Are we parents yet?

The Clements’ IVF Journey

WTF…! January 30, 2009

If I recall correctly, I had about 15 follicles on Tuesday in the range of about 10mm to 14mm. And then there’s one that’s far ahead of the rest, closer to 18mm. That one’s just going to have to be let go.

At today’s ultrasound, there are 17 in the same range, so after an estrogen level check (took three stabs thanks to my bad veins) the Follistim is lowered to 75IU. Next ultrasound is Saturday.

I’m sure everyone has head of the woman who had the octuplets.

California Octuplets’ Mom Already Has 6 Kids: Report
Octuplets Mom Has 6 Other Kids
Octuplets’ Mother Has Six Older Children Already (VIDEO)
California octuplets’ mom already has 6 kids: report
http://www.momlogic.com/2009/01/octuplets_mom_has_six_other_ki.php
Reports: Mom of Surprise Octuplets Already Had 6 Kids
Octuplets’ mother ‘already has six children’
Report: Octuplet Mom Already Has Six Other Kids

Yup, she already has six other kids.

Is it just me, or is there something irresponsible about this? I mean, she lives in her parents’ home in a neighborhood of houses with two or three bedrooms each, has six kids, including a set of twins, naturally, and then decides to go use fertility drugs, despite her track record of being able to get pregnant? The chance of natural triplets is 1 in 8000 quadruplets is 1 in 712,000, and quintuplets at 1 in a little over 40,000,000. I believe as the doctors claim, that she used fertility drugs of some sort. Irresponsible idea when you’ve already got six kids. Without a doubt, tax dollars will be supporting her 14 kids.

 

Needles, needles, and more needles January 26, 2009

Filed under: Uncategorized — Aria @ 6:21 pm

I dread the evenings all day every day because I know the shots will have to come. I can’t give them to myself. Cody has to.

I have the Lupron drawn up in each of the syringes and each syringe is in a plastic bag with a vial of Menopur and diluent to mix it, the syringe for it, hypodermic, which is separate for this one, and a Q-cap to help with mixing, and alcohol pads. Each night I grab a bag and the case with the Follistim and the pen (it looks like a pen until you take the cap off and attach the needle). I mix the meds myself and get it ready. This is the way I fee some control.

Then I lay down on the couch and pull my pants down or skirt up, whatever, to expose my abdomen. Lupron first, since it hurts the least. It itches though. Then the Follistim. Finally the Menopur, which burns so much I come close to crying and usually yelp in pain. Cody massages the sites to help make them feel better.

It’s a bit harder this time around because…I don’t know. It just hurts more. And I guess also it’s a bit harder because I didn’t think I’d have to go through this again. But it’s easier because we know what to expect. I’m not nervous about the retrieval, just the IV. Last time I felt like I needed my hand held each step of the process, and I feel like an ol’ pro now. Maybe this is why the success rate on second cycles is better than first cycles. People aren’t as stressed because they know what to expect.

Tomorrow is an ultrasound, and I’ll know then if I go back Wednesday or Thursday for the next, and on that day, when the next will be. And it’ll be like this until the hCG shot to trigger ovulation, then 36 hours later, the retrieval. This both happen fast and take forever from this point on.

 

Baseline ultrasound and semen analysis information January 21, 2009

Filed under: Medical appointments and stuff — Aria @ 7:36 pm

Today was the baseline ultrasound. My uterine lining is at 5mm with a bit of that being the last bit of menstrual lining. My right ovary has one follicle at 8mm and 12 under 8mm, and my left has one at 8mm and 14 under 8mm, as well as that cyst measuring 14.5mm. So they’re a little smaller than at this point last cycle, but the doctor said that’s perfectly fine, that each cycle isn’t going to be exactly the same. Of course I’m feeling anxiety because we lost them last time, so anything that, in my mine, isn’t “as good or better” than last time, at least as a I perceive it, worries me.

We also go the results of Cody’s semen analysis. This was from last cycle, a new one not being needed this cycle. I had no idea what any of it meant until looking it up a few minutes ago.

1.5mL volume, when they usually like to see 2.0mL on up
136 million concentration/density, when they usually like to see at least 14 million
79% morphology
10% motility, when at least 14% is usually desired

So motility is basically the percentage of sperm that actually move and swim toward the egg right. Dr. Baker said they’d like to see a lower motility with a high concentration rather than a higher motility with concentration closer to 14 million. So it’s important to keep in mind that all the results need to be taken together to get a full analysis, that just one or two parts mean little without the rest. For example, the lower volume and motility are made up by a much, much higher concentration.

Since it’s IVF, the sperm are placed right next to the eggs anyway rather than having to swim through the entire reproductive tract in search of an egg. More info on semen analysis It’s hard to find information online for semen analysis as it would relate to IVF versus natural conception, but the basic idea is the same.

 

PMS times 20, and a bunch of random, semi-related paragraphs with a rant January 20, 2009

Filed under: Financials for IVF,General thoughts,The process — Aria @ 3:40 am

We got the statement from United. Sure enough, they’re claiming almost $4,000 for the Follistim. Now to wait for the statement from Apothecary. There’s already precedent in place showing United pulling crap to get out of paying.

It’s night night for the Lupron, and I’m not a happy camper. This is the time when I’m stuck dealing with a period in addition to the Lupron effects. For me, the Lupron makes me itch for half an hour or so, gives me monster headaches, loopiness (it’s referred to as Loopy-Lupron for a reason), makes it hard for me to focus, meaning I’m not driving any more than absolutely necessary because I don’t want to cause an accident, especially since I’ve never even had a ticket, I feel flaky, don’t feel much motivation to even sew anything since I lose focus, and have to deal with food craving for the same food.

Both last time and this time all I’m wanting are potatoes, three of them diced with butter and lemon pepper and garlic salt thrown in the microwave for 15 minutes, then mashed, add a couple ounces of either colby-jack or cheddar cheese, in the microwave another couple minutes to melt it, mash it up, and add about half a cup of sour cream. Repeat every five hours or so, ’round the clock. Also, like last time, I’m easily nauseated by nothing at all. I can just be sitting here and next thing you know I’m running to the bathroom.

Really, the shots don’t get any easier. I dread them all day. If Cody didn’t give them to me, I couldn’t do this. IVF is really awful for someone with a severe phobia of hypodermics. It’s hard for me to even look at them. You’d think one would get used to it, but that’s not the case for someone with a true phobia of needles. I lay on the couch with my hands pushing into my eyes, feet hitting against each other, muscles tense, the top of my pants down or skirt up, so Cody can give the shot in my abdomen. He’s gotten good at doing it quickly. On Thursday we add back in the Menopur, the stuff that burns like fire, and the Follistim, which isn’t too bad. Not pleasant, but it doesn’t burn or itch. After five days or so last time I started to feel bloated really bad, so I’m not looking forward to that. There were 24 follicles that produced 14 eggs, but each follicle was about the size of a king marble. So imagine having a couple dozen large marbles shoved in your abdomen with very very little time to adjust.

Yeah, this whole process isn’t fun. Last time I looked forward to it with a naive optimism. It didn’t cross my mind that we’d have to do it again. I thought for sure we’d end up parents instead of mourning loss and repeating the process.

This time I don’t feel the same excitement. I’m more afraid and no longer feel the certainty that it will happen, more like it might, it might not. Rather than feeling sentimental and sappy over shows with babies and Gerber commercials because that would soon be my family, I see these things and want to cry from sadness. Last time I was captivated by shows like John & Kate + 8 and Bringing Home Baby. This time, I have only a little interest. Like last time, I’m fed up with seeing those damned Duggars all over TV. It’s like pouring hydrochloric acid on an open would being related to those people rather than the salt on an open wound last time.

My issues with the Duggars doesn’t stem from jealousy. It stems from them having so damned many that their older children take complete care of the younger ones and they have a sign-up sheet to see mom or dad one-on-one, appointment-style, and can take months. They mix up their kids’ names! They have so many children that they don’t have the time to get to know them and appreciate them for the individuals they could be if they weren’t forced into being teen parents. They have all these children, yet their children are strangers to them. TLC’s shows play this off for humor, but it’s really really sad. So many infertile people would love to get to know their own children, and here my mom’s cousin and his wife have so many they don’t even know their children. What’s the point? Oh, right. Attention and to attempt to out-populate non-Christians in this world. No, I’m not just saying that. It’s part of the Quiverfull movement. When I was Christian still, I was repulsed at the thought of any one religion trying in any way to rid the world of other religions, even if it was fellow Christians trying to rid the world of other religions. This is a terrible reason to have children, and a terrible job to give children.

It is important to us that our children be children and not be given a task before birth, and that they grow up respecting all religions and all people who don’t hurt others. Gays, transexuals, Christians, Jews, Pagans – respect. Those who hurt others are a different story. But respect those who don’t hurt others when they do their own thing, believe what the believe, be who they are. We believe the job of parents is to instill in their children acceptance and respect and morals and responsibility. While the know-how can’t come 100% from research as each child responds differently to different methods, we have researched different methods and discussed what we want them to learn.

Their education is important to us, and we’ve decided that our first choice for education is Montessori, but we are realistic and know Montessori is one of the most expensive types of school for young children. Easily $15,000 or more per child per year, and discounts for more than one child at a time is not more than a couple hundred dollars per year. If Montessori isn’t feasible, and really, it might not be on the salary of two people 28 and 26, then our next option is to home-school. Public schools don’t let children learn at their own levels. Both Cody and I were heads of the class and know the boredom that comes with not being challenged and suffering grades and just feeling like school was time wasted. On the flip side, if a child doesn’t get something just yet, the child still must move on with the rest of the class, falling further and further behind. What I believe we will ultimately do is home-school using Montessori methods.

Wow, this post makes me sound crabby and like I wouldn’t be a fun mom. I certainly hope that won’t be the case, that I will be a fun mom instead, but I am definitely feeling crabby. This is like PMS times 20.

 

Well, well, well… January 16, 2009

Filed under: Financials for IVF — Aria @ 4:43 am

We DEFINITELY aren’t the only ones being screwed by United. UnitedHealth, the parent company of United Health Care, was just ordered to pay $50 million because the database, called Ingenix, used to determine “usual and customary charges” (used in determining how much services should cost, with the client paying everything over) is obviously biased because they own it. This has resulted in clients paying millions more than they should have. This happened to us with the first doctor they sent us to. Our co-pay for specialty office visits is $20 with 100% of usual and customary paid after that. Well, the charge was $180, which is less than the lowest I’ve heard of any of my infertile friends paying, the lowest being $200 for this initial visit. After our $20-co-pay, that lest $160. United covered half of that saying that the usual and customary for an initial infertility appointment is $100 ($100 minus our co-pay left $80). We got billed the rest. Interesting to see they’ve just been ordered to pay millions in New York for their based database. Obviously if you own the database, your employees will want to make it as much in your favor as possible, which is what happened.

Of course there is a complication that will affect other companies. They allowed Blue Cross in Illinois to use their database, meaning Blue Cross may have been (unknowingly, I hope) also short-changing their clients.

They were ordered to pay $350 million in a separate suit today, two days after the one I just mentioned, for using their database to determine how much to pay for out-of-network services, resulting in people being reimbursed far less than they should have been. The New York attorney general calls it a scam. So the first order is to fund an unbiased database, and the second is to reimburse people ripped off.

Mary Jerome was diagnosed with ovarian cancer, and was told by her insurance, Oxford, a company owned by UnitedHealth, that Ingenix determined that many of her treatments, INCLUDING CHEMOTHERAPY DRUGS, “were not considered “usual, customary or reasonable.”” So. Chemotherapy drugs are not a reasonable treatment for cancer. Bull shit. Like IVF isn’t a reasonable family-planning method, even though it’s listed specifically as being covered. Bull shit. At least in Mary’s case, United Health Care in New York (also owed by UnitedHealth) has been “perfect” so far. Too bad United Health Care in our area isn’t perfect. Different region, different assholes, but all owned by the same company that’s in trouble for ripping people off by scamming (the attorney general’s word) people out of scam cost hundreds of millions of dollars (also his words).

As son as we get the statement from United showing what they claim to have been charged by the pharmacy, as well as a statement from the pharmacy of what the actual charges are, I’ll be filing with the insurance commissioner here in California, and sending a copy to the attorney general. It’s not acceptable for an insurance company to lie about what it was charged to get out of paying for more medications. “Over $4,000” for a medication that costs, AT MOST, $238 per vial (11 vial). Yeah. I can’t wait to get the statements.

 

What we have left, and what we still need. January 7, 2009

Filed under: Financials for IVF — Aria @ 6:16 am

Well, I figured we could buy some time if we had enough Lupron left from the last cycle to get started. We started last time, as we will again this time, with 10IU per day for 10 days, then 5IU until the trigger shot, which was nine days last time. I pre-fill syringes because it makes me feel like I’m doing something since Cody actually gives the shots. I filled 10 syringes with 10IU and 12 syringes with 5IU, and still have some left. So we are set on that.

We also have seven cartridges of Follistim left. Last time we were originally going to do 300IU of Follistim per day, and counted on 11 days, so got 11 cartridges of 300IU, then went down to 125IU instead because of how many follicles were forming and the concern of hyperstimulation. Due to overfill, which is always done, we only used four, so have seven left. More than enough.

We have two vials of Menopur left out of the original 11. We need seven to have as many as we used before. We also have six syringes and hypodermics left, as well as two of the Q-caps. So we’d need a few more of each.

I doubt the ability hCG to last for weeks after mixing, so, even though we used 5,000IU last time out of a 10,000IU vial, I’d feel better getting a new vial due to the extreme importance of this drug.

We also have 16 doxycycline pills left. Four times how many we used before.

We have half the bottle of progesterone left, so wouldn’t need more right away, but would later if we’re successful.

So as it stands, we need seven more vials of Menopur to have what we used before (I’d feel best with another nine), five more syringes and hypodermics, nine more Q-caps, and a vial of hCG. The pharmacy said the hCG is covered. So we’re good there. I wonder if not refilling the Lupron, doxy, and progesterone right now would get the Menopur covered? Worst case scenario (and I talked this over with Cody) is that we’d buy on the secondary market. Many couples sell what they have left over. I was planning to sell the remaining cartridges of the Follistim. Sure, there’s a little risk, but what have we got to lose? We’re backed into a corner with an insurance company that wants to play games.

Regardless, with the Lupron being plentiful, as well as the Follistim, and two vials of Menopur, this will set us for the first 12 days. Even though we start on Monday, this buys us until the 23rd. Come the 24th and we’ll be out of Menopur. But we’re good until the 23rd. Of course we have NO intention of waiting around until the last moment. I’ll call the pharmacy again tomorrow and see what can be worked out.

 

Welcome back, Insurance Games. Now DIE!! January 6, 2009

Filed under: Financials for IVF — Aria @ 9:38 pm

Insurance games continue. And we have proof. They’re trying to not pay for the meds. As of November, we had spent about $2,000 of our $5,000 cap. We have proof. Their own bills. (Our co-pay was $140, but insurance companies have to send full bills so you can see what’s been charged.) This time around we only need a couple of them, and they aren’t covering. Why? We didn’t know. The pharmacy told us, and didn’t know why. So I called United, our insurance company.

I dialed the number on the back of our insurance card, 866-348-1286. The first United rep I spoke with (whose name I forgot to ask) verified our copay should only be $35 for the Menopur. She didn’t see any reason it should be more. So she transferred me to Diane, who said the same thing. So she transferred me to Shamika, who was beyond pointless. Rather than ask anything, she told me she knew nothing and would transfer me to MedCo, United’s prescription division. She transferred me to Dana. Dana also said it should be $35. Then she said wait, the Follistim was charged at $4,000 (in November, each of the 11 vials were $75 each, $825 total). So never mind, nothing is covered at all anymore. When I asked her how the price had changed, she said she didn’t know, call the number on the back of my insurance card (which is the number I called and ended up being transferred to her.

So I called the same number again, this time speaking with Dario. Dario couldn’t find anything either, so called Janice with MedCo. This was a conference call. Janice was saying that I need to tell her how things we billed because she didn’t have access to billing codes. Um, like I would? Billing codes is insurance stuff. She’s the insurance person. Yet I was supposed to know? She said she didn’t have access to what was billed, when, names of meds, etc., and Dario admitted being confused about how I could be denied prescription coverage by the prescription division if no one can tell me what’s been billed. How can they decide to not cover without telling me anything? Finally she said that the total spent under the caps was $4,600, and began giving numbers, $4,000 for the Follistim, $900 for the Menopur – already it doesn’t add up right (and remember earlier in the call she said she didn’t have access to this information). Dario mentioned this. Janice immediately transferred us to someone else, Darlene. Darlene said they had access to nothing, no break-down, but she did see that we were at $5,781 of that $5,000-cap. Dario heard the two different figures from two different people, and asked also how the costs were different when nothing changed. Darlene said maybe Janice looked at something wrong.

United has said we can file a written appeal for reconsideration and they MIGHT reimburse us then, but that takes six months. Monday is six DAYS away.

Hmmmm, so a rep “looking at something wrong” means clients are given wrong information. We clients rely on the reps to give us the correct information. And here’s one saying someone else gave me the wrong information. How am I supposed to have faith in an insurance company that keeps giving contradictory and incorrect information?

So now we’ve supposedly spent either $4,600 or $5,781 of that $5,000-cap (even though they supposedly don’t have access to what’s been spent, how it’s been spent, or how it’s been billed, but I’m supposed to know billing codes). Yet the bill we received shows about $2,000. We’ve moved since November, so I need to dig this out. I have no doubt at all in my mind what it was. The Follistim was $75.

I did a long Google-search and found 3 of the 300IU cartridges of Follistim average about $200 for insurance to pay. (Insurance companies tend to get discounted rated while self-pay is usually more, and this goes also fo self-paying when seeing a doctor!).

After beginning this entry, after I finished that last paragraph, I decided to call the pharmacy we use. They told me they charge self-pay clients $228 per cartridge. So even if we were self-paying, the Follistim wouldn’t have cost us more than $2,508. And insurance companies get a rate at about a third of the self-pay rate for this drug, which would be a little over $800, which is about on par with what the original bill we got. In other words, no where NEAR the $4,000 United/MedCo are now claiming to have paid.

What this means for us us now though is that, two weeks into the cycle, we are now $350 short. We need these meds by Monday. They’re mail-order from the East Coast, so we have two days to come up with $350, or else we have to stop. We can pay what the pharmacy is charging, which is based on what United will/won’t cover, or wait several more months. We need another $350. If we can come up with it, you bet we’ll go forward now and file the appeal with United with the copy of the bills we’ve received to date and a statement from the pharmacy of what they actually charge, and if United won’t reimburse, well, we can either get an attorney on a contingency, or ask my aunt to take the case (and demand punitive for their lies and the heartbreak their lying has caused). She’s dealt with fertility issues and never succeeded in having a baby. Sadly, she knows how this feels.

We’d rather United just knock it the fuck off and pay (though nothing will get them out of a formal complaint with the state insurance commissioner) rather than for us to have to sue. If someone from United sees this and can get United to just pay, that’s fine with us. It’ll take less time, and save United some attorney fees and having to explain, on public record, why they’ve lied so many times.

We’re being sent a bill from United showing the prescription “charges” for November. However we already have a bill for November. Meaning they’re sending us proof of changing costs to get out of paying for things. Either that, or they’ll send us a bill showing the same costs of the bill we already have, which would mean they are supposed to cover the meds this time. Either way, whatever they send will fuck them one way or another.

We’ve kept every single piece of paper that’s come our way, even print-outs regarding support groups, things not directly related to us specifically. I’ve kept track of every person (except a couple times I forgot to get names) we’ve spoken to, and what the conversation was about. Today the big kicker now is that the pharmacy has told me they don’t charge anywhere near what United is claiming to have been billed.

United has lied again. Trying to get out of paying. We’re gathering more proof.