVF....

Well, my current insurance covers $10K of IF treatment - specifically for IUI and/or IVF. We haven't used any of that $ yet, bc we've yet to make it to the actual insemination part of any medicated cycle.

The question I think I will have to ponder this weekend is this: Should we move straight to IVF? Cancel this IUI before we have to waste any money on it? And if we say yes to that question, then the next question that follows is whether we should sign up for one cycle of IVF, which would probably run around $6K, right? OR, go whole hog and shell out for shared risk - which I think at my clinic is $24K, making our out-of-pocket around $14K?

Lay it on me y'all, what do you think????

Update: The RE's office just called with my instructions, and well, golly, what a surprise! They want me to stay on the SAME dose, for yet another 4 days. And then come back in for another blasted wanding session on Tuesday morning. So that they can tell me the EXACT same thing. And then call me on Tuesday afternoon, and tell me yet again to stay on the SAME dose, and come back again on Saturday morning. Whereupon they'll say the SAME thing and tell me to stay on the SAME dose and come back again on Wednesday, etc. etc. ad infinitum, ad nauseum.....Groundhog Day, anyone? I feel like screaming BLOODY MURDER, people, I'm losing all of my positive thoughts, and all I can see is this never ending, perpetual headache-causing, pain-in-the-ass cycle stretching out for weeks and weeks on end in front of me. AAAAAHHHHHH! Stupid, stupid, stupid fucking lazy-ass ovaries!


Friday, March 2, 2007

MWAH-HA-HAAAAA!!!! (in manner of The Count, from Sesame Street)

Went for a wanding session this morning, and my RE took one look at the sonogram screen and said, "K, your ovaries are laughing at us." While I was trying to figure out how to take that little gem, on his way out the door he said, with his hands over his ears, "They're saying, we can't hear you! We can't hear you! Let's try another four days of meds, and hope that they don't decide we're shouting at them....See you on Monday!"

Well, at least the man has a sense of humor. And if I wasn't able to laugh at this point, I'd be homicidal.

So, I'm going to try to have a heart to heart with the old ovaries tonight. Give them a little pep talk, you know, if I can manage to get their attention. This attitude of theirs, this aloofness, has really got to go. They can't continue in this fashion, it simply isn't becoming.

The RE has also decreed that I shall switch from Bravelle to Follistim as of Monday (if there's still no cooperation from the ovaries.) Since I'm taking a dose and a half of Bravelle each time, and since I have to mix up the meds from the vials, I'm basically having to throw away a half dose of the stuff every night. And these drugs ain't cheap, am I right ladies? So, I'm all for the Follistim, as the RE described that I can just dial up whatever dose I need from the pen-thingy, no muss, no fuss, and no dinero down the drain each time.

Oy vey -