HOLY FUCK!!!!!

Today is my “desk day” where I sit down to go through all my paperwork and make all the phonecalls I need to make. One of the things I needed to do is call our insurance to get details on what is covered and what isn’t, as well as figure out who exactly needs to send in the paperwork for the pre-authorization, and when, since our appointment is coming up very shortly. So I’m pulling out all my paperwork to refresh my memory and prepare myself for this call, jotting down questions, etc. I pull out the insurance member guidebook. We had gotten a new one last week but I had filed it away and not paid much attention. This is the first time I flipped open to the Infertility Services page and really read it.

OUR INSURANCE NOW COVERS IVF!!! To say my jaw dropped open is an understatement. I am in shock. It only covers 2 cycles of IVF, GIFT or ZIFT, with a maximum of 2 embryos transferred each cycle, and there is some other restrictions on it that I can’t seem to make sense of right now, but holy fuck.

(The “other restrictions” I can’t seem to make sense of, it says this: ” These cycles are not covered when the Member has not been able to conceive or produce conception or sustain a successful pregnancy through the less expensive and medically viable treatments covered by this Plan.” Somehow I think that’s a big typo. Because otherwise that is just stupid – if you could get pregnant with a lesser method you wouldn’t have to do IVF, DUH.)

Is this life’s way of making up for the medical problems we just found out about with the dog? This timing is just… eerie.

:: ::

I just got off the phone with the insurance provider’s CSR. I must say, she was very helpful and very nice. Wow, what a shocker. She did point out that Den is covered by the federal government so they don’t have to follow state mandates, which I already knew. She said only IUI is covered and I read to her what the new book said. She was surprized and went to check it out herself, came back and confirmed that it was correct. She said, “Wow, that’s excellent!” LOL! She said they get calls from federal employees now and again, in regards to infertility coverage. I’m sure most of them are not very happy to hear the feds don’t cover the same as the rest of MA.

So in any case, she confirmed with me that I do not need a referral for an RE visit. I was a little bit confused, because I got the package of information from the RE’s office earlier this week and it has a letter in it about different types of insurance and that people with HMOs need to bring a referral from their PCP. Apparently we have a special kind of HMO, it’s an HMO Open Access, which means you don’t need any referrals for specialisits, as long as the specialists are within the insurance network (which the RE is).

She also said that we do need pre-authorization, but it’s something that the doctor will fax in once we decide what we’re doing. So I guess nothing is needed for the initial consultation, just when we decide we’re going to do x drugs or do IUI or whatever, then he needs to fax it in to get authorization from the insurance company. I’m sure the RE is well accustomed to dealing with insurance at every bend. They have a financial officer who is there to help with insurance issues as well.

So when I got the package I filled out the questionaire all about me and my cycles and our family histories, etc etc. Den was grumpy when I asked him what his weight was, lol. They say to hand-carry any pertinent medical records to the visit. I don’t know if my bloodtests are important, but I suppose I’ll get them just in case (they were not the day-3 bloods or anything else, they were checking immunities and thyorid function). I already have a copy of Den’s SA, yay me for being on top of things. (The first thing I said to Den that day was, “When he calls you, get him to fax it to me!!”)

Balls are in motion. Let’s just hope they don’t flatten us.

Ovulation must be coming up, my body is screaming “fertile!!” I told it to screw off, a whole lot of good “fertile” has done for us the last 12 cycles. I’ve taken a total of 2 tempertures this month so far. I just don’t care. I don’t care if we have sex, I don’t care when I ovulate beyond wanting to know when AF will be here so I can plan… but seeing how I ovulate very regularily on CD15 I’m not too concerned about that either.

I feel less obsessed this month. I’m kind of coming to terms with the idea that kids might not happen very quickly, if at all. I know that’s a large leap to make, but when you have no idea what could be wrong and nothing seems to be working right you start considering all the possibilities. So I’ve dialed it back a bit.

I’m still angry and resentful though. I find myself reading less and less pregnancy-related things. Some I’m okay with – but seeing more people announce pregnancies just gets harder and harder. I don’t want to deal with it anymore. I don’t want to have to put on my happy face.

I’m still not temping. At this point it’s not even worth bothering, since I don’t have enough of them. But we had sex. Which means timing should be decent, provided I ovulate normally. I guess I wanted to make sure I had the good timing in, just in case… even though I think it’s pretty useless.

Of course, then again my body could just go and not ovulate. The one month I decide not to really pay attention because I’m always so predictable… I take my temp on CD16 and it’s really low. WTH?

The land of (in)fertility is so busy right now. On the forums I’m on one woman just had twin boys, two more women are pregnant with twins, and Soralis just found out she’s pregnant with twins! Wow! I am so excited for all of them, but I have to say that the thought of me having twins terrifies me. I have serious doubts as to how I’m going to handle one baby, much less two at the same time. Unfortunately there are already two sets of twins in Den’s family… so I’m getting a little nervous about starting any kind of infertility treatments that increases those odds!

In sadder news, one woman on the forum just lost her baby at 12 weeks. My heart breaks for her.

Kids just don’t really have much of a clue about things, but it seems the whole extended family is pretty ignorant to our plight (except my mom). Just now my cousin says to me, “Oh you remember ****? She’s expecting in May.” This is someone I haven’t seen in about 3 or 4 years, am not related to, was only aquainted with. I reply with, “Ahhh, that’s neat.” When really what I want to do is say. “That SUCKS. I don’t want to know that. I don’t want to know that the entire world is pregnant except for me. But thanks for pointing it out for me.”

Thankfully she’s only 13, and I can’t expect her to really understand how much it hurts.

Tonight I am photocopying our records in preparation for the RE appointment tomorrow. I really don’t know why it’s so unusual for a person to have a copy of their own records. I know I never thought of asking for my own records before all of this. And it’s so easy, too – not for everyone, but for me all it took was walking in and asking for copies. And for DH’s SA he just asked his doctor to fax me a copy. I get to keep it all right here with me. I actually know my numbers – what my TSH level was, what my lead level was. I am really liking this. I know some people never want to know and are happy with their doctors knowing everything and just telling them the end result; I am not one of those people.

In any case, other than making sure DH signed his release of medical information form they had sent us among all the other papers and getting those papers photocopied I really don’t have much else to do. Oh, I need to print off some of my charts, let me do that now.

Okay, that’s done, I printed off my cycle statistics too. (Not like they’re really going to be too interested – but I like to be prepared!)

Appointment is tomorrow morning at 9:10am. I’ll write about it afterwards.

The end result of the appointment today: No wasted month for us. Soon as I get my period I’m to call the office to schedule Day 3 blood tests and my HSG. Also on day 3 I’m to start my clomid. Which I take for 5 days. Then Day 10 I go in for an ultrasound to see if my follies are ready to pop and hopefully get my trigger shot. The day after the trigger shot (which may be Day 10, may be a day or two later, depending on my follies) we go in for an IUI.

So yeah, first cycle of infertility we’re doing clomid and IUI. Holy crap. Someone hit the pause button for a minute while I gather my senses.

The long story of the day is indeed quite long. We got there at almost exactly 9:10, the time of my appointment. I handed in the paperwork I’d filled out, they photocopied my insurance card, and we sat to wait. And wait. Someon called my name, but said it was just for quick vitals and I’d be coming right back. So I went into a little waiting room with a nurse person, she took my weight (139.4), my blood pressure (100/78 ) and my height (still 5’6″ ). Then sent me back to the waiting room, where we proceeded to wait again.

And wait. And wait some more. Other women would come in, sit down, get called in, and leave – and we were still sitting there. I know the others were only there for ultrasounds (which is what they typically do in the AM), and we were there for our first consult, but gahh. Den was getting pissed off, he was taking time off work this morning to come with me and he was muttering something about something he had to get done by noon at work. Over an hour later someone came out to apologise for the wait, said something I didn’t catch (something about the Resident who was supposed to be calling us in), and left. Shortly after that we were finally called into the back.

A male resident and a student (who just sat there, observing) joined us in an office room. He went over my form and clarified things, basically just asked the same questions that was on the form making me wonder why I filled it out in the first place. Then he left.

He returned with the doctor. She said nothing jumped out as obviously wrong. She explained what they do at the RE (which of course, me being an internet-researcher extroirdinaire) and showed me statistics for things. Such as, a couple dealing with infertility – which we now are – with no obvious problem has about a 4% chance of getting pregnant each cycle. Clomid + IUI raises that percentage to 8-12%. Injectibles (I forget what the name of the drug was) + IUI raises it slightly more. IVF is a 45-50%. She looked at what someone had write in my chart about my insurance – I guess part of the wait was them calling our insurance to find out the specifics of what we’re covered for – and told us that what they prefer to do is 3 cycles of clomi + IUI, then 3 of injectibles + IUI, then move to IVF if there’s still no pregnancy.

Which is all well and good but our insurance covers only 3 cycles of IUI total, 2 total of IVF (or will in 2007), and a max of $1500 in meds. I didn’t ask what she’d suggest for us with those limits – if we’d move to injectibles sooner or what. Grrr, put that on my list of questions to ask later. (Doesn’t matter for this month though, since I would not be comfortable doing injectibles yet.)

I’ll point out here that I forgot my list of questions. Yes – DUH. In all the ultra-preparedness that I was, I forgot the list of stupid questions. I did remember some though. I asked her if she was in charge of my case, if I would always see her, etc. She said that yes she will be my lead RE and in charge of any decision-making. She will probably be the one to see me for proceedures, but if she is not in then one of the other REs at the practice would see me – but again, if anything came up requiring a decision it would go back to her. There is also a number to call with questions, day or evening, and if the call is before 4:30 they will call back the same day; if after they’ll call back the next day. All sounds very good to me.

The one thing I’m a little confused/concerned about is that we’re going straight to full clomid with an ultrasound only on day 10. No clomid challenge test? And of course I forgot to ask about it. Sigh. I felt like the whole appointment was very quick once it got going. Not that they weren’t thorough – she gave me the feeling that she was very competent and knew exactly what she was doing, but for someone like me it was a little quick and didn’t quite give me a chance to gather my thoughts.

So then after the consult they sent me into an exam room to do a quick pelvic exam and ultrasound to make sure everything looked good. DH was kind of silly in an annoying way – he didn’t want to be in the room, and when I rolled my eyes and pointed to the chair in the corner and told him to just sit down he stared at the ground the whole time. Like he hasn’t seen my hooha many times before? Of course it didn’t help when we were sitting in the room waiting for someone to come in and I pointed out the dildo-cam. Apparently all the previous times I’ve explained about internal ultrasounds he wasn’t really paying attention because he looked at it, did a double-take and kind of squeaked a little. “That? They use that? Eeww!” Good grief. So we and the doctor got a bit of a chuckle at Mr Stare-at-the-floor. He just mumbled.

So the ultrasound showed a uterus and two ovaries. My ovaries had little black dots here and there, she said were follicles possibly from past cycles’ corpus luteum. She couldn’t definitively identify one that had released an egg this cycle, but did find one that was larger than the others and could possibly have been the one. I think it was on my left ovary.

After that the nurse/technician person came in with paperwork and such for me – instructions. They wanted Den to get some blood taken just to screen for diseases – he’s probably been screened for them before at work (military, remember), but they said it’d just be easier to get them drawn again and they’d have the results faster, and he didn’t care one way or the other. We went to get his blood drawn in the same building after we were done. She also handed me a blood draw script for my day 3, the instructions for taking clomid and who I’m supposed to call when (and who I can call with questions), and they gave us a brown bag with, yep, a semen sample cup. To be used for the IUI. The RE had also mentioned possibly getting Den’s SA done again. (Because they use a different lab than where he had gotten it done before – and personally I don’t disagree with them wanting it done by their own lab, since I wasn’t too impressed with the other one, it just didn’t seem… I don’t know.)

Afterwards Den was concerned with two things. One, it finally has hit him that we have some very stringent limitations on this based on our insurance. We get 3 shots at IUI, 2 at IVF, that’s it. Who knows what we could afford after this. I think he’s starting to panic a little bit. Of course I’ve been telling him all of this since I found out, but again I guess he wasn’t really paying a lot of attention and it only sunk in when the RE mentioned it. And two, he’s muttering and whining about possibly having to re-do his SA. Excuse me for not having a whole lot of sympathy here, but doing an SA again is very MINOR compared to what I’m going to be doing – even just with the IUI, it’s not going to be fun. I’m a little annoyed that they mention me doing an HSG and IUI and internal ultrasounds and taking medications that may make me totally crazy, and he’s whining about a stupid SA.

So, that was our first appointment. I don’t know what to think right now. I’m really glad that we’re moving ahead, that next cycle will really change our odds and give me hope again, that we won’t have to just sit around and twiddle our thumbs while tests get done. But on the other hand I’m really nervous about it all, that we’re jumping in with both feet, that doing day 3 bloods seemed to be an afterthought and she never even mentioned 7dpo bloods, nor a clomid challenge test. Not to mention I have the same fear as Den does – what if this doesn’t work? What if we blow all our paid-for chances, go through all of this, and we still have nothing to show for it? So yeah… I’m a little scared.

I’m up in the middle of the night thanks to an aching hip and a loud, unhappy cat, but things are a little clearer now. I think the reason I’m most on-edge and put off by the way everything went is because it’s not what I was expecting. I was expecting a month full of testing, then a month to start treatment. I expected them to be seperate. It seems a little bit odd (premature) to be starting treatment before you find out what’s wrong. Like what if I do the HSG and my tubes are blocked? We don’t find out until after I take the clomid. Or if the day 3 bloods show something wrong. The RE said that she doesn’t expect anything to be wrong since I’m young and everything else looks good.

I forgot to mention that she gave me an option. With the clomid and the IUI, to do ultrasound monitoring to know when to trigger, or to do OPKs to know when to do the IUI. She said they prefer to do at least one round with monitoring. But I’m under the impression that not monitoring with any ovulation meds is not a good thing.

I don’t know, the whole thing just leaves me full of questions and unease. I don’t have a choice in RE clinic, there’s only one in all of western MA. But maybe I should postpone the IUI until next cycle, after the testing. But if I do that, it means next cycle won’t be giving us much of anything in terms of possibility of getting pregnant. I do have the decision-making power here – it is my body – but I don’t do too well at making decisions like this.

I’m really feeling down because I didn’t speak up more at the appointment – this happens a lot, I’m the kind of person who needs to mull things over to formulate ideas and questions. Everything was coming at me too fast for me to be able to think. I could call in to ask questions, but that’s even worse because I have a pretty strong phone phobia. I don’t mind calling to ask a specific question, but I don’t have one, I have a whole slew of confusions. Maybe I could get another appointment to sit down with the doctor?? But that makes me feel self-concious.

I talked to Den about it and he’s very soothing and reminded me that I don’t need to have everything figured out right this second (a tendency I have), that I have a week before my next period will start. But he can’t really help me with decisions – he doesn’t know much about the whole thing and is happy to just go along with whatever he’s told (by the doctor, or by me). I need someone who has been through it to help me figure out what the hell I’m doing. I think I’m going to use the peer infertility counselling list over at Stirrup Queens to find someone to talk to. I didn’t realize until now what a great idea that is.

Okay, so Den fell down a little yesterday – he was probably feeling pretty overwhelmed with everything too. But I’m happy to report that he’s been very good after the fact. Last night he gave me hugs and kissed away my worried tears. This morning he encouraged me to call the doctor if I have questions, and to postpone things if I want to. He said if I feel uneasy about anything then I need to do something about it. He’s just very supportive. He’s always been like this (about many things, but specifically our fertility journey).

Right now I think the main thing preventing me from making a decision on the clomid/IUI is the fact that we only get 3 paid for. If we had unlimited I think I’d be much more okay with just going ahead and doing it now – what do I have to lose, right? And I think that’s where the RE is coming from as well – like someone pointed out on a forum, in the long run clomid/IUI is pretty cheap. But the fact that we only have 3 tries is making me very very nervous! Like we should plan it out better or something. Make sure we have all our ducks in a row in terms of testing. Oh yes, that’s my obsessive-compulsive side coming out. (And that’s a large part of my anxiety as well… because it didn’t happen “as I expected”. That always throws me into a tailspin. DH has been on pretty strict orders since we started dating that I am always to get lots of forewarning on any plans, and that I severely dislike surprizes. It’s just not pretty to see a grown woman freak out because some plans changed last minute. Just don’t do that to me.)

I guess I just have to keep reminding myself that the odds of the clomid/IUI won’t change, whether we do it next month or the month after. If the HSG shows something really bad it would probably just jump us to IVF faster, which wouldn’t affect the clomid/IUI cycle (or at least it wouldn’t mean we lost anything). There’s really no reason for me to go to injectibles unless clomid doesn’t work for me, because I’m not taking them to induce ovulation; if clomid gets me to release two or three good eggs we don’t want to go any more than that!

So I guess the question comes down to – what do we stand to gain by waiting an extra month? Other than possible peace of mind on my part. I mean what medically. Is there something the bloodwork or HSG could show that would affect the way we approach the medicated cycle? I guess that’s the money question. (And see, this is why I type all this out, even though there’s going to be an aweful lot of words the last two days. This is how I work things out. The true value of my journals is not for communicating with others, that’s a side benefit – the true value, to me, is allowing me to work things out. I think so much better with a keyboard under my fingers. The same is not true of working things out verbally, for me – I need to see it written down.)

Oh, did I mention the possibility of twins? Obviously increasing your eggs released from one to two or three increases your chance of having more than one baby implant. The risk is increased to 7-8%, versus 2% in the rest of the population. That sounds like a small number – better than, say 20%. But 2 in 25? Okay that’s starting to sound a little scarier. I know several people with twins now (or pregnant with twins) – and I think it is an amazing, wonderful miracle. Two of DH’s siblings have identical twins. So I see it in action. Raising two children who are the same age just seems like such a hard thing to do, and I worry about me being able to handle two. Not to mention my worries about carrying two babies to term. But yesterday, when Den and I were walking out to our truck talking about how these chances we’re taking to get pregnant are once-in-a-lifetime, I said even if we do get pregnant with one, say through IVF, we may never get a chance to try for a second if we use up what our insurance allows. I know, I know – let’s worry about the first before we think about the second. But we both really want two kids, and now we’re facing the idea that we might not ever get two – we have to face the possibility that if these tries fail we may not have any. And in that moment I thought, you know, it might be a blessing for us to get two at once.