Frustrated, Inc.

Nothing like billing and insurance to make one completely frustrated.

Last night I received the claim forms from the clinic’s billing office that I’m supposed to send in to my insurance company for reimbursement. The claims total $7,050. I paid $8,900 up front – so shouldn’t I expect to get claim forms s totaling $8,900 to submit for reimbursement? I left a message this morning before I left for work, but of course haven’t heard back. Maybe there are more forms coming to me in the mail, but I’m worried that this is going to be just the first hassle in getting any reimbursement.

And then there’s my acupuncture. I sent in some forms to my insurance company to see if they’d reimburse any part of it. I didn’t expect that they would, but the longer I waited the more I got it into my head that they would. Of course, today I got the rejection. But it wasn’t a complete “no” – the claims were denied because they don’t have enough information. Apparently if I submit peer research on why acupuncture is beneficial they’ll reconsider my claims. This should be great news considering that I know there are many studies out there that validate this – but how do I get my hands on them? Anyone out there have any ideas? Just in the journal Fertility and Sterility there were at least ten – but I don’t want to shell out $30 a pop for something that my damn insurance company should be doing the research on. The whole point in getting this stuff in the first place is to save money!

Grrrrrr.

I’m also a little frustrated by my vacation plans. Trying to choose a hotel is driving me mad. Here are the details – and I welcome any input and itinerary advice:

I promised D for Chrismakah that he could go to the Skip Barber Racing School and learn to drive Formula One race cars on the famed Laguna Seca. We haven’t had a non-family vacation since 2003 (coincidentally, right when we began this ttc stuff) so a few days in Monterey seem like a good plan. Then we could drive down the pretty, scenic PCH (although, I gather it’s not officially PCH in Northern CA) to Los Angeles and visit D’s father and some friends. So that’s the plan.

We’re flying into San Jose Airport on 3/26 and will drive to LA on the 3/30. But where oh where to stay and what will I do while D’s racing laps?

Here are my thoughts, and honestly, I welcome everyone’s two cents.

At the moment I have 2 hotel reservations – 1 in Monterey at the expensive Monterey Plaza Hotel and 1 in Carmel at the much more reasonably priced Carmel Valley Ranch. Ideally, we want a room with a pretty, pretty view and I’d love to be able to indulge in some spa treatments while I’m there, as well as maybe a few dips in the pool and a pilates class or 2. I’m also thinking about driving up to Santa Cruz (I think it’s about 45 minutes north?) and partaking in some surfing lessons ‘cuz I really had fun doing that during our last vacation. Other than that, I guess I’ll just spend my days wandering the streets of Carmel and/or Monterey – so I don’t know whether I should be within walking distance of the cute, quaint shops or not.

And D is, as always, content to leave all the vacation planning to me, so I'm left feeling the pressure of possibly ruining the holiday by choosing the wrong place. That's overly dramatic, but I do want this to be a good time for us. We deserve it.

Two Great Things That Don't Work Together

Remember when you all thought I had it together and was being so strong? I sort of relapsed over the weekend. I don’t know what happened, but starting Friday night and all of Saturday I was one mopey, forlorn gal. And I couldn’t explain why. D asked if it was “For the usual reason?” and I couldn’t even say it was. But isn’t it sad that I have a usual reason? The usual is supposed to be your daily drink, or your daily lunch order – not the daily reason for tears. By Saturday night I was thinking that perhaps my mood was mostly due to my hormones – could I just be premenstrual? And sure enough my period arrived in her red splendor by Monday. The cycle of IVF #1 is officially over.

Fortunately, my mood has picked up somewhat. We met with my RE yesterday and discussed both the failure and the future. I learned that rescue ICSI can only be done if failure to fertilize was after ICSI – they can’t do it after trying the regular way because there is no way to be sure that a sperm did not penetrate the egg and had one, it would be very, very bad. He told me that while they can’t really tell how mature my eggs were since they don’t strip them down the way they do for ICSI, the embryologists did expect 14 of my eggs to have fertilized when they left them in the dish. D is making an appointment with an urologist to see if they can identify anything that might help us, though the RE didn’t expect that to be the case. And the new plan is to take this cycle off, and when my period next arrives to go on the pill and start suppressing for IVF#2. My RE said he’d probably not put me on Repronex at all – just the Follistim since he didn’t want me to do the coasting thing again. Updated to add: And yes, we will be ICSIing all eggs retrieved. He was quite complementary about my eggs – saying that taking this month off was not at all a bad thing, and that my eggs have no sign of not being good quality. The thing is that sometimes they just don’t fertilize. For some strange reason, I keep thinking it’s the opposite of Reses Peanut Butter Cups.

So, you know, we wait.

Meanwhile, I want to extol the virtues of the Ipod. My cousin recently told me that she’d make love to hers if she could, and I thought she was being hyperbolic – then I was given one for Valentine’s Day. The first day I used it was actually while I was in the waiting room for the Retrieval, and I’ve carried it with me on my daily commutes ever since. I honestly think my Ipod is part of the reason I haven’t been depressed. Listening to my favorite music for an hour and a half each day makes me feel good and can totally help control my mood. As Spanglish wrote recently – we NEED music, and I had forgotten. I’m enjoying making a soundtrack to my life and the Ipod does it so well: if I need to pick up my spirits and get a little rowdy I program Blink-182, if I want to ruminate there’s Tori Amos, and I’m loving listening to all the old albums from the 1990s that I haven’t played in years - all with just a little turn of a wheel. Music can be the best therapy.

And here’s today’s question of the day: Did I really do IVF if the F never happened?

Failure is the key to success; each mistake teaches us something. -Morihei Ueshiba

Thank you so much for your kind, supportive comments. They mean a great deal to me and it helps to know that I’m not alone in the frustration and disappointment I feel. That being said, I’m handling this much, much better than I ever thought I would. Absolutely there were many, many tears on Saturday. But I surprised both D and myself by not turning to mush for the entire weekend.

Part of it may be that D was remarkably considerate, consoling and caring – obviously quite worried about my mental state. Honestly, he did okay with the taking care of me after the retrieval – but it was after the phone call where he really came through.

But I think a big part of it is that I suspected this could happen. Back when we met with my RE about starting IVF I asked him if ICSI can be done if an egg wasn’t fertilizing – and he explained that once the decision is made to not use ICSI and just go the regular route it can’t be changed. Many of you asked about “rescue ICSI,” and I’ll bring it up at my meeting with my RE next Tuesday, but I suspect that Cornell doesn’t do it since the studies show it doesn’t usually lead to a successful pregnancy.

And with this complete and total failure, there’s a strange part of me that feels some validation of my IF status. I think since there was no explanation for my infertility, despite the obvious lack of success for the past 2 ½ years, I felt like I was kind of faking it. I know that’s ridiculous – but when there’s no logical reason for infertility it’s hard to have your emotions follow logic. But on Saturday I got handed to me on a petri dish a bonafide problem. There may not be an explanation for why it’s a problem, officially my diagnosis may still be “unexplained,” but clearly a problem exists. And I’m just fortunate that there also exists a solution (let’s have a shout out for ICSI!).

So, we’ll do another cycle. My RE mentioned on Saturday that he’d put me on birth control pills, so I guess we’ll be altering my protocol some. But D & I will discuss all this with him on Tuesday. I don’t know when we’ll begin, since we’ve planned a vacation for the last week in March (details to come in another post – but anyone near Monterey, CA interested in getting together?) and will have to work around that. But I’m rearing to go again. Sign me up for another ride.

CRASH.

The good news:

- I don’t have to worry about the pio shots.
- I can drink alcohol.

Ummm, that’s all I can come up with.

The retrieval yesterday actually went just fine. We got to the hospital at 8am as instructed, and D got called in to do his thing around 9:15. My turn didn’t actually come ‘til after 11am. They got 17 eggs. 17 - a nice prime number. It’s how old I was when D & I first kissed – 17 years ago Monday night. Sure, I was terribly crampy and uncomfortable afterwards, but there was no bleeding and it all seemed good.

Then at 10am this morning I got a call from my RE. Not from the nurse with the fertilization report and my transfer day – but from my RE directly. NONE of the 17 fertilized, not a one. They can’t explain it – the eggs looked good, D’s numbers were great so they left them to unite. They didn’t use ICSI on any of them because it didn’t appear to be needed. But apparently it was.

So the last 4 weeks or so have all been for naught. It’s as if I’ve spent these last months training for a triathalon only to end up with a DNF. It’s little consolation that I was ahead of the pack during the swimming and even the bike part seemed to be going my way. But when it was time to switch to the running, I crashed hard. The result was I could no longer compete and had to withdraw from the race.

I know there are more races to enter, but this was the medal I really wanted.

All Aboard

A nurse was supposed to call me before 7pm with my evening instructions yesterday, so I stayed at work an extra hour to make sure that I’d be available to answer my phone and ask any questions I might have regarding the news that they gave me. At 6:50pm, I assumed that little ole me had gotten lost in the big clinic paperwork and figured I’d have to call the answering service. The phone number was at home so I figured I might as well start the trek. I walked the 10 minutes to the subway station, holding my cell in my hand just in case they actually did call. As I entered the station the clock said 7:02pm, yet I still kept looking at my phone to see if I was getting service.

Once inside the station I had service for longer than I expected – I made it down the 2 flights of stairs before losing access. I walked along the length of the platform as is my norm, to the last car (since that’s where my exit is nearest) and waited for a train. Since none was forthcoming, I decided to wait atop the nearest flight of stairs just in case my cell phone could get service and just in case the nurse actually called. Sure enough, I got service, but a train rolled into the station. I ran down to get on – realized it wasn’t in fact my train, and retreated back up to the stairs. And wouldn’t you know, my cell phone rings.

It is indeed my nurse calling with instructions. I’m expecting her to say “you’re still coasting – just the .1 of Lupron” but instead I hear “Do you have a pen?” And I say “No” since I’m standing in my winter coat, hat and scarf in the middle of the Columbus Circle Subway Station and just trying to stay out of the path of the other commuters. She tells me I “need one” so I throw my purse and the phone onto the ground and rummage through my purse looking for a pen and some paper. Fortunately, it wasn’t too long and I was able to hear her say:

“Stop all your current drugs. You’ll take 3,300 units of HCG tonight at 2:05am. Report tomorrow morning between 6:30am & 7:00am for pre-op instructions.”

Apparently my E2 only rose slightly from 28 hundred and something to 29 hundred and something. So retrieval is tomorrow. I'm not coasting any longer - it's time for the final push.

I have to get to the hospital tomorrow at 8am, and D’s scheduled to do his thing at 9:30am. But since I triggered at 2am, doesn’t this mean that my retrieval will probably be closer to noon?

Whatever. They know what they’re doing. I’m happy to have gotten this far. Am hoping that I won’t get a call saying we messed up the HCG shot, which apparently happens not infrequently. But really – everything looks good. When I asked the doctor today doing the ultrasound how many eggs she’d guess I’d end up with tomorrow if she were a betting woman, she came back with 20! Of course, only half of those would probably be mature, but still, that would be something.

Waitin’ By The Phone

I’m waiting for you to call me up and tell me I’m not alone.

So yeah, I’m waiting for them to call with today’s E2 levels and with this evening’s instructions. My follicles didn’t grow a whole lot since yesterday, so the RE at today’s ultrasound didn’t think I’d trigger tonight. As he put it, things are “looking nice - but we don’t want them to look too nice because I’m not ready yet.” The big follicles were measuring between 15 – 17mm, most around 16mm.

Of course, now I’m fretting that retrieval won’t be on Friday, and that I’ll be coasting for a prolonged period of time. While I found this somewhat reassuring, I’m back to being nervous that something bad is going to happen and I’ll be cancelled after all - even though I know that nothing bad has happened yet.

I’m a little confused by the decision to coast me – since I don’t seem to have over 20 follicles and I hadn’t broken the 3000 level. But I’m trying to trust my doctors and the clinic. Still, if anyone has any coasting stories to share I’d love to hear from them.

And if retrieval isn’t on Friday, does that mean I have to have sex again tonight? The horror….

Coasting

No stims tonight. It’s Day 12 of my cycle and my E2 has skyrocketed to 2800, so there will be no further injection of FSH. My handful of follicles today measured between 14 – 15mm, and my lining was a pleasant 9mm. It looks like I’ll be triggering tomorrow night for my retrieval on Friday.

I guess that means we should have sex tonight, in order to insure that D’s sample on Friday is optimal. How sad to still have to schedule sex and sad to not be particularly excited by the idea. Hopefully this will be the last planned intercourse for awhile.

I don’t know what to expect at retrieval. When they measure the follicles each morning, they’re only measuring the largest 3 or 4 on each side as the others are much smaller, so I’m not sure I should hope for more than 5 or 6 eggs. And since it’s out of my control I’m trying my hardest not to worry about it, and to approach everything from here on out with a “what will be, will be” attitude.

I do know that I expected my ovaries to be much more sore and to be causing much more discomfort than they are.

As I lay in bed last night awaiting sleep to settle in, I found myself talking to all the follicles growing inside me. I explained to them what a great adventure lies in wait for them, and how a lucky 2 will have the opportunity to bunker down in quite the luxury accommodations for the next 9 months or so. Seriously, I was speaking aloud to these microscopic cells. I’m clearly losing my mind.

And then there’s this: last night I told my boss that I may be out Thursday & Friday, but didn’t know for sure. He asked me this afternoon if I knew yet, and I replied that now it looked like Friday and maybe some days next week. He asked if I was okay and I answered, “Yes. We’ll see.” I’m sure I’m giving him the complete wrong impression of what I’m undergoing, all though I know he knows that I’ve been trying to get pregnant for years and haven’t yet. The strange thing is that when I left his office after both conversations, I found myself somewhat choked up. And I’m not sure why.

Regardless, as the nurse told me when she called with my instructions, I’m real close now. I can just coast to the finish. I hope.

Cycle Day 11

I remember reading the IVF books where they advise you that it’s a demanding process. I p’shaw’d away the concerns – really how different was it then the injectible IUIs? Sure, some stronger meds and more office visits, but surely these women were making it tougher than it is. Silly stupid me.

I’ve entered week 2 of stims and all I can say is that this is exhausting. I don’t know whether it’s the side effects of the drugs or the emotional toll, but I’m looking forward to making it through retrieval and transfer, just so some of the unknowns will be answered. And so I can stop going in to the office every morning. For some reason, I’m not nervous about the PIO shots or the retrieval procedure; I’m just looking forward to getting there.

Of course, the good news is that I’m pretty confident I will make it to retrieval. I have no idea what it’ll bring, but that’s the next step. Yesterday’s E2 was 1160, today’s will surely have risen higher (update: today's e2 went to that rockin' year of 1979). This morning’s ultrasound made my RE “quite happy.” It showed a handful of follicles around 12 - 14mm, my lining at 8mm plus some smaller follicles. He thinks retrieval will be either Thursday or Friday. I’m trying my best not to expect any specific number.

Meanwhile, I seem to be limping from last night’s shot. I can't explain why it was especially painful. It doesn't make sense why some nights are worse than others. Currently, I host 2 symmetrical bruises - one on each thigh – but they’ve been there since the start and haven’t grown or spread. Just kind of changed color like my grandmother’s old mood ring: Purple = Excited, Blue = Anxious, Yellow = Bitchy and Hormonal. Each night as I look to see what kind of colors will appear on the thigh, I’m reminded of one of my all-time favorite blog posts by the eloquent and witty Bugs. Suffer we must, I suppose.

Cycle Day 9 (7th Day of Stims)

Things seem to me moving right along. Yesterday (Cycle Day 8/Day 6 of Stims) the ultrasound still showed the 15 follicles, all still under 10mm. My E2 on Day 7 was 359, yesterday it had increased to 607 and today’s reading had it at 995. This morning’s ultrasound showed a few follicles over 10, one at 11 but most still under the 10mm mark.. But they’ve cut me way back on the meds: as of yesterday I stopped the Follistim, and decreased the Repronex to 1 ½ vials. Tonight I’m to reduce the Repronex to just one vial. I’m taking it as a good sign – that the follicles are growing sufficiently and don’t need so much help.

So I’m doing okay. Still optimistic about the cycle, but definitely feeling wiped physically. I don’t know whether to attribute it to the drugs or having to get up 2 hours earlier every morning. My acupuncturist today said that my pulse definitely showed that my body was working, and between the sensitive nipples, and sore middle I’ve developed I’d have to agree. I’m trying to drink lots of water to keep the headaches at bay, but that doesn’t seem to be helping today. But if I walk away from this ten months from now with an infant it’ll obviously have been worth every single minute.

This morning the waiting room, usually fairly quiet with everyone keeping to themselves, practically felt like a cocktail party. It was packed as usual, but maybe because it was a Saturday everyone was chatty. There were 2 couples that may or may not have known each other before chatting it up on a center couch and various conversations between waitees happening throughout the room. I even had some nice exchanges with three women - and we didn’t just talk about IVF. Maybe because it felt especially early in the morning since it was a weekend, and reading just seemed to be too much of an expenditure of energy, we all found that talking to each other was a great way to pass the time. As one of the women I spoke with said, it is kind of silly that here we all are, day after day going through the same thing – why not chat a bit about it? It was good. I’m actually looking forward to seeing them tomorrow morning.

It’s one of those situations where it’s easier to open up with a stranger than a trusted friend. So while I still hope I don’t run into any other people I know at the clinic I wouldn’t mind at all if a stranger wants to introduce herself and tell me her story. Besides, I keep hoping that one of those strangers is one of you!

Cycle Day 7/Day 5 of Stims

Today’s update brought to you by the letters I, V, and F and the number 15.

First, thank you for all your comments – it was reassuring to hear that I’m not the only one to worry her pretty little head over such things.

Second, I’m happy to report that things seem to be progressing well. My E2 on CD5 was 104 and rose yesterday (CD6) to 220. At yesterday’s ultrasound they saw 7 follicles on one side and 8 on the other, all less than 10mm. They cut back my Follistim after just 2 days from 150iu to 75iu, but I’ve been taking the same 2 vials of Repronex and 10cc of Lupron. I keep reminding myself that slow and steady wins the race, so I should just be patient.

But about those shots, let me just say the stomach was not a good idea for me. Granted, I had to give the shots to myself Wednesday night since D was working late (and when I write late, I mean to 11:30pm) and I’m not the expert he is. So maybe the ensuing pain was due to my poor technique, but I think I’m just sore for 2 days after the injections. EXCEPT that last nights’ shots, which D masterfully inserted in my left outer thigh, have left me with nary a complaint. Yesterday I felt like I was sucking in my breath all day and keeping a remarkably straight posture because I was so hesitant to have anything – including the waistband of my skirt – touch the injection site. So who knows? And honestly, it doesn’t really matter as long as the drugs are doing what they’re supposed to be doing.

And now, some waiting room stories.

I realize that I’m going to a top-rated clinic (statistically speaking) so I honestly don’t mind that it’s been around a 45 minute to 1-hour wait for an ultrasound. But this does mean I’m in the waiting room for a good period of time, usually with at least 50 other women and a handful of men. And despite the fact that I’ve been going to this clinic for over a year, and have gone through 7 IUI cycles with them, I’d yet to run into someone I knew in the waiting room. After all, this is New York City – where 7,000,000 people live and I don’t know anyone. But on my newly assigned cd3, as I’m sitting in the corner crocheting a square for a baby blanket, I recognize a man as he’s walking towards his wife. He’s not a friend or colleague, but he was an assistant to a professor of mine from my Master’s program and I had interviewed with him years ago for a job. I didn’t get it, but he did pass on my resume to a friend of his, and I did end up working for his friend. So, he too works in the small Broadway theater industry and I think he would remember me, but I’m not 100% positive. So while my first instinct was to go over and say hello, I then remembered where I was and thought “Oh my gosh – he’s straight?” (You have to realize, a straight man working in theater is in the minority) and thought it might be best to just hide in the corner and keep crocheting away. Which I did.

And yesterday morning, as I’m waiting a woman walks in to the office and sees a friend of hers – apparently someone she cares about but obviously hadn’t seen lately, nor expected to see – and issues a loud scream, and hugs the woman genuinely. I was thinking how strange it would be to run into an old friend in that office, when the woman’s name was called and she turned around and I saw that she was someone from my Masters program – a year ahead of me. Once she returned from her blood draw, she and her friend were preoccupied with each other and I made sure to keep my head down and focused on my crocheting.

So I wonder, if she hadn’t known someone else in the waiting room, would I have gone up to her and said hello? I think I would – but I can’t be sure. I wanted to with the husband as well, but I think a man would be more embarrassed about running into someone at a fertility clinic. (This makes me think of Chandler running into Janice in that silly “Friends” episode.) But why should there be any embarrassment? Isn’t that the problem with the fertiles of the world? That they don’t realize how prevalent infertility is? And don’t we all know that being infertile IS NOTHING TO BE EMBARASSED ABOUT?

On the other hand, maybe it’s not embarrassment that keeps us quiet. Maybe it’s the fact that having children is a personal choice, and not one that should be shared with just anyone. Maybe it’s that being infertile can be so distressing, that one would prefer not to talk about it. And maybe when you’re going through treatment, you want to avoid saying anything that may jinx the outcome.