Costs

The hysteroscopy is going to cost as much as an IUI cycle.  I didn't want to think about it, but I raised the question of what if we decided to just stop here and not get into all this, but Papa Bear said he would want me to do the hysteroscopy and remove the polyp anyway because of the fear of cancer.  I don't think my mom's cancer was genetic, but it was such a freak kind of cancer that we don't know for sure.  Now we're having to look at which of the trips we had planned this fall (related to volunteer work but also then involving seeing friends we never see) we can cut so we can afford this shit.

Where to next?

Yesterday was our follow-up consult with the new doctor, now that testing is all done.  I felt too shitty about it to post last night, so I'm taking the plunge on that now.  We knew about the SHG and needing the hysteroscopy and still being scared of complications.  What we didn't know until yesterday is that my AMH has dropped from 0.87 in August 2016 to 0.47 in July 2017.  We also didn't know until yesterday that here in Georgia an IVF cycle costs twice what it did in Maryland 5 years ago.  Because of that, we're going to try IUI for a round or two, despite the odds only being 10-15% with my age and only one ovary.  I don't have much of any hope of it working, but we can at least afford to try it by then.  If it goes to IVF, we only get one shot.  We had to finance a car in January when we hadn't been planning to.  We might be able to get financing through a medical financing group to finance the cost equivalent of one brand-new sedan for a single cycle.  I highly doubt anyone in their right mind would finance us for the equivalent of two or more brand new cars, even with it being a medical loan rather than a commercial loan.

I hate my body for betraying us in this way.

Antral Follicle Count

The clinic called today with the results of my day 3 ultrasound and confirming the SHG results.  I had 9 antral follicles, which the nurse called "really good" for only one ovary.  I'm used to having more, but I know I was younger then.  For 35, is that actually good or is she trying to make me feel better?

The nurse did also confirm that the doctor wants to do a hysteroscopy to remove the polyp.  She said we don't have to rush to schedule it immediately, that it can wait until after our next appointment on August 8 (we're going out of town next week, and we have the older kids the week after).  I know Papa Bear and I are going to have a LOT of questions for the doctor, so I'm glad he can come to that appointment.  Another reason I'm glad to have moved to a clinic closer to home.  We had been talking about doing the hysteroscopy on a Thursday or Friday when we won't have the older kids that weekend so I can rest without worrying them, but we're going to have the kids every weekend in August.  There's also the question of how much it will be, given the deductible issue.  Overall, Papa Bear is freaking out as much as I am, if not more, and for the same reasons.

One Small Step

This is a really weird post to write.  I thought about writing it last night, but I didn't have the emotional energy to be able to.  I still can't believe I'm here.

I took my first pill of Clomid yesterday.  That puts me farther in some ways on the fertility journey than I've ever been before.  My ex and I had prepared to do IVF, but one thing after another kept getting in the way right before we could start the first shot.  So I have never actually taken a fertility medication before yesterday.  I've had a box of medications and syringes on my dining table for months on end before, but until yesterday I had never gotten to take a dose.

I almost didn't get this far.  I almost got stopped again right before I was going to be able to TRY something instead of sitting on the sidelines waiting for my turn.  My AMH level came back over the weekend and, because the doctor was in surgery on Monday, did not get read until late in the day Tuesday (my day 2, when I was to start Clomid on day 3).  The nurse had called me, but I wasn't able to call back before 5 because I was with a client.  She left the message that she needed to talk to me.  So of course I was panicking all night Tuesday night, and I was right to.  Yesterday morning, the nurse called to tell me that my AMH was 0.87.  According to the website I had been looking at, "low normal" is 0.7-0.9 and "normal" is 1.0 and above, although it said there was disagreement about where the borders between categories really should be.

Through the nurse, the doctor first said that he was not going to prescribe the Clomid and that I should see an RE.  I completely broke down sobbing on the phone with the nurse because I was pretty damn sure that there was no way we could see an RE this calendar year, between leave for Papa Bear (especially with his boss about to go out on paternity leave) and the question of whether appointments would even be covered, even with an endometriosis diagnosis.  And all the while that we can't get in, months and cycles are ticking away.  We had to wait months to be able to afford the HSG before having a chance to try, months of eggs dropping away unused, and now it was going to be even longer, making my ovarian reserve worse!

I was lucky that the client I was on my way to see canceled, so I went to church to talk to one of the pastors.  Just before the pastor prayed over me, my phone rang, but I let it go to voicemail.  As I left church, I checked my voicemail, and it was the nurse.  She said that she talked to the doctor again and reminded him that we really couldn't go see the RE, and he decided to write the Clomid anyway.  He said that he did not think our chances were good, so he would rather we work through the RE for their expertise.  But since we can't, he's at least going to let us try.  We also have estrogen for days  8-12 and progesterone pills for after day 18.

Papa Bear asked me how I felt after taking the first pill yesterday.  I didn't really know what to say.  I didn't feel bad, but I was afraid to feel good.  The best description we could come up with between us for how I felt was "guarded."

We're trying to get information on what is and is not covered (after our massive deductible, of course) if we can see an RE.  The first answers we have on that raise some questions for us, and especially Papa Bear to address.  It turns out that IVF is covered at 80% (which a lifetime max benefit of $2000, so it's like they pretend to cover IVF and really don't give a fuck), but IUI is not covered at all.  Papa Bear is Catholic.  IVF isn't allowed by the Catholic church.  Amusingly, IUI is, but only if the sperm is gathered from a condom after sex.  That could make getting samples in the little room at the clinic interesting, since even if we can't do IUI, there's still the testing for him that the clinic will want.

So yeah, it's been a weird couple of days.

Sped-Up Alphabet Soup

Turns out that with my CD1 being on a Thursday and the clinic only doing HSGs on Wednesdays, they want to do it tomorrow instead of next Wednesday.  So it has been a mad rush trying to get the right form sent in by my doctor and get the antibiotic called in and picked up and the insurance information in.  And now I find out that I have to pay for it tomorrow rather than being able to have a little spare time while they ran it through insurance, since there's still thousands of dollars left on our deductible.  I was hoping to be paying it AFTER rent was paid; I just felt more comfortable that way.  So much for that.

And now I'm scared.  Scared that the pain will be worse than I remember.  Scared that it will be bad enough that I won't feel up to orchestra rehearsal that night.  Scared of even getting there on time because I had to put in a client appointment at noon when I have to be there at 1:45 and the clinic is an hour away from my office.  And scared of what they will find.  Scared that my other tube is broken too.  Scared that I'm going to need more surgery to "fix" the endometriosis.  Scared that even with more surgery my tube won't be salvageable.  Just, scared.  I found myself crying as I was driving today.  I don't remember being scared before my last one, but before that one I was so desperate for answers.  Now I have enough answers to know that having more answers may hurt more than it helps.

So Now What?

I had my doctor's appointment today.  It was SO hard being there while not being pregnant, especially since it was the first time since the follow up appointments after the surgery.  I was crying in the waiting room, although I was able to distract myself with my book and my silly Game of Thrones FB game.

It was better once my doctor came in.  He greeted me with a hug and immediately understood how hard it was for me to be there.  He said he had been rereading his notes from my case last year and that the hair on the back of his neck had risen again at how close a call it had been.  One thing that I have appreciated with him has been that he has been very human through this.  It would have been harder if he had been more of the "I'm always right, even when I'm not" type of doctor.

I told my doctor what has been going on, what symptoms I have been having that make me think the endo is back.  He confirmed that there was endo tissue that he hadn't gotten on the left because there hadn't been time while keeping me alive.  However, he also said that the symptoms I've been having may be more consistent with polyps than with endo.  He did say the pattern I have been having with my cycle falls into the realm of "normal" but could also make sense with the endo still being a problem.  I did forget to ask what stage the endo had been, so I'm going to call the nurse tomorrow and ask.

The key thing that he said, though, is that now that I have been diagnosed with endo, I can get things covered by insurance because it's testing and treating the adhesions from the endo, a diagnosed medical condition, rather than treating "unexplained infertility."  The first things he wants to check are the possibilities of polyps, a luteal phase defect, or another blocked tube.   He wants to do a kind of ultrasound to look for polyps, and he wants to do an HSG to see if adhesions are blocking my remaining tube.  I'll be calling around for prices on the HSG since that isn't in his office and even though insurance would cover it, I still have to be price-conscious because of having a deductible.  To check out the possibility of luteal phase defect, he wants me to start doing OPKs again so that he can then test my progesterone level a week after ovulation.  I wonder if I should start doing BBT again to go with it.

Depending on what we find out, we may be looking at anything from oral progesterone to Clomid to IUI.  Whether it falls into what insurance will cover or not, I can do anything short of IVF with him instead of with a fertility clinic.  I feel good about that, at least.  I know that, after what happened last year, he will pull and work anything he can to help us.  He thanked me for coming back to him after what happened, but it's what felt the most right, both because of how committed he is to us and because of the midwives there, who kept my son from being a c-section.

We will see what happens, but it's nice to be able to do something other than wonder and then despair every month.

Doctor, Doctor, Gimme the News

Tomorrow morning I go back to the doctor who had done my D&C and, in the process, found my endo.  It's time for my yearly fun appointment, with all the fun since my mom died of a gynecologic cancer.  I need to talk to him about it seeming like the endo is back and discuss what we should do about it.  And then I most likely get to consider the finances and whether to pay for more surgery if it's recommended or whether to keep masking it with NSAIDs.  Fun timing, especially since this Sunday will be a year since we found out I was pregnant with Otter.

#MicroblogMondays: The Finances of Miscarriage

Not sure what #MicroblogMondays is?Read the inaugural post which explains the idea and how you can participate too.

I'm on several Facebook groups related to miscarriage, and this article just showed up in my feed from one of them.  I hadn't thought about how much miscarriage would cost for other people.  When I thought mine was a "normal" miscarriage, I was thinking about how this baby that we had wanted was gone, dead inside me.  I wasn't thinking about the cost to us for appointments or the surgery.  I get reminders of the economic impact of my surgery frequently, as we are still working on paying the bills ($4000 or so?), but blood transfusions and an ICU stay will do that.  I didn't think about what other people would pay or what I would have been paying if mine had been a "normal" D&C.

Food for thought, especially in this age where "everyone has insurance" means "we act like we'll take away your tax money, but we know you don't pay taxes because you have no income and we won't actually give you Medicaid until you're already dying of cancer and unable to be saved instead of 2 years earlier when it could have helped."  No, I'm not bitter.

Decisions, Decisions

I got a call from my nurse earlier today, and the cycle is officially dead before it began.  Again.  After having said that the pre-implantation genetic diagnosis (PGD) probe needed to be done before I started shots, my doctor switched up on me (again) and said that he won't let me start pills until it's done.  This is at least the second time he's switched things up on me, after originally saying that he would prefer a day 5 biopsy instead of a day 3 one and then changing "would prefer" to "will only do."

My nurse is also pissed at this point.  She's pissed at the gene lab for putting her in the middle and telling her to call me and tell me they needed parent samples rather than calling me themselves.  She's also pissed at the gene lab only saying at first that they wanted samples from my parents and then later saying they actually wanted samples from both sets of parents.  She's also pissed that I did what I was supposed to and that other people not doing their jobs is what is preventing me from cycling.  So at least I'm not the only one that's pissed.  She and I were kinda yelling to (and specifically not *at*) each other on the phone today since we were both upset.

So where does that leave me now?  Well, for one thing, swinging back and forth between numbness, tears, and anger.  Especially with getting the final word from my nurse, it's a good thing I had called in sick today (I'm basically ok, but running a bit of a temp and just feeling crappy), because I would have had a hell of a time holding it together for clients. 

It also leaves me with a major decision to make, about whether to cycle in one month or three, and I'm interested in opinions.  DH told me it was my decision and that he was ok either way.  Two months just isn't an option because of an event at the end of June that DH and I are running. 

If we cycle in one month, we have to have the probe done (which takes 3 weeks after they receive the samples from all 4 parents) by April 21.  Overnight FedExing of the sample kits each way, but I'm not going to have the last address until tomorrow at best.  I'm scared of the probe not being done in time and having to go through this emotionally again.  Cycling in one month would also mean missing something at the end of May that is fulfilling to me.  I've been told my friends will make it be ok if I choose to miss it, but it's something I get a lot out of and a chance to see friends I rarely see.  Cycling in one month would also make it possible to get a second cycle in before my plan year ends on 9/30 (DH's plan year is 1/1 to 12/31).  I have an out-of-pocket max of $3000 and an employer-paid deductible of $1500.  This year, we put the other $1500 on DH's flex spending account both so that we didn't have to pay taxes on it and so we had it all at once instead of having to save it up.  For a cycle after 9/30, we would need to either pay the $1500 between deductible and out-of-pocket max by gathering it together between 9/30 and the end of the year or by waiting for that next cycle until January 2013 so that we could have a new year's flex spending account.

If we cycle in three months, I don't have to miss my May event (although I would miss it next year if the cycle worked, but then I'd miss it less because I'd have a baby), and I don't have to be scared of the probe not being completed in time.  I would start shots while DH is at or just coming back from a curling trip (yes, in the summer), but I would be about at or already at the beach with my family, and several of my cousins are/were nurses (one's a doctor, but I dunno if he'll be there).  *Insert Smithers-like tapping of fingertips together*  I would have to wait longer to cycle, though, and I don't think there would be any way to get another cycle in before my insurance plan year ends.  So IVF #2 would entail either waiting until January or coming up with $1500.  Which I know isn't an astronomical about, but still.

I don't need to make a decision right away, but I do need to make it soonish since I need to buy plane tickets if I'm going to the thing in May.  I'm working on getting the sample kits out to the parents right away either way, to leave myself that flexibility, although if it takes long to get those back, that'll make the decision for me.  It feels like the two main things driving me right now are fear of the probe not being done in time for waiting just one month and not wanting to miss the May event.  What do y'all think?

This Roller Coaster is Making My Stomach Hurt!!

So last night I was jumping up and down and crying and wanted to frame the approval letter (especially after having gotten one the day before that extended the amount of time they had to decide further than it had already been extended).  And last night I was sobbing on the kitchen floor after opening another letter.  And today things are ok again.  No, I'm not Bipolar, I promise.  This process is, though!

The second letter came from the PGD lab in Maryland.  The one that had told me that they took my insurance and were in-network.  The one that my insurance company had confirmed was in-network (not that I trust CareFirst for anything anymore).  The letter said that the lab did not take insurance payments, only check or credit, and that the cost was $6250.  It's a good thing DH was home already when I opened this one, because I think that's what kept the meltdown from being fairly epic, him calming me down (kinda).  As it was, I was still trying to figure out how many years this would set us back.

My mom pointed out when I talked to her about it that all was not lost and that this didn't necessarily mean that insurance wouldn't pay and that I could possibly pay out of pocket (possibly with a loan from Dad) long enough to get reimbursed by the insurance company.  I still don't trust CareFirst for anything, so this made me nervous, but I was up for talking more to Mom about it over the weekend to explore the possibility.

This morning, I got a call from my nurse, who said she had spoken to the people at the PGD lab and they needed my insurance information.  Wait a second, what??  I thought they had just said they didn't take insurance payments!  So I called the finance person at the PGD lab, and she said that they do actually take insurance payments, they just prefer not to since many insurances don't cover it.  As I gave her my insurance info, I sagged in relief, which is probably what kept me from hitting the roof at them having frightened me like that for nothing!  I'm still pissed about it.  I wish I could just tell them what to do with that letter, but they're my only chance of being able to do a day 5 biopsy without freezing the embryos with money we don't currently have, since they're right across the hall from my clinic and can therefore get and test the samples in time for a day 6 transfer.

DH thinks that by the end of this, I'll end up writing a book about the finances of infertility.  Mom thinks I should see if there are organizations out there to help couples with the insurance issues of infertility and start one of my own if there aren't any.

Like I said in the last post, this weekend (along with Monday) was a nice interlude where the whole IF thing and the whole fighting-with-insurance-and-the-clinic thing weren't bothering me so much.  It was a good break, but definitely bracketed by a lot of frustration and struggle.

When last we saw Our Heroes, they had just learned the various downsides of the California lab for PGD and were planning to make an appointment to figure out why the heck the RE would be wanting to use that lab.  Our Heroes had also at that point been waiting for 2 1/2 weeks for the medical necessity letter from the clinic to appeal the IVF denial (which I am now comparing to an insurer authorizing bypass surgery without authorizing the opening incision).

Well, we're still waiting for that letter.  The nurse called last Wednesday and said that she was going to follow up because she didn't see the letter in my chart.  I left yet another message for her today because I haven't heard anything.  I'm going to follow my one friend's advice and start calling the doctor instead, leaving messages every day until I get the letter.  I shouldn't have to do that, but nothing gets done if I don't.  Oh, wait, nothing was getting done while I had been calling the nurse every day either. 

I had called to make an appointment to try and get some answers, and got an appointment for the 25th.  Then DH told me that day was bad.  So while I was making calls today, I went to change that appointment.  Best I could get was the second week of February, and it had to be Friday the 10th since the other days that week I will be in a class in the mornings. 

Since I hadn't been getting calls back from the nurse for days at a time, I called the Maryland PGD clinic to try to get some answers.  They can do the testing without a $375 courier fee and without samples from our parents that we pay out of pocket to get tested and without taking 8 weeks to make the probe.  It would take them 3 weeks to make the probe, but that would all be covered in the cost billed to insurance, and 3 weeks is a hell of a lot better than 8 (plus the time to get samples to them from Egypt and several places in the US).  I also found out that this lab and Shady Grove have...differences of opinion...that are why they don't prefer to work with each other anymore.  I was afraid that SG was going to refuse completely to work with them and force me to go to another clinic (which would require 25-30 mile drives in rush hour traffic for monitoring appointments), but my nurse did say when I had caught her last Wednesday that they would work with the lab if people's insurance didn't cover the California lab.  So I'm going to insist that they work with this lab whether they damned well like it or not.  Just as I'm going to have to insist that they do the day 3 biopsy and day 5 transfer if they want my business, since we just can't afford the day 5 biopsy and later FET (especially not after having to spend another $300 on stuff from last plan year now that the insurance stuff from then got straightened out).

So now the plan is to badger the RE till I get my letter, appeal CareFirst's moronic decision, and insist on the RE using the Maryland lab and doing a day 3 biopsy.

And while all this is happening, I've been lapped by yet another person.  Maybe, if I'm lucky, now that I've gotten these posts out (I was going to write most of this last week, but every time I was going to it just seemed like it would take too much energy) I'll be able to concentrate on what I started trying to do 5 hours ago and have to get done before bed.

Fading into the Distance

The last couple of days have been...well...educational.  I ended up finding out that CareFirst, in their infinite wisdom, had denied the IVF for not trying IUI first while still approving and authorizing the PGD!!  (For those who aren't aware, it's impossible to do PGD without doing IVF.)  Between DH and a couple of friends, we've come to the conclusion that CareFirst's decision-makers are the monkeys that weren't smart enough to be locked in the Hamlet-writing room.

To make life more fun, I had a scheduled phone call with one of the genetic counselors at the PGD lab in California that my clinic wants to go with.  (Why they want to go to one in California when there's one they talk about on their website that's across the hall from the main clinic in Rockville, I don't know, but that's a question for another day.)  Apparently this clinic doesn't work with the genetic testing place that has a patent on actually looking at the gene, so they have to look at whether DH and I transferred the chromosome 5 from our moms or our dads.  To do that, they have to get genetic samples from at least one of my parents and at least one of DH's.  Then they get the same testing on those that DH and I got to see which of each of our parents is the carrier.  When they look at the embryo tissue, since they can't look at the gene itself, they have to look at, for instance, "OK, in this one Jessie's chromosome 5 came from her mom, so that one's the carrier.  DH's chromosome 5 came from his mom and she's not the carrier, so that makes that embryo a carrier but not affected."

So that adds into things time for them to send the sample kits to our parents, time for the sample kits to get back (when one parent out of four is overseas), time for those samples to be tested, and time for them to then create the primer (also with blood from me and DH).  Oh, yeah, and my insurance isn't going to cover getting those samples tested.  That's out of our pockets unless what insurance our parents have will cover it.  As is the $375 courier fee to get the eventual biopsied cells to California.  Yes, a $375 plane ticket for 20 cells or so.  Again, WHY do they not want to use the place across the hall??

At this point, it seems like all Shady Grove wants to do is make us spend more money and time.  Now there's no way we'll get in 3 cycles (if they're needed, obviously) on this round of deductible and out-of-pocket max.  DH was asking if it might be worth going with another clinic, but the closest clinics other than Shady Grove are in DC and Baltimore, and that would SUCK in terms of going there for monitoring!!  I am going to make an appointment for another consultation, though, to try and figure out why the hell the doc wants us to go with the California people.  If I get the answers I need before the appointment, I can always cancel it.  Oh, yeah, and I still haven't gotten that letter of medical necessity for the IVF appeal from him!

I Don't Even Know Anymore Who I'm Supposed to Be Mad At

One thing that I forgot to mention yesterday was that I tried to check with CareFirst and make absolutely sure that the PGD had been requested along with the IVF, as I had been told by the fertility clinic's finance person, hereafter referred to in this blog as Finance Bitch.  (No, I don't usually go around calling people a bitch in anything other than a momentary expression of frustration.  But this woman seriously is.  I'm not expecting her to be all bleeding heart about the subject because she gives almost as much bad news to people as their doctors/whoever calls with beta results, and as a therapist I can see how it would be too hard to get emotionally caught up in every couple.  But by the same token, she does give a lot of bad news, and that warrants an attitude at least a little more considerate than one that says "oh well, sucks to be you.")

So anyway, since I was already calling CareFirst to try for the second or third time to find out who was in network for PGD, I asked about the status of the authorization request for the service.  The woman I was on the phone with said that she did not see an approved authorization for it.  I asked about pending/denied authorizations, and she said there was one open request.  I asked specifically what procedures had been requested in that auth, and she said that she couldn't tell me.  I asked to speak to someone who could, and she said that no one could tell me what had been requested, even if they could see the information.  Why, you ask?  Apparently because I'm only the patient.  They're only allowed to discuss that information with the provider, not with the person whose body the procedures would be done on.

Today I come home from a day of work that involved helping others through a loss there that I'm also grieving myself, and I see that I got the denial letter from CareFirst.  It says that authorization has been denied for the procedures of IVF, assisted hatching (a necessary component to the PGD biopsy), and ICSI (intracytoplasmic sperm injection, recommended for us both because of the PGD and because of an extremely minor thing with DH's numbers).  Nowhere there is PGD mentioned.  I really hope that's because that's considered a separate authorization request that is still pending.  Because if it was never requested, I'm going to blow a gasket.  Because it might be Finance Bitch's fault that I won't be starting my first IVF cycle this weekend.

At least the basketball game was good.  My throat hurts from yelling, but my Terps looked good out there, and I was impressed with our 7'1" freshman that started for what I think is the first time tonight.

One Major Answer Acquired!

I was feeling really bitchy and whiny about having to go into work today with no time off at all.  After all, I avoided retail jobs so I wouldn't have to do that shit!  In the end, though, I'm glad I went in today (although I'm also glad I went home a little earlier than planned and took a nap).  Why am I glad I went in?  Because when I opened my work email, I saw a message from the CareFirst lady (not the one I had been dealing with all week, the one I had gotten some answers from back in September).  Now, the amazing thing is, she emailed me back on Saturday.  I could have checked my email from home, but I didn't expect her to email me back after not being able to reach her for days!  She does earn back some of the points she had lost for being impossible to reach by emailing me back on Christmas Eve, whether she celebrates or not.

So, which answer did she give me, out of the many I have been arguing/begging for?  The Out of Pocket Max DOES apply for infertility treatments!!  And unlike when she told me it should back in September, this time she attached a PDF of the 150-page plan booklet AND told me where in there to look!  So now I have a listing of what the exclusions are for the OOP max, and infertility is not on there.  I'll take a copy of that section over to the clinic on Wednesday.  I also need to call/email my nurse tomorrow and check on the status of the letter of medical necessity for the IVF appeal.  And check with CareFirst about who's in network for PDG now that I have a better idea of what companies to ask about.  And get the process started with whoever is in network.

But the important thing is that now I know that I can go ahead with those, secure in the knowledge that the amount we had budgeted and put in the FSA will be enough for anything and everything non-cryo-related.

Coming attractions in this space: Book review of What He Can Expect When She's Not Expecting, by Marc Sedaka.  DH read this a while ago, but I just got around to reading it after DH pulled it out to explain that I wasn't at the top of the Wife Psycho Scale even in the middle of last week.

I Used to LIKE Roller Coasters!!!

So I got a voice mail from my nurse this morning.  My RE had been out yesterday when we were playing phone tag, but she grabbed him this morning and found out that he wants to just do the day 5 biopsy and FET rather than giving us the option of the day 3 biopsy and day 5 transfer.  ARGHHHHHH!!!  I left her a voice mail asking if we can insist on the day 3 biopsy and day 5 transfer, because we really just can't afford the cryo costs.  So at this point, the answer to whether we can insist on the day 3 biopsy and day 5 transfer is also the answer to the question of whether we can go forward with a cycle anytime soon.  Of course, just to make life more fun, it's too late to change the amount that we put in DH's FSA, so we can't raise the amount to be enough to cover cryo, but we also can't decrease it based on not doing IVF at all.  So if the RE continues to insist on the day 5 biopsy plus FET, we may be in the position later in 2012 of deciding whether we want to spend a couple thousand we can't afford on cryo or lose the $1500 that's in his FSA because of not doing a cycle.

Querying the Blogoverse

OK, now that I'm ready to talk about Friday's appointment, I have questions for those who have done PGD.  When I was reading online, I only saw information about PGD done on day 3, with a day 5 transfer.  My RE was talking about that option, but also about doing a biopsy on day 5 and freezing the embryos for later FET.  Did y'all have that option?  Did y'all do day 3 biopsies or day 5?  Did you get more/better embryos to transfer by doing day 5 biopsy?  At this point, we might have to insist on day 3 biopsy and day 5 transfer because our insurance doesn't cover freezing, and we can't afford the cost of freezing, storage, and thawing.  Everything else is covered by insurance, but not that.

I did find out from the insurance company today that there is no waiting for approval for IVF since we're using an in-network clinic.  Now I just need to hear from the case managers at the insurance company about where is in network for PGD and fertility pharmacies, as well as whether a day 5 biopsy and later FET would count as 1 cycle or 2, since apparently insurance companies differ in how they count that.  Since we get three cycles per live birth covered, that is a key question!

Orange Crushed

Wow, I feel like a fucking idiot.  I didn't give the RE's office my new insurance card ahead of time, so I got into the finance office all excited about starting a cycle on about January 1 with almost perfect timing (if nothing was screwy with the genetic testing people) and found out that insurance companies take 4-6 weeks to approve IVF.

I think it was 20-30 minutes before I stopped crying.  Mostly.

DH was really supportive, telling me I haven't ruined everything and that I didn't know, it's not like I did it on purpose.  I feel so stupid, though.  I should have known.  I should have given them the new card when my insurance changed.  Or gone over there with a copy of the new card when I made the appointment (even though that was still less than 6 weeks from when we wanted to start a cycle, I think it was more than 4).

I called in crazy to work, at least for the morning.  I'm already 3 hours ahead on the pay period anyway, the two clients I had for the morning are ones I can easily reschedule, and I'm just not in a state at the moment to be emotionally present for clients.  I know I will be ok, but I'm not ok right now.  I told my boss I'll decide about the afternoon once I see to what extent a couple hours of kitty therapy (and a nap) help.

The Big Day

Well, I'm 30 now.  As I was on my way to bed last night (ok, early this morning), I was thinking that it felt weird in its very lack of weirdness.  I know I'm not any different than I was yesterday, and I didn't feel any different than I did before midnight, but it felt like maybe something should feel different.  Which is completely silly, I know, but anyone I know IRL can tell you how silly I am!!

I did get about the best birthday present possible from my friend K last night.  After she had shared her wonderful news, we were talking about what would come next for us, and I told her that we were hoping the finances would work for a cycle early next year.  K and I were talking about flex spending accounts, though, and she reminded me that if we use DH's FSA, the money is available as soon as the year starts.  I had completely forgotten that about FSAs because neither DH nor I has had one available to us for about the past 3 years.  Even better, K and I had this conversation during DH's open enrollment time, so we didn't have it too late for him to enroll, nor did we have it (this time, since we have talked about it before) so early that DH and I would forget by enrollment time.

Also, since I'm flying somewhere in January and was hoping to get by with just a carry on, K let me know that I can take the needles on the plane if I'm that far into the process, as long as I have the medical necessity paperwork with me!

So I'm going to see (just not today) about making an appointment to discuss timeframe.

ICLW #2

As we get into my second International Comment Leaving Week, it's been an eventful week over in this part of IF-land, rife with hard financial decisions.

For those new to the story, DH and I are currently stalled out waiting to find out whether he is a carrier for spinal muscular atrophy, like I am.  Finding out that I'm a carrier killed our cycle from last month before it started and pushed us into a new insurance year and new insurance plan, taking us from no coinsurance for IVF to $1500 coinsurance.  We've been waiting for insurance coverage for DH in order to get the testing done.  He could have gotten it done while he was on my insurance this month, but it's taken two weeks so far to find out what effect that would have on the HSA that covers my deductible.  His new insurance will take effect this weekend, and once we know his insurance numbers, we can order the test for him.  We can't really afford to do the test at this point, since it would fall under the deductible and thus come out of our pockets.  At the same time, the emotional cost of being stalled out is high enough that DH said tonight that we can't really afford not to do it now either.

Speaking of costs we can't afford, my oldest cat, Kechara, was sick again over the last couple of weeks.  Through it, we found out that even when he was healthy, he was losing weight.  He's lost 5 pounds over the last year or so.  The vet said last night that if his labwork came back normal, which it basically did, that we'd be most likely looking at cancer.  However, there's no way to tell unless we do an x-ray ($150) and possibly an ultrasound (a couple hundred dollars).  And if we find out that he does have cancer, we'd have the question of whether surgery would be helpful or harmful and, if it would be helpful, whether we could afford it.  There would be no way to afford it without putting our dreams of IVF on hold for a while longer. 

So I'm feeling caught between whether to possibly save the life of the furry child I have now or whether to create my possible human child.  Either way we're looking at uncertainties and possibilities.  I don't know if Kechara has cancer.  I don't know if we would be able to conceive on the first try with IVF.  I don't know if he does have cancer, if it would be operable (without hurting him more than it helps).  I don't know if we could become pregnant through IUI instead of IVF.  I don't know how long Kechara would live if cancer was able to be surgically removed...he's 12 years old, but before last year he was perfectly healthy despite being overweight.  I don't know anything except that it will break my heart whenever I do lose Kechara and that it's breaking my heart not being a parent to a human child. 

Held Back Again

I feel like I'm one of the kids I knew who was held back in Kindergarten, unable to get past what should be the easiest part. 

I got the call back from the genetic testing people this morning.  The test is $500 if they run it through insurance, and he has a $500 deductible which of course he hasn't met yet because he's DH and he never gets sicker than a cold. It would be only $350-400 if it was just paid by cash, but we don't have that kind of money either. 

So, we wait to see what his new insurance covers.  Fortunately, his insurance will kick in as of the first day of the new job, with no 30 or 60 or 90-day probationary/waiting period.  Unfortunately, he won't find out anything about the 4 plan options until that first day, so his insurance will backdate to the first day but we will still have to wait while we make a decision and the paperwork goes through.

It's hard for me to even write this, but I called my nurse a few minutes ago to say we had to put everything on hold for however long.  A couple of my coworkers told me to ask if they do payment plans for the patient part of things so we could do something sooner than the middle of next year, and I didn't think they did but I checked anyway...I was right.

So now we wait. Again.  Our nurse at work had her baby a month early (prayers are needed for them both...she had a ruptured placenta, and the baby is in the NICU at Children's), and now I'm wondering every day as I go in who's going to be the next one to announce.  After all, it doesn't seem possible at this place to NOT have someone pregnant, and it's sure as hell not going to be me, so someone's got to fill that gap.