hurry up and wait

This morning I had an appointment with Dr. P's IUI lead for an ultrasound. We were looking to see how many follicles I had growing and how big they were. She found 2 on my right side measuring about 13.5mm and 9mm and 1 on my left side measuring about 9.5mm. We want one to be pushing 20mm if possible. So I will be doing 3 more days of injectable medication. I go back in Friday morning to see what's going on.

She also saw that I have fluid in my uterus (again), but Dr. P says it's no big deal yet because I'm not ready to ovulate. He thinks it will go away by the time we are ready for the IUI.

Hurry up and wait, hurry up and wait.

intermission

I was going to post my blog about our first IUI round, but I had an epiphany...wait until you get a copy of that round from the doc. That way I can get all the numbers right and give you more information than my twin-mom brain can hold onto. So instead, today I'll just give you an update on what's going on.

I've had 2 days on Gonal and there are side effects I forgot about. I anticipated (and warned those around me) about the mood changes and the fact that I will get pissed about the dumbest stuff and that I may cry at sappy commercials. But I completely forgot how stinking tired this medication makes me. My only saving grace this weekend is my cousin. My husband was out of town from Friday afternoon until Sunday night and all of the usual helpers were busy since it is Memorial Weekend. I still had to clean, do dishes, make food, change babies, listen to them cry and get up in the middle of the night when neither of them would sleep for more than 2 hours at a time (Friday night was a bad night), but I didn't have to chase them around or try to entertain them...my cousin so very kindly did that. THANK YOU!!!

I'm sooooo excited to go see Dr. P tomorrow and see how my follicles are growing! In a perfect world we want them to be over 16mm, 18-22 is ideal! I'm also curious to see how many follicles I have that are growing...keep in mind, the one that worked last time I had 2 dominant follicles and they both released, they both fertilized, they both implanted, and they both grew into healthy babies. So I'm a little leery of anything more than 2. I don't want to end up with 5 or 6 kids at once...I already have 2 at home. :D Have a wonderful day!

Round 1

WARNING!!! Lots of anatomy terms that could be embarrassing will be in the following post.

In March 2009 we did our first IUI cycle. I was excited, terrified, and very hopeful!

I started my period and made THE CALL. I was scheduled for a 'baseline ultrasound' on day 3 of my cycle. It was to check my ovaries for cysts and my uterine lining to make sure it had thinned out properly. Everything looked good. I had a few small cysts on my ovaries, but nothing to be concerned about. I took my Femara for 5 days then went back for another ultrasound to see how my follicles were growing.

Now when I say 'ultrasound,' Dr. P doesn't do the nice, cold gel on your belly, external kind. He only does the exposed, undress from the waist down, 'you'll feel some pressure,' vaginal kind. Needless to say, I kind of go used to 'exposing' myself in front of Dr. P, various nurses, and several medical interns.

I don't have the exact numbers, but I know that nothing looked very promising. I may have had 1 follicle that looked 'okay.' Dr. P said that it should continue to grow over the next few days and we would do the IUI in 5 days. 3 days later I had my husband give me the trigger shot (my first injectable) and 2 days after that we had our first IUI.

Here's the procedure as I recall it: We arrive at the fertility center at about 8:30am. My husband goes to the designated room to do his part, then we sit and wait. While we wait the lab washes the sperm. This basically means that they separate the sperm from the surrounding fluid to make it more concentrated. They also check the sperm count, motility, and mobility. Once again, everything looked excellent and we were a go for the IUI. About an hour and a half later I found myself, once again, on an OB table with my feet in stirrups. Dr. P inserted a small catheter into my uterus and deposited the washed sperm as close to the fallopian tubes as possible. This is ideal for many reasons. The sperm don't have far to go to find the egg (if it's there) and it doesn't have to fight through any mucus (which kills sperm). Once that was done, I got to lay on a tilted table for 15 minutes talking and dreaming about the possibilities with my husband.

We spent the next 2 weeks hoping and dreaming and holding my belly, wanting so badly to be pregnant. If you know me, you know I can't wait for surprises. So 5 days before 'my missed period' I started taking home pregnancy tests. Every day it was negative and every day I kept telling myself that some people don't test positive until after they've missed a period. But the blood work 14 days after the IUI came back about as negative as you can get.

On the emotional side...

Right after we started the medication I went to my sister-in-law's baby shower. I thought it was hard. It was hard to see her so pregnant, talk about being pregnant and feeling the baby move. The worst part was hearing her answer questions like, "Is this the first grandchild?" In my head I answered, 'Yep. I'm never going to be able to have one, so she's gets to have the first.' I know that's not why the questions were asked, but that's where my brain went.

Even better? We got our negative blood work results on a Wednesday, I started my period on Friday and I went to a friend's baby shower Saturday. I probably shouldn't have gone, I know I didn't bring a very happy attitude. Fortunately it was a couples shower so my husband was right by my side. And when we left early because I couldn't choke back the tears any more, he drove us home because I couldn't stop crying enough to drive.

So we do it again...

Christmas, New Years, and surgeries

Ok, back to the last journey.

Christmas 2008

We couldn't wait any longer. Something had to get moving. Since there was no immediate hope for a cadaver bone, we decided to get moving on the fertility front. After a visit to Dr. P we were instructed to have timed intercourse, he wanted to try the least invasive methods first. We were supposed to have sex 'every other day between days 10 and 20 of my cycle.' Some of you might think, "Awesome! That's guaranteed sex 6 times in 10 days." Think about this... You 'get' to have sex with your spouse on set days at set times. It kind of kills the romance.

We still have to pay the bills, so we both occasionally have long, exhausting days at work. We still have to keep the house running, so we still have to do laundry, dishes, cook, and clean. But we still 'get' to have sex...every other day for 10 days. So we do what we are told to do and try our best to enjoy the moments.

One thing you hear in the infertility world a lot is how draining the '2 weeks wait' is. This is referring to the 2 weeks between conception and a missed period. Now imagine that over Chirstmas. I had a good Christmas with our families, but we were supposed to have a baby by then. This was supposed to be his/her first Christmas and I wasn't even pregnant. Kinda makes the holidays a drag. And of course, right after Christmas we found out that we weren't pregnant. Not really surprising.

With New Year's we tried to 'make a new start.' This would be the year that we get pregnant and have a baby...damn it! Since the timed intercourse didn't work, we decided to get my other problems taken care of, then jump back into fertility treatments full speed. In, mostly lost, hopes we did times intercourse in January. Again, not pregnant.

So in February I had surgery on my ankle. The doc said if I needed to replace any bone or cartilage he would just take it from my knee. It wasn't exactly ideal, but it would fix my problem and I could do strengthening exercises for my knee. Fortunately, nothing had to be replaced! I just needed to have a TON of scar tissue removed and a little bit of cartilage removed. This was awesome news because I would only be off my leg for 2 weeks instead of 2 months. I figured, while I'm out of the baby making game, let's just get my wisdom teeth out. The bother me all the time and all 4 have to be surgically removed. So I did it. 3 weeks after my ankle surgery, I had my oral surgery. And 2 weeks later I was healed enough to get the party started.

Update

I promise, I will get back to my past journey...tomorrow.

After 6 phone calls to 3 pharmacies, 2 insurance companies, and my REs office I finally had an answer about my medication. But my insurance company didn't want me to have Follistim. They would rather me use Gonal instead. Fortunately, these are the same medication with different names. I don't understand how an insurance company can tell you which medication you should use when my doctor is the one who went to school forever and has years and years of experience, but it is what it is. They overnighted me my medications and they arrived this morning!

Common Side Effects of Femara (the pill I've been taking the last 5 days): back, leg or arm pain; breast pain; constipation; cough; diarrhea; dizziness; headache; hot flashed; flushing; increased sweating; indigestion; joint or muscle pain; loss of appetite; mild swelling or fluid retention; nausea; night sweats; sleeplessness; stomach pain; tiredness; vaginal dryness or irritation; vomiting; weakness; weight gain or loss.

The reason I tell you this is to explain just how messed up my body is. Usually I react with at least 1 negative side effect if a medication causes it...not on this stuff! I have had no pain (other than a mild ache in my belly), no tummy troubles, my night sweats and hot flashes have gone away, my heartburn is gone, I've been eating everything under the sun, and I've lost 2 pounds. So I am "suffering" some of the mentioned side effects, but I'm happy to suffer them. Hehe.

It's funny...I start giving myself injections tomorrow and I'm not overly nervous about it, even with my husband out of town. I'm excited to see how well these medications are working!! If all goes well, we might be doing the IUI at the end of this week or the beginning of the next. I'm soooooo excited!

mail order meds

I have to get 2 mail order injectable medications for this cycle,

Medication #5 - Follistim - This is a 'pen' that you attach a small (insuline-like) needle to the end, dial your dose and inject it into the belly. This medication is meant to help the follicles grow.

Science lesson - A woman's body usually has one dominant follicle form during her cycle. Around day 12-14 of her cycle, the follicle releases an egg and we all know what happens after that.

Medication #6 - HCG - This comes in a vial. You have to draw it up into a syringe and inject it with a not-so-small needle into the belly. This is also known as the 'trigger shot'. It tells the follicles to release the egg it is holding.

Here's where the fun part comes in. I was told that the mail order pharmacy will be calling me to get my insurance information and they will be sending me my medications. So late yesterday afternoon they called, I gave them my information and they said someone would be calling me back with the cost. This morning I get a phone call, but they tell me that in order for my insurance to cover any of the cost I have to get it from their 'specialty' pharmacy. Here's where it gets complicated.

I have Aetna medical insurance and a completely different pharmacy insurance. I was told I needed to get my medication from "Aetna Specialty Pharmacy." The phone number I was given turned out to be a fax number. So I used my brain and decided to call the customer service number, thinking I would be transfered to the person I needed. Silly me. The CSR I spoke with said I needed to contact my pharmacy insurance because my Aetna coverage was for medical only. Okay... I called the mail order pharmacy back to verify I had my information right. Turns out they gave me the wrong number to call. Now I have the right number so I call it and I get to talk to Mr. Attitude.

"When did they send the prescription over?"

"They faxed it this morning."

"Well it's not in the system."

"Okay, so what do I need to do?"

"Well, we have a 48 hr process time, so it may just not have made it into our system yet."

"That's not going to work for me because I HAVE to have one of those medications by noon on Saturday."

"That will work then. It's faxed on Tuesday, processed on Thursday and we can overnight you the medication."

"And if their is another problem?"

"You'll just have to deal with that if it happens."

Awesome! I called again this afternoon in hopes that whoever is in charge of taking paper off the fax machine has done their job, but I had no luck. So I'm still waiting and desperately hoping I will get my medication in time.

Can anyone tell me why and Aetna CSR doesn't know that they have their own pharmacy? I still can't figure that one out.

Here's yesterday's post:

Today I went to Dr. P's office and had a baseline ultrasound. I love quick and simple doctor's appointments. (It helps that I know what to expect this time around.) The ultrasound looked great! The lining of my uterus has thinned out and there are no remarkable cysts on either ovary. So I was given my schedule of medication and my prescription for Femara and I was out the door. Well, first I had to check out at the desk and pay my part.

"That will be $335 please." She said with an expectant look. As I gave her a dumbfounded look she added, "Oh, and I need a copy of your insurance card. I know you don't have coverage, but we need it on file anyways." .....

The funny part is that I was told at my last appointment (by the same person) that I did have coverage. And since we knew we were going to probably need it this year, my husband and I made sure we had fertility coverage (and we pay for it too). So you see how I still haven't responded yet. "Um, I'm pretty sure I have coverage." I said. "Nope. It says right here that you have coverage for diagnosis, but not for treatment."

After a brief conversation where I tried not to yell at her, I payed my $335 bill and briskly walked to my car. I called my husband to complain and said I would call the insurance company when I got home, but if we truly didn't have coverage we would only be able to afford one cycle right now. Fighting back tears by blaring my music, I drove to the pharmacy to get one of my medications for this cycle.

I get to the pharmacy, drop of my prescription (15 minutes until it's ready), get a Starbucks drink and coffee cake, and sit down to talk to my friend and let her know how things went. By now, I've calmed down and I'm trying to stay positive that either this cycle will work or we have insurance coverage...hopefully both. When I go t get my medication, the pharmacists comes to me and says we have a slight problem. Not what I wanted to hear. She said that on the prescription it says the medication name, the concentration of the pill, the number of pills, and to "take as directed." The problem with this is that the pharmacist doesn't know what directions to put on it. She has a call in to the doctor, but has to wait to hear from them until she can give the medication. Awesome!

So I go home and sit and chat with my aunt, who was there to watch the girls while I was at my appointment. 30 minutes later, the pharmacy calls and says all is well and the medication is ready for pick up. Fortunately I live about 2 minutes from my pharmacy.

After that whole fiasco, I got home, took my pill, and decided it was family nap time. My husband was already napping because he had been up all night on work calls and it was nap time for the girls so I took advantage. 2 hours later I woke up in a whole different world. I had forgotten how quickly these meds can work. I felt like a normal human being for the first time in a few months...my hormones were close to balanced.

Time to bite the bullet and call the insurance company. I call and ask the representative if I have fertility treatment coverage. It took her about 2 seconds to tell me YES...BUT I have to 'sign up for it'.

So now I get transfered to another department to answer 15 questions about my infertility. Once that's done, I'm signed up and Dr. P's office needs to call an 800 number to get authorization for my treatment. Now I only owe $45 (co-pay) plus 10%...much more affordable.

To let you know how much this costs:

visit 1: baseline ultrasound - $335

visit 2: mid-cycle ultrasound and blood draw - $400

visit 3: 2nd mid-cycle ultrasound and blood draw - $400

(it's possible to have more than 2 of these)

insemination - $410

progesterone blood draw - $100

This means, without insurance it would cost at least $1645 for each IUI cycle.

In the grand scheme of things, that's not a TON of money (IVF is much more expensive). BUT that is a LOT of money to spend in 1 month, and if you have to do it more than once... You get the idea.

Look at it from this point of view (the one I had the first time around). It costs me that much money for that one little part. Keep in mind I've already had many many tests and a surgery to be able to get to this point. Now think how much it costs most people to get pregnant...ZERO. This is one of the reasons why some women who go through fertility treatments want to beat the crap out of pregnant women who complain all the time. We would spend more money that you can imagine and go through hell and back to be able to smile when we get kicked in the bladder.

I will post today's post tonight after the girls go down. Sneak peak? Mail order injectable medications for infertility aren't easy to come by.