Feel free to avert your eyes...

Hello again! I've kind of been buried in unpacking (it will NEVER END, will it?) and work and daily life crapola. It's amazing how quickly the weeks slip by, isn't it? Anyway, with all of these weeks slipping by, it seems my month of freedom is over and we are back in the reproductive technology saddle, and HOO BOY is it different this time around. To sum up, after giving ovulation induction plus timed intercourse the old college try, I was ready to eliminate some variables. Given the particulars of our situation (many antral follicles making it very difficult to mature only 1 or 2 follicles, no male factor), IUI would not have increased our odds of success and it came with a hefty price tag. This left us with IVF.

I could write a dissertation on the b.s. that is our health insurance racket industry, but I'll sum it up quickly. Our insurance covers diagnostic testing for infertility, but generally excludes treatment. This means that for ovulation induction cycles with timed intercourse, we were paying out of pocket for the meds, but all of the bloodwork and ultrasounds were considered diagnostic and therefore covered for the regular "specialist" copay. However, if you add in just the IUI procedure, the same monitoring bloodwork and ultrasounds are no longer just diagnostic; because there is an end therapy in mind, they are considered treatment and excluded from coverage. I guess this is pretty common because my clinic offers IUI cycles for a flat fee that, while still including a comma in the number, was not much more than I was spending on injectables alone. The one exception to the general treatment exclusion is IVF. Because my husband works for a Maryland-based company and Maryland is blessedly liberal on these issues, our health insurer is obligated by statute to cover three IVF attempts per live birth. For this reason alone, we have access to the treatment option best suited for our needs AND it is costing us significantly (significantly) less money than less invasive treatment options, never mind what it would have cost us out of pocket. It is a game changer to say the least; I'm not sure we could have done this without insurance coverage. At best it would have been a decision between buying the new house and trying for a baby. Needless to say, I am feeling beyond grateful these days. 

The gratitude is taking a backseat to feeling completely overwhelmed, however, when it comes to the actual protocol. It's Day 13, and we're in the Birth Control Holding Pattern. I had the mock embryo transfer on Monday, and I think it was actually more painful than the HSG. (It was either someone's first day on the job or they were using a speculum made out of two shivs. Unpleasant!) Next appointment, for the pre-IVF evaluation, is on my birthday and obviously getting spelunked is totes how I had hoped to ring in #34. After that, we're heading to Boston for the weekend, then returning home to start shooting up. I nearly died when this arrived at my door last week:
Behold: An entire cycle's worth of meds for the price of maybe a dose or two out of pocket.
Because it is totally cool for multiple follicles to mature this time around, we do not have to be quite as cautious as before, so everyone is very hopeful that the injectables portion of the process will be well under the 17 days of stims I had last time. This does not mean that there is not intense monitoring; there totally is. In fact, this cycle's super fun drama (to date) has revolved around the scheduling of my first post-meds monitoring appointment.

My appointment is on the 22nd, and that is a hard date -- no wiggle room. I have a business trip scheduled for that week, but I figured it would be no big deal. I told the colleague booking our client visits that I needed to be back in DC on the 22nd. We had only three visits to make, so I figured Monday/Tuesday/Wednesday, fly home Wednesday night, and we're good to go. Easy, right? I still cannot fathom why, but the colleague scheduled our appointments for Tuesday/Wednesday/Friday. When I asked that he reschedule the Friday appointment for Wednesday or earlier, he rescheduled it for Thursday. While I wanted to rip my hair out in frustration, I was cool about it. I mean, people undergoing IVF surely have to travel on occasion, so I asked my doctor who they could work with in the San Francisco area. I found a clinic near my hotel that my doctor could work with and that also had doctors considered in-network for me. My nurse sent them an order for the procedures I need, they scheduled everything, and all was well. Well, at least until I spoke to the finance people at the SF clinic. It seems that their policy is to require non-patients to self pay, even if there is a doctor there who is covered by their insurance. Self payment was going to be many dollars for basic monitoring bloodwork and ultrasound. I called my insurance to see whether they would reimburse me and they said, "Sure! Our negotiated and contracted rate is [less than half of that outrageous amount]." (Note to clinic: if a health insurance company thinks your policy is unfair? YOU'RE DOING IT WRONG.) At this point, I threw in the towel and decided to attend the last of the client visits via conference call because COME ON. 

Anyway, I have typed too many boring, rambling words (as usual), so I shall shut it now. Assuming all goes well (haaaaaaaa), we're anticipating an early September retrieval and a 5-day transfer. Cross some fingers and think good thoughts if you wouldn't mind, ok?


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