Archive for April, 2011

So – I finally spoke with Dr. Zimon (after freaking out because I missed her call by literally a minute and then they were being ridiculous about transferring me directly to her when I called back).  She made me laugh with, “well you’re probably wondering what is going on…or actually what isn’t going on in there…”  She said people on Clomid sometimes have 35-40 day cycles, so I’m still right there in the middle of my cycle, but she really doesn’t know what is going on.  She is not concerned about my estrogen dropping (what I considered a drop apparently is what she considers staying the same).  She did say that sometimes PCOS women can have follicles that turn to cysts rather than grow as mature follicles and we’ll see if that is the case.  She thinks that tomorrow will show us some more information – I asked if tomorrow was the deciding factor and she said depending on what shows she may have me go in one more time. The good thing is she is the doctor on call so she will be the one actually looking at my results – that made me feel better. 

She did ask if I was getting frustrated with this cycle and I said a bit, but more because I don’t understand why it’s so different than how I responded the first time.  She admitted that she truly doesn’t know why this time is so very different but that it’s all sort of pieces to the puzzle.  I think she was going to offer me to opt out of this cycle if I wanted to but, goodness, I’ve come this far…what’s another round or two of bloodwork and u/s?

She wrapped up by saying that if this doesn’t work we’re going to have to sit and decide what to do next.  I asked what that typically entails and she said fertility injections – basically stronger drugs to help me respond. She knows I can respond as they confirmed ovulation last month so we just need to get there again.

Chris is probably going to lose his mind because he thinks the answer to “what do we do next?” is IVF.  Pray for me while I give him this update…

But seriously, Dr. Zimon is so nice.  She just is normal and not doctor-ish and as much as I may get frustrated that it’s like Ft. Knox to reach people there, Boston IVF is dedicated to its patients.  Nurse Karen really pulled through in arranging my conversation with her and it makes me feel better knowing that she, too, has thought about “what next?” if this doesn’t work out and she, too, sees that we need to fast track and get this done.  GET ‘ER DONE.


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Nurse Karen called yesterday afternoon after I went for my third round of bloodwork and another pelvic u/s.  Because I had been stuck on the left arm twice in less than 5 days, I asked the phlebotomist to try my right.  Well, I am now sporting the biggest black and blue – it is about the size of a golf ball!!  The pelvic u/s was the least painful I had – the technician was really great.

The results were not as glorious:  my left ovary has two measurable follicles, 15.1mm and 14.0mm, and a few less than 12mm and the right has a few less than 12mm.  My estrogen is 61.3 which is low.  I am scheduled to go for a fourth round of bloodwork and u/s on Saturday.  I started asking questions and Nurse Karen suggested that I schedule a call with Dr. Zimon, so I left a message with her administrative assistant to schedule the call to see if we should even continue with this cycle.  I don’t know – this just doesn’t seem right at all.  *sigh*  I asked if there was anything additional I could take to stimulate growth and she said no.  This is so exhausting.

I am waiting to hear back from Nurse Karen as they tried scheduling me for Monday and that just isn’t acceptable to me.  Monday would be CD21 and I need answers now as to whether this is something that is common or is it something we should be concerned about.  I am worried that my estrogen is dropping and that we’re now, today, on CD17.  I just need some answers from Dr. Zimon as to whether this could turn into a viable cycle or if we’re kind of spinning our wheels here.  I don’t mind making the continued efforts if it’s worth it but I’m a bit alarmed right now and I think I’ve given it enough go arounds (3 rounds of bloodwork and u/s with a 4th scheduled).

We shall see – the good news is that if this is a viable cycle, Chris will be home on Saturday night so he’ll be able to continue the process with me.

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MYTH: It’s covered by insurance.

BUSTED: I’ve done more jumping through hoops than a clown in the circus in dealing with various insurance companies so that we don’t drain every last penny of our savings account.  It all began when we were referred to a Reproductive Endocrinologist (RE) for further evaluation since it had been over a year of trying “naturally” (I put that in quotes because how natural is peeing on a stick for an Ovulation Prediction Kit every day for a year and timing intercourse with my husband?).  At the time, we were covered by my insurance, which is Blue Cross Blue Shield (BCBS) and it’s based in New York.  I called the insurance company to discuss what would or would not be covered since it was a Preferred Provider Option (PPO) and my RE was listed in their network.  They told me that there was ZERO fertility coverage unless “it was a procedure to cure the fertility”.  Well, how exactly is that defined?  If it’s a procedure that makes me successfully have a baby, is that considered a “cure”?  Nope.  The example they gave was if there was a tube blocked, a procedure to unblock the tube would be covered but because I have PCOS which isn’t “curable”, only the diagnostic testing would be covered.  At the suggestion of my RE’s office, I took a list of billing codes from them and called BCBS back and we went code by code to see if it “wouldn’t be rejected” because of course they couldn’t guarentee payment.  Holy moley.

What I finally learned, in speaking with a good friend who is a benefits broker, is that regardless of the MA state mandate that infertility is a health condition and employers are to provide coverage – anyone who is a self-insured organization is exempt to the state mandates as they only have to abide by ERISA and not the state regulations.  Of course, I work for an employer that is based both outside of MA and is self-insured so we had both variables against us.

(Note:  ERISA is the Employee Retirement Income Security Act of 1974 (ERISA), which is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.)

We went forward with the diagnostic testing and ended up spending over $770.00 out of pocket.  So much for diagnostic coverage, right?  I even had to fight with them to cover the Varisella vaccines since my titer came back inconclusive.  It is a vaccine!!  After all of this chaos and at open enrollment time we looked into my husband’s insurance “just to see” if it had any fertility coverage.  And low and behold, they did!

We got onto Harvard Pilgrim (HPHC) with a Health Maintenance Organization (HMO) plan – the cost weekly for us was almost the same and the coverage for infertility was incredible!  One careful thing we learned was that there are a lot of approvals needed – we actually missed a month because we didn’t have the approval from HPHC yet.  We finally went through our first medicated cycle of treatment with IUI and the only thing I paid was 1-2 $20.00 copays – I did not receive a bill for any of it! 

As life would have it, my husband was recalled to the fractional carrier where he flew for over 8 years before being furloughed 2 years ago.  This was an increase in salary of over $45,000 a year but of course the first thing I said wasn’t “yay I am so glad you’re going back to the job you loved” but it was “oh crap – I wonder if they have fertility coverage”.  I immediately Emailed the HR Manager to inquire about their plan document for the health insurance carrier they’re currently using.  She was gracious enough to send me all the information I needed and my heart sank when I read, “Exclusions:  Infertility”.  Yep, we have another self-funded plan with no coverage.

So, we had to sit down and really calculate out the costs of our current and potential future treatments and figure out a path to take.  Unbelievably, it is more cost effective for us to pick up COBRA on our existing insurance with HPHC than it is to pay out of pocket for future treatment.  That means $800.00 a month will be going to COBRA simply to keep our insurance and hope that one of these cycles sticks!

All of this means that even though we are lucky enough to live in a state that is generous and acknowledges infertility as a health condition, it unfortunately isn’t strong enough to protect us and in the end we’re spending what many spend on rent just to continue our coverage.  All because I have an endocrine disorder that I didn’t ask for or contribute to – and all because all I want in this world is to be a mom.

For a basic understanding of infertility visit: http://www.resolve.org/infertility101 

For the background of National Infertility Awareness Week® (NIAW) visit: http://www.resolve.org/takecharge.

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The nurse called (and not my normal nurse…) and my estrogen level was 75.3 which is “right where they want to see it” and I had two measurable follicles on the left ovary (14mm) and one on the right (around 12 mm).  But, because they’re not at the ideal size, Dr. Zimon wants me to come back on Monday morning for another round of bloodwork and another u/s to check their growth and see if we can trigger.

I have to cancel my business trip to Chicago as if things go right, I’ll be triggering and getting the IUI next week. 

I cried – and I really shouldn’t.  I just don’t understand why my body is reacting differently than last time – I don’t know if that is bad / good / neither.  All of this is just a lot.  It really is. 

EDIT:  I had called and left a message with the nurse and she just called me back.  She said it is completely normal for each cycle to be different.  She also said it is more ideal to have 2-3 follicles (obviously not ideal to have 5-10) and yes, it slightly increases our chance of multiples.  I asked about my progesterone level and it was less than 0.2 which means my body isn’t ready to ovulate, either.  She said this cycle is looking good – I just wish I could be excited about it but of course I’m so consumed by work and other things…

It’s been a rough week emotionally.  I feel like I’m in this turbulent place where everything in my life is swirling around and out of my control.  My chest is constantly tight, which means my anxiety is high.  This is not easy – none of this is easy.  The “innocence” of trying to become a mother, getting pregnant, the whole thing has been stripped from me because of this process.  I am grateful for modern medicine and all of the people who are trying to make this happen, but part of me wants to just run away to an island and escape it all.

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I went in this morning for my bloodwork and another round with the pelvic ultrasound to see how I was progessing from the Clomid.  This was the first time I got my blood drawn by this lady and it didn’t burn – which was a good thing!  The u/s was next and the woman was very nice – again it was difficult to get at my left ovary, but she had me push down which makes it a bit easier.  She took a bunch of pictures of my uterus and then of both ovaries.  When we were done she told me that I had a bunch of smaller follicles less than 12mm on my right ovary and I had some of those on my left but two follicles at 14mm each which looked good.

I left and headed to work and now I’m just waiting for the call.  14mm is kind of small compared to what they typically look for when on Clomid (18-20+), but they grow 1-2mm a day so I think they’re probably going to have me hold off on triggering.  Of course, I’m nervous because I am concerned this isn’t a good sign (why aren’t they as big as before?) but also because I am scheduled to fly to Chicago for work on Tuesday morning.  I know what is most important, this process, but it doesn’t make it any easier when I have other things going on that this is impacting. 

So – now I sit and wait for the call.  We’ll see what my P4 level is and if it is on the rise, which indicates preparation for ovulation, as I’m sure that will contribute to their decision as to if / when I’ll trigger.

More to come…and yes, two follicles means an increased chance of multiples…yet another thing to stress about!

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Cycle #2: CD7

So, tonight is my last day of taking the Clomid.  This time, the only real side effect I’ve had has been wicked hot flashes – I now understand what it will be like to go through menopause and holy cow, it is not fun!  No motion sickness this time, which is weird but I’ll take it!  My usually small fuse has been a tiny bit smaller, but nothing completely unreasonable and that could be caused by other things (stress with family, husband returning to his previous job, stress with work, etc…) so I can’t throw Clomid under the bus.

I don’t really know what to think – I feel pretty jaded by this whole process now and so I’m having less emotions about it and more numbness.  I am not sure if that is bad or good but it is what it is.  Also, life has been so hectic that I haven’t had as much time to think about it as usual so maybe that’s where some of the lack of emotion comes from.  I’m sure the results of the bloodwork and pelvic u/s on Friday will set off a flurry of emotions depending on the outcome.  I am really hoping that a) the Clomid works and my body is making a nice follicle or two, b) my body shows signs of ready to ovulate on Friday, and especially c) that the IUI can move forward and it can be done on Sunday or Monday so I can fly out on Tuesday for work.  CUTTING IT VERY CLOSE.

Other than that…same old, same old…  Looking forward to more concrete information on Friday.

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Seriously, I’ll never question the abilities of Aunt Flo again.  Holy shit.  I went to the Red Sox game last night (which is a whole other topic I’d like to forget…something happened to them when they left Spring Training i.e., they FORGOT HOW TO PLAY) and I started spotting again.  When I got home, it was heavier and when I woke up this morning it was just – wow – she’s here and she’s here with PRIDE. 

Ahh, PCOS, you’re freaking ridiculous.

So, I called Nurse Karen to see if we’re counting last night as Day 1 or today.  I suck at this whole cycle count thing.  But the good news is – we get to start the party again!!!!  Clomid and Ovidrel – here I come!

I spoke with Nurse Karen and we’re classifying today as Cycle Day #1 (CD1)!  So, here is the plan for our second cycle:

– Take two tablets (100mg) of Clomid starting on Thursday, 4/14 through Monday, 4/18 (CD3-7)
– Pelvic u/s and bloodwork on Friday, 4/22
– Ovidrel trigger TBD
– IUI procedure TBD

The funny thing is, if my body reacts similar to how it did in the first cycle, I would trigger on Friday, 4/22 and have the IUI on…Easter!  Maybe the Easter Bunny will bring me a sticky bean?!

Of course, Chris’s consent to thaw form expired a couple of days ago so he has to sign a new one and get it notarized before he leaves on Monday, 4/18.  Since he’ll be gone through 5/1 or 5/2 for in doc in Cleveland and training in Dallas (my husband is a pilot who was recently recalled from furlough to his position with Flight Options – a fractional operator), we’ll be using the frozen spermies.  He doesn’t get in from his last week with Cape Air until Thursday evening so he essentially has Friday to wrap all this crap up.  He’s stressed but we’ll get it done.  I am now so grateful that we decided to freeze his sperm – and there is no statistically relevant data to show that frozen sperm is any worse (or better) than a live donation.

And, because this is how my life works, I am scheduled to fly to Chicago on Tuesday, 4/26…  Here’s to hoping it all just “works out” and the IUI procedure happens before Tuesday.  I’ve already alerted my boss to the fact that I may have to change my flight to the afternoon on Tuesday or cancel it altogether but I really want to be on-site for these meetings.  We shall see.

And here’s a video with my RE – I have to put all my trust and faith in her that she will get me a sticky bean.  Positive thoughts…


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