The Egg Drop Post

It’s been a couple of weeks since I posted, so I’ve decided to do a run down of all the news that fit to print since my last post.

Fertility Update

Nadia and I went to see Dr. Feelgood earlier this month. When he entered the room, he said, ‘That last cycle sucked!” No, shit! He talked about my poor response, my age, and my post-fibroid uterus—all factors that will make it difficult for me to get pregnant. He said that we should and could try again with a different protocol. He said that I would probably never have a cycle that would produce 10 eggs but I could produce four mature ones and that could make all the difference.

I responded by telling him the truth. And the truth of the matter is that I’m not sure if I can keep going back there. I really admire him but I associate that office with 9 failed cycles and that’s a big hump for me to get over. I try to imagine myself getting up at 5 AM to go there for one of a trillion sonograms and my mind goes  blank.

Maybe it’s time for a something new?

At the same time, honestly, I don’t know if I have the fortitude to continue at all. I’m definitely not emotionally ready to start again anytime soon. It’s not so much that I didn’t get pregnant, even though that is extremely disappointing, but it’s also the fact that after all of the needles, medication, and sonograms, I only had one embryo to transfer. That makes me feel like a failure, and I told my doctor that. He was very sweet and understanding, assuring me that I’m not responsible for my ovaries or uterus. He told me that if I decided to change doctors, he would completely understand.

Nadia and I have an appointment later this month with another RE to get a second opinion and explore our options.

Insurance Update

But actually, he did have a bit of good news. Because his advocacy with my insurance company, I was given a bit of a reprieve. According to the company, I only have to self-pay for 2 more IUIs before they will cover another IVF. Prior to my doctor’s advocacy, I would have had to pay for 5 more IUI’s, so I guess there is a silver lining to this raincloud. I’m 2 IUIs away from receiving the infertilty diagnosis that I crave. The reason why I wrote, ‘self-pay’ is because this new insurance, the one that Nadia and I are paying extra for, doesn’t pay for IUI’s for women in same-sex relationships. But I guess paying for 2 more IUIs will be cheaper then paying for one more IVF. So, we’ll see.

One option would be for me to do two natural cycle IUI’s and then another round of IVF but who knows when I will feel psychologically ready for that?

The C-Word

So while I have been whining and writing about my fertility struggles, Nadia has been plugging along on her own medical trajectory. Last month she had a routine annual physical. Her doctor noticed some nodules on her thyroid and suggested she get a sonogram. At the time, I thought nothing of it because I read an article on the internet that said that 95% of all thyroid nodules are benign. What would cause me to think that she would be a part of that 5%? So Nadia had the sonogram, sandwiched between giving me fertility shots in the morning and evening and a full day of work.  After the sonogram results, her doctor told her to get a biopsy. Again we thought nothing of it. In fact, we were still very nonchalant about it.  A few years back, I had a biopsy in my breast and nothing ever came up it. It’s better to be safe than sorry right?

So last week, Nadia went in for a thyroid biopsy and it turns out that she has thyroid cancer.

Ouch!

I’ve never gotten punched in the stomach before, but I imagine that it feels as if the wind has been knocked out of you, similar to how I felt when I heard the news.

All my energy, anxiety, strength and hope are now focused on Nadia and her body and her struggle. Since I heard the news this past Tuesday, I’ve done a lot of research, and it turns out that papillary thyroid cancer is “one of the best cancers to have”, that is, if you have to have cancer at all. Most people have a 100% recovery with no incidence of recurrence but we have yet to see a specialist. We have appointments later this month and until then I am holding my breath.

I titled this post, “Rundown to the C-Word” but I should have titled it, “When It Rains, It Pours.”

It’s pouring.

Well, the IVF didn’t work. I’m not pregnant.

I’m pretty upset about it and will write  more later.

I have been writing this post in my head for almost two weeks. At the same time, I’ve been trying to remain calm and in my ‘pretty place’ so that I can be a welcoming host for my little one. But it’s time to let it out.

This is my tale of woe. It’s a story about the hidden cost of lesbian infertility.

In spite of my best efforts, my RE’s office did not start calling my insurance company for IVF authorization until 4 days into my cycle. I asked them in May when Nadia and I decided to move forward and I asked them again in July when I received my insurance card. I had the misfortune of speaking to the same receptionist both times and both times she said that they would get the procedure approved once I started. I was a bit leary of her, but at the same time I reminded myself that she did this kind of stuff all of the time, so she would know best. That was my first mistake.

One reason why I did not push it with her is because I myself had called my new insurance company several times to inquire about their fertility coverage. The first time was back in March and Nadia was on the call. In fact, it was Nadia who clearly inquired about health insurance coverage for her partner. We had them on speaker phone so, I chimed in several times to ask clarifying questions. It was on that call that we were told that they did pay for IVF, as long as I could prove medically that I had been trying to conceive for a year. Well, I knew that that would not be a problem for me. After all, I had had 7 IUI’s cycles (with 2 IUI’s per cycle), five of which were medicated, one fertility surgery, and one canceled medicated IUI cycle due to a poor response to medical stimulation. I got really excited about the prospect of subscribing to Nadia’s insurance when her open enrollment period would begin in July. I knew that we could do a few more rounds of IUIs and then if those didn’t work, it was comforting to know that I would not have to pay for the big IVF guns out of my pocket. Once I got my insurance card in July, I called them again to make sure that all of the paper work was in order and to reconfirm the benefits and requirements. I was told that everything was in order.

At the time, there was no way for me to know that with every phone exchange with my insurance company, I was operating under a false assumption that would prove to be very costly. I naively thought that they were operating in good faith. Please don’t ask me why I was stupid enough to think that because I really don’t know.

Imagine my surprise when I learned a couple days before my scheduled retrieval that they would not pay for my IVF treatment. “What?” I asked my doctor’s billing coordinator. “Well, it seems as if the fact that you don’t have a male factor, is a big factor,” she said. Needless to say, I was a bit confused.

It turns out that my health insurance company has different medical standards for women who have “access to sperm” and those who don’t. According to my health insurance, as a member of a same-sex couple, I am required to have 12 medically supervised IUI’s to prove my infertility and only after those 12 IUI cycles would I be eliglbe for IVF coverage.

What that means is that women who have male partners have different medical requirements than those of us who don’t; either because we are single (using donor sperm) or in a same-sex relationships (using donor sperm). Needless to say, finding this out at the 11th hour before my retrieval left me flabbergasted and dejected. I had come so far in my TTC journey only to discover that I had to foot an $8500 bill for IVF, if I was really going to see it through to the end.

There are many things about the situation that make me furious, but the fact of the matter is that each time we spoke with a rep for the company we identified ourselves as lesbian or in a same-sex relationship. We clearly explained that we were calling to confirm fertility benefits for the non-insurance holding female partner. I was never told that the medical standards for women in same-sex relationships were ‘different’, i.e. higher than those for other women. You would think that their employees would be trained to alert same sex callers about the differences, but no. If I had known about these differences, I still would have been outraged, but I could have planned things differently.

For example, maybe I would not have signed on to this health insurance; or maybe I woudn’t have waited three months…or maybe I would have continued with IUI’s until I reached their threshold, or maybe, hell, who knows? I never thought about different medical standards based on relationship status or sexual orientation

Another reason why I never thought to question my same-sex status and it’s effect on my medical coverage was because Nadia’s insurance is based in Massachusetts. Mass. is the first state to authorize same-sex marriage so I thought that made us all equal under the law. I never considered that they were would be ’separate but equal’ medical standards. Their company rules allow her to put me on her insurance–which in many states and for many employers is still a big hurdle same-sex couples must face– yet then they create different rules for us, even though we pay the same premiums.

Under the circumstances, my doctor was understanding. He said that he would help me with the appeal by personally calling my insurance’s medial reviewers, writing letters, and doing whatever he could to help but, obviously, he wanted to make sure that he would be covered, so I had to authorize his office to charge the full $8500 payment to my credit card. According to my doctor, if my ruling is overturned, I will be fully reimbursed.

OUCH!

I am not sure what hurt more, having 4 eggs sucked out of my bloated ovaries or signing that charge receipt.

As is stands now, my doctor has spoken to their medical ‘expert’ and he says it does not look good. They don’t seem inclined to budge on their requirements in spite of the fact that in his expert opinion whether or not I had a male partner, I would still have fertility problems and would qualify for infertility treatments. On my part, I have also written a letter to the company that is awaiting review, but they did answer my question about different medical standards for same-sex couples fairly quickly and this was their response:

“Our policies clearly indicates a member must complete 12 MD supervised IUI’s, which is equal to 12 months or one year of infertility. This has been in policy since 8/03. This is in accordance with the state mandate of one year. State mandate indicates a woman must have one year of infertility prior to coverage, in order to prove one year of infertility in a same sex couple or single female, they must show 12 IUI’s/12 months/ 1 year under the care of a md.”

One thing that they don’t mention in their response is that a woman in a same-sex couple would have to pay for the 12 IUIs. They won’t cover those either. So their fertility coverage for single woman and women in same-sex relationships is really non-coverage.

As of today, I remain embarrassed, angry, sad, humbled and little more broke than I had originally planned. In my case, the diagnosis of ‘lesbian infertile’ remains elusive and costly.

Now, back to my pretty place.

I had almost finished it. It was the post about how my health insurance company totally screwed me a couple of days before my retrieval. It was almost done, in my head anyway, when I opened my inbox and  saw the email.

It was an email from my embryologist with this picture of my little one, my 5-cell, day 3 A- embie. Isn’t she beautiful?

The rant post is almost completely gone (for now, anyway) and I’m in a pretty place for the moment, hoping against hope. I will find out this weekend if she took and, until then, I think, for the rest of the week, I’m gonna act like she did.

Folks have been asking me how I’m feeling and truth be told, I feel 45% optimistic, 30% pessimistic, 15% scared out of my wits and 10% exhausted. I have cramps, headaches and lower back pain, but these are exactly the same symptoms I have when I’m about  to have a visit from my Aunt Flo. So who knows? Also, I’m on progesterone so my body is totally out of whack. I can’t trust myself physically right now, but I’m delighted to have this photo.

As I write this, I find myself focusing on baby steps. I’m fighting the urge to fall flat on my face, while I’m struggling to move myself forward one small step at a time.

This morning my RE, Dr. Feelgood, transfered one single A-  5 cell embryo in my body. This was immediately after he told me that it is possible that I could get pregnant from one embryo transfer but not likely.  He said my poor egg production this cycle demonstrates that fact that my ovarian reserve is slowing down. The second embryo that had also fertilized stopped developing, “and so”, he said, “it would make absolutely no sense to transfer it.” 

I know it only takes one embryo to make a baby, but it’s hard to stay positive after my doctor’s bleak tone; however, if there is anyway to keep a positive attitude in the midst of this, I will.

The procedure itself was more invasive than I thought. I was lead into a pseudo-operating room and joined by a nurse, two embryologists, and my doctor. This was the same room where I had my retrieval but, unfortunately, I was awake this time. The lights were bright and it’s cold in there. They had me contort my body in ways I didn’t know I could. My vajayjay acrobatic skills have really developed over the past year and half.  My uterus is still raw from the retrieval 3 days ago, so when he inserted the speculum today it really hurt.

To top things off, I had to have a full bladder during the procedure to help with the imaging of my uterus. The sonogram helps them place the little one in the optimal spot. The one cool thing  was that they showed me a picture of my little one right before the transfer, which they promised to email me. He’s so cute! And, btw, I’m still waiting for that email.

After the transfer, I lay there for 30 minutes, contemplating the meaning of it all and listening to Aretha’s “I Say A Little Prayer of You”.  It is the perfect song for my little one. I go back in two weeks for  blood test. I’m hoping my prayers will be answered then.

So the last time we met, I had had 7 follicles that yielded 4 eggs. Yesterday I learned that 2 were mature and they both fertilized.

Today I learned that one of my little embryos is an A- minus and the other one is “unknown”.

You see this morning when Jack, my embryologist, went to check on them he found that one had split into four cells and that one had not done anything at all. According to Jack, I shouldn’t worry because there is still plenty of time for the little guy to catch up to his big brother or sister. It’s just time for me to play wait and see.

Anyway, believe it or not, despite the fact that I am a nervous wreck, I’m still optimistic. I do believe in miracles. And let’s face it, an A- isn’t a bad grade. It’s something to celebrate.

Tomorrow I am going to have acpuncture before and after my transfter, which will take place around 11:15.

Wish me luck!

 I had four eggs retrieved this morning. We’re not quite sure what happened to the fifth one my doctor spotted on Thursday, but he seemed very hopeful. I was totally freaked out that we lost one along the way but he assured me that things could really work out and that I should not worry at this point. 

Tomorrow morning they will  let me know how many were fertilized. We are fairly confident that it will be a day three transfer, which puts me at a Tuesday.

The procedure was quick but I am very, very tired and I feel crampy. Tonight I start on progestrone suppositories (yuck) and tomorrow  morning I start my shots (ouch).

Okay, so I’ve been to the doctor a couple of times since my last post. It turns out that I have 7 follicles but it’s more than likely that I will only have 3 or 4 eggs for retrieval. We will pull the trigger tomorrow night and have the retrieval on Saturday.  My transfer will probably Tuesday, Wednesday or Thursday.

Three shots a day is too much for me. The medication is kicking my arse. It’s kind of like  PMS on steroids. I feel a constant range and rush of emotions; it’s very hard to keep it together.

I hope this works because–Rosie the Riveter aside– I really don’t know if I have what it takes to do this again.

Okay, remember this feeling: You come home from a long day’s work, run to the refrigerator and you pull out an ice cold beer; you pick up the beer twist the cap and, if you’re lucky, it’s so cold that it emits a cold vapor cloud, and you just want to say ‘Aaaah’?

Well, imagine what that beer must feel. Yesterday, I imagined myself as that cold beer waiting, waiting, and waiting when suddenly my cap was popped, and I too felt a sense of release. Yesterday I got some relief from the incredible hell of the IVF cocktail. This morning, I feel soo much better than yesterday

Here’s what worked:

Acupuncture. It really worked yesterday. It was the first time I had a treatment sinse I started the cocktail and remembered why I do it. I felt such a sense of relief after my treatment yesterday

Green Tea. Even though I hate the caffeine, it just makes me feel less out of it.

Lavender. I have lavender hand cream and I used it lavishly yesterday. It really helps to calm my anxiety. I also have a lavender sleep pillow which enables me to sleep through the night. I feel like a new woman.

Nadia. ‘Nuff said.

All of You. Thanks for your support!