Archive for the ‘pre-cycling’ Category

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On a Scale of 1 to 10…

Holy Crap, I’m still in so much pain from today’s HSG that I think I might throw up. It comes and goes in waves, but this is really not feeling great. I’m not enjoying this.

Update (6am, Wed.): The pain has subsided quite a bit, but I’m still really nauseated. It is possible the nausea was unrelated to the pain and HSG entirely.

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First, see my previous post for the latest on my girly parts.

Second, here’s the latest on the insurance situation:

I am definitely switching to the insurance at Big Large Corporation (BLC). It is unquestionably better coverage. If I exhaust my coverage under BLC, I can go back to my husband’s insurance and then exhaust his coverage. Sneaky, eh?

Unfortunately, the insurance with BLC, which uses Well Known Insurance Company (WKIC), does not include Dr. McB as a preferred provider. In order to continue seeing him, I would have to see him as an out-of-network provider, which would completely defeat the purpose of having kick-ass benefits under BLC/WKIC. This is, of course, not an all together bad thing, what with the 30-40 mile drive (depending on whether you’re driving from my house or my office), but you know? I had really begun to like Dr. McB. And we had a plan. And a timeline. And we were moving forward. And it was all good. Except the geography. But everything else was pretty good. Okay, so his SART Stats weren’t great, but SART Stats, to be honest, aren’t everything. Even SART says flat out that the stats can be deceiving because some clinics have a habit of purposely weeding out patients that will pose a greater challenge, and some clinics specifically see those patients that are more of a challenge, so their stats may be lower. So you see? It’s all a little deceiving.

That being said, even the raw data for my old clinic is better – over 10% of their transfers are elective single embryo transfers, which is well above the national average of 3%, and well above the Hatchery’s 0%. And the number of cycles initiated is vastly bigger – nearly 1200 compared to 36 in my age group. Bigger isn’t necessarily better, but it does make their data easier to interpret since their sample size is bigger. There is defintely something to be said for the smaller clinic and the single doctor who isn’t going to forget me. But I never felt like my doctors didn’t know who I was at the big clinic, either. I never felt like a patient number at the old clinic (though I still know my patient number by heart).

Anyway, it’s the right decision to make – to go back to the old clinic. Geographically, financially, and probably in terms of success rates. But it sucks because I had a plan, and now the plan has changed and because I really did like Dr. McB as it turned out, and I think he would have done good things for us. I hate that money stands in the way of the things we want in life. Or in this case, money and geography.

So the plan:

1. Get HSG done – either clinic could use the same HSG results anyway – CHECK
2. Schedule a pre-pregnancy consult with perinatologist – CHECK (Dec. 15th)
3. Schedule consult with Dr. Amazing at old clinic – CHECK (Jan 5th)
4. Go on BCPs when next period starts – I’m still going to do this in anticipation that Dr. Amazing will be on board with my plan to go forward with IVF and that way I won’t be delayed in waiting to start a cycle – I’ll already be on BCPs. Sneaky, right?

And now we wait.

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The Plot Thickens

So I had my HSG today. Truthfully, an HSG wasn’t strictly necessary, since we knew we were going to do IVF no matter what the HSG indicated, so I could have just done a sonohystogram, since all Dr. McB really needed to see was the uterine cavity, but he left it up to me to decide what I wanted to do. Me being me, I’d prefer to know what the status of all the girly parts is whenever possible, even though my last HSG was totally clear back in 2005 and there’s no reason to think anything has changed. But really, my last HSG didn’t cause me any true discomfort, except when threading the catheter through my cervix and that was short lived, and I’m not really all that concerned about the invasiveness of the procedure. Truly, you don’t get much more invasive than a high-order-multiple pregnancy and subsequent c-section, to be honest. Frankly, my comfort level for one procedure is not my main concern here – getting the baby on the other side of all of this is my main concern. So bring it on, doc.

Which brings us to this morning. I hauled my tushy all the way up to The Hatchery, 33 miles away, arrived 30 minutes early (whoops), and waited. And waited. Okay, I didn’t wait that long – they were running about 10 or 15 minutes behind, so it wasn’t so bad, but considering how early I was and the fact that I’d failed to bring any books with me and the Radiology Center at the University doesn’t have any decent magazines… it sure did feel like forever.

Doing the HSG at The Hatchery is different than at my old clinic (I’ll have to think of a new pseudonym for the old clinic…). The Hatchery uses the University hospital services for everything they do – so the HSG is done downstairs at the radiology center, retrievals and transfers are done in the main hospital (I think in a regular OR, but I could be wrong about that). The old clinic was a self-contained unit – everything they did was in their own suite, their own labs, their own surgical center, their own facilities, period. So I was taken to a changing area where I changed into a gown, but then from there I had to walk down a hall to a room where they took a flat, pelvic xray, and then down the hall to another room where they did the actual HSG. Both times I walked through the hall, there were several gentlemen sitting in chairs waiting in the hall. Not really who I want to be walking past as I’m walking in a gown with nothing covering up my nether-regions ifyaknowwhatImean… (I mean, I know the GOWN covered up my nether-regions, but I still felt a might bit TOO exposed for comfort’s sake.

The equipment that this radiology center used for the HSG was different than my old clinic, also. Rather than being on a bed with stirrups, I was on a flat x-ray table, and rather than having this adjustable floaty thing above me that was attached to a computer screen showing my uterus in real time and all that like last time, there was a more normal x-ray machine (just smaller) that slid out over me when the time came (still attached to a computer thingy with live shots, but they took several still shots rather than having the computer capture the pictures). It seemed… less modern, but it did get the job done, so I don’t know if it was less modern, or just different. I am certainly no doctor, and I will say that my husband works at this hospital and is the pharmacy manager for technology and they are anything but archaic in the pharmacy department, so I can’t imagine that this was archaic – it was just different.

Dr. McB came in and was really very pleasant. Honestly, I really feel badly for calling him brusque after our first meeting – in retrospect, while his manner was quite matter-of-fact, he was probably at least partly responding to my manner, which was pretty much, “I know why I’m here, I don’t need you to hold my hand through this, let’s get on with the show.” It’s just that any consult with an RE is a bit… I dunno… demeaning in a way. It feels like it strips away a bit more of my femininity each time I walk into an RE’s office and I get a bit more defensive each time, I think, even though I don’t mean to, and I know it’s not their fault I’m there.

Wow. Tangent, much?

Anyway, Dr. McB came in and gave me my consent form and ran down the list of risks that there are associated with an HSG, but I’ve been there, done that. Kudos to him for explaining them very clearly and explaining exactly what they do to mitigate those risks. Needless to say, I wasn’t worried before, I am not worried now. We joked around for a bit as everyone was getting ready and then it was time for me to assume the position, which isn’t as easy as it sounds on a totally flat table, but whatever. I told him that this was certainly MY idea of a good time on a Tuesday morning, and he said it’s certainly a typical Tuesday morning for him. It’s only my second HSG, but I sure hope it’s not just his second… he assured me that although I was only his second of the day, I was not his second HSG ever.

Now, next bit of kudos to Dr. McB – he did a really good job of always letting me know what he was about to do next, which I really appreciate in a doctor. Not all doctors think to do that, but it’s a nicety that really helps patients feel like they matter. So if any doctors ever read this blog – by golly, take that as a lesson to you! He told me he was about to insert the speculum and I said, “You do what you need to do, doc!” But holy smokes, that hurt. And it didn’t stop hurting until the end of the procedure when he pulled it out. Could it have been pushing against my cervix or something? Whatever it was, it hurt! “Now I’m going to wash your cervix with betadine,” he said. “Okay, hold it right there, doc. Now I think you’re getting just a little too up close and personal, don’t you think?” Hang on there, kiddo, it’s about to get a lot more personal than this! Then he told me he was going to give me something to numb the cervix. Hey, I don’t remember my old clinic doing that – apparently he’s just nicer than them. “You won’t even notice this…” YEOWCH! Big huge, horrible, ouchy pinching! “really? The last woman didn’t even notice me doing that!” Clearly, I’m just a sensitive soul.

He let his resident inflate the balloon, which she seemed to have a little bit of difficulty with, but I have no problem with that – you have to learn somehow, right? And he was in total control of the situation the whole time, which was abundantly clear, so I wasn’t in the least bit concerned. There was some discussion about catheter sizes. Apparently my cervix wasn’t as cooperative as one would l ike. Tell me about it. I felt exactly the same way when it shortened from 4cm to 1cm overnight while I was pregnant. Uncooperative, indeed! Mind you, all the while I’m still in some pretty fine pain from the damn speculum. Dr. McB asked a couple times “How you doing up there?” “Just as great as could be, doc!” “Well, I just like to keep the lines of communication open down here!” And good for him. How dare I judge him at our last appointment? No really, how dare I?

And then came the dye. At my last HSG, the worst of it was getting the catheter through my cervix. After that, it was smooth sailing and I never noticed the rest of the procedure. So I figured that the rest of this procedure would be a piece of cake. Not so.

Holy Crap! They actually had to remind me to breathe, because I really couldn’t move a muscle it hurt so much. I wanted to squirm but knew I shouldn’t and I wanted to writhe, but knew I couldn’t. They started taking pictures and I said yeowch a few times (as calmly as I could) and Dr. McB said, “Well there’s an obstruction there on the left side.” Huh wha? Excuse me? That’s a new development. And so not okay. Well, said Dr. McB, it doesn’t really matter since we’re doing IVF anyway. But that certainly doesn’t mean I wanted there to be something else wrong with me just for the
heck of it, now does it? He kept taking pictures and asked if I could roll a bit over on to my left side and I swear I was in so much pain that I couldn’t remember which side was my left side, but I did figure it out in time. Yep, definitely obstructed.

WTF, people?

I mean, seriously! I’m supposed to be doing this IVF thing because IUI works too well – not because I actually need IVF! Okay, that’s a little harsh, since I almost moved on to IVF twice the last time around, so clearly I did have indications for IVF regardless. But it does change my perspective a little bit. Somehow, I feel just a little bit more “legitimately infertile.” This is ridiculous, of course, because the 5 years of infertility, the $20K, the 5 cycles of clomid, the 6 IUI with Follistim cycles, the miscarriage, the hundreds of injections I gave myself – those all should have been clues that … hello? I’m infertile. (And don’t anyone go pointing out that I have a gaggle of kids so I must not be infertile – infertility and barrenness are not the same things – I am SO tired of people saying, “You’re not infertile, look at all those kids!”)

So it turns out that I need this IVF thing after all. Not just to avoid another set of multiples, but because without it, I’d only have a chance at getting pregnant whenever there was a dominant follicle on my right ovary. What a pain in the tushy.

Meanwhile, the plot thickens on the insurance front also, so more on that later – this post is long enough in and of itself.

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Change in Plans.

Let me back up.

I’ve been working at my current job as a subcontractor to BIG LARGE CORPORATION (BLC) since January. As a subcontractor, I did not have medical benefits (or any benefits, for that matter), which was fine, because I have medical benefits through my husband’s employer. I was recently hired on as a regular employee with BLC. Before I agreed to explore permanent employment with BLC, I reviewed their benefits packages to see what I was in for, just to see if there was anything exciting about it. The corporation is based in a state that mandates fertility coverage so my hope/expecation was that they would cover fertility treatment. Alas, it appeared that BLC “self-insured” and it said quite clearly on their benefits summary data sheets that fertility coverage was specifically excluded from their plans.

In fact, the exact wording under “What is Not Covered” was:

Actual or attempted impregnation or fertilization including, but not limited to, in vitro fertilization and artificial insemination, ZIFT, GIFT and injectables, except for initial diagnosis

That seems pretty clear that fertility treatment is excluded, no? However, when I was looking at the plan information back then, I was looking at information that described the BLC “Total Health Plan” which was pretty clearly a “self-insured” plan.

My first official day at BLC was last Monday and in my over-the-phone orientation with my HR manager (I work several states away from my manager), she kept talking about plans with Well Known Insurance Company (WKIC). I couldn’t for the life of me figure out how they were getting around my state’s mandated insurance coverage if they weren’t self-insuring. Over the weekend I finally got my benefits package in the mail and was able to access the website today with all of the plan data on it.

I searched and searched for the information about fertility coverage, but found nothing. NOTHING. Nothing about coverage, but also nothing about exclusions. What could this mean? I couldn’t find anything anwhere on the site that talked about plan exclusions at all. And the summary plan descriptions were pretty high-level and just didn’t give me enough information to know whether fertility treatment was covered.

Soooo…. I called the Benefits Service Center (BSC) at BLC and asked them if they had a listing anywhere of Plan Exclusions. The representative helping me had no idea what I was talking about and referred me to the summary plan descriptions. No, I countered, those are too high level and don’t really explain exactly what is covered, nor do they address plan exclusions. She didn’t have any further information for me, but would be happy to research the information for me and get back to me. Meanwhile, if I wanted, I could contact WKIC directly if I wanted. Oh! That would be lovely, thanks.

I called WKIC directly and spoke with an absolutely lovely representative who was happy to help me sort this all out. No, they didn’t have a list of plan exclusions, but was there a particular service I was looking to find out about? Ahem. Well, yeah, actually, there was. What about fertility treatment? Oh, well, fertility treatment is covered just like any other medical claim – same copay, coinsurance, deductible, etc. There’s a $100K cap on coverage for fertility treatment/medications, etc. A limit of 6 IUIs per lifetime. Limit of 3 IVFs per live birth. No coverage for ICSI or Assisted Hatching. No coverage for freezing or storage of embryos (this is pretty typical).

This is way better coverage than my husband has, particularly when you factor in that I’m not limited to the one clinic that is 40 miles away, which makes life logistically difficult. So the choice is clear. Or it should be. I mean, obviously, I’ll switch to BLC’s insurance pronto.

It’s just… Gosh. I’d really decided that I do like Dr. McBrusque. And that while his manner may not have been perfect, I did like that he was willing to hear me out and he was willing to think about doing single embryo transfers despite the fact that he’s never done them before, and the fact that he had an innovative solution to the hyperstimulation problem. I liked that he called me himself about the metformin/breastfeeding problem. The things I didn’t like were basically out of his control. With Dr. McBrusque, I have a protocol laid out, a timeline set, and all I have to do is wait for my next period, and we’re ready to get started as soon as the first of the year rolls around.

I don’t deal well with change. So obviously, I’ll change plans and start over, but it’s going to mean delays and changing mindsets and reorganizing my thoughts, so it’s going to mean a bit of whinging on my part. I apologise in advance.

So here’s the current plan:

  • I will still have my HSG tomorrow.
  • I still plan to schedule a pre-pregnancy consult with my perinatologist to determine whether it would be wise to even consider allowing more than single embryo transfers.
  • I will schedule a consult with another RE… I have to decide who this will be – should it be my old clinic? Should it be someone entirely new? I don’t know! And if it’s my old clinic, should it be the first doctor I saw there, or the second doctor? I love them both, but one moved to a location further out, which is the only reason I stopped seeing her. The second doctor was great, but he definitely didn’t love that I didn’t reduce the HOM pregnancy. I dunno.
  • I will find out if the current clinic (the one that is 40 miles away) accepts the insurance that I’m switching to. If so, I’ll continue to proceed as planned with them, until I determine whether I should be switching to a clinic closer to home.

That’s the plan so far. I can work with plans. I always need a plan. This can work, right? I mean, after all, it’s GOOD news that I’ve got coverage, and that I’ve got better coverage, and that I can now have my choice of clinics, even though it throws off my entire timeline, right?

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One thing I keep forgetting to post… when I spoke with the infertility nurse coordinator on Wednesday she cleared up one thing that had really, really, really bothered me about The Hatchery and made me feel much, much better.

The Hatchery batches their IVFs, which really bugs me because it gives me less control over my timeline. It especially bugs me because they used to batch their IVFs quarterly! I was feeling incredible time pressure with a quarterly timetable. I had forgotten to ask Dr. McB if they still batch their IVFs quarterly when I saw him on Monday, but when he was talking, he’d made it clear that he batches his patients, so clearly, something was up.

Still, he’d said some things that made it sound all so flexible, like, “So when do you want to get started?” and “What kind of timeline do you want to look at?” And then when the nurse called me on Wednesday she was also asking me similar things… she was asking me if I wanted to start BCPs this month to do my IVF next month or if I was waiting. Finally, after all my important questions had been answered, I asked if they still batch their IVFs. “Yes, we start cycles every two weeks now.”

Wow. Every two weeks. Well, that’s practically all the time! That kind of batching I can totally handle. No time pressure, I can still pretty much pick when I start. She said this just helps him control his schedule a little better, because it gives him one procedure weekend and one ultrasound weekend. Whew. With only one doctor in the practice, I can totally understand that. I’m really all about it.

Glad I cleared that up.

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Metformin? Sucks.

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