More on IVF

March 28, 2008

Hola friendly readers! Sorry for the long delay between posts. Nothing has been happening! (Well, that’s not true. We went to see this Wednesday night–spectacular! Also, my period started on Wednesday, and I went back to a 28-day cycle this time: no idea why, but I like it. And I’ve been doing some cool professional stuff. I gave a talk on my book at a university the next state over, and just found out that I got accepted to present at a major conference in my field that’s taking place out west this October. Which is cool, because my acceptance was a real long shot. But mostly, nothing has been happening)

Anyway, our IVF orientation class was yesterday. It was informative–surprisingly so, since I went in feeling like I already had a pretty good overview of the process–but the nurse who gave the class had a very bizarre teaching style. She. talked. really. really. slowly. and. repeated. everything. twice. So, she. talked. extremely. slowly. and. said. everything. a. second. time. Imagine a class about treatment protocols, medication-mixing and injection mastery with every piece of information–and I mean EVERY piece of information–delivered just like that. The good: it was nearly impossible to miss anything or get confused, because if you somehow didn’t catch her super-slow and carefully enunciated version the first time, you would surely get it the second go-round. Bad: we had to listen to her super-slow, carefully enunciated instructions for three hours with only one ten-minute break.

Afterwards, G and I talked privately to another nurse about the urologist issue (we still have not gotten G an appointment–all the names Dr. No-Nonsense gave us have turned out not to accept his insurance, and are booked well into the summer anyway). She said that there was no problem with us going ahead with an IVF cycle without yet having seen a urologist. According to the nurse, the issue of finding out why G’s numbers are low is more a health issue for him than an obstacle to us going forward. Since G has adequate sperm to do a cycle, the urologist is more about following up than about needing to fix a problem before proceeding. This is good news, but there is some even better news.And that news is: before this morning, I was thinking we might have to pay completely out of pocket for the medications, but no! We don’t! I feel very, very lucky. I’ve already mentioned here, I think, that Aetna does not cover injectible fertility meds. Before the class yesterday I had not allowed this to worry me, in part because my prescription drug coverage does not go through Aetna anyway–any and all prescriptions I need, typically, are paid for by the faculty/staff union’s drug plan. Cool! BUT, after further research, it appeared that this union plan did not cover any fertility meds. Crap! BUT, after even more research, it appeared that the union plan also excluded any and all injectible meds, and instead those are covered by another plan, paid for not by the union, but by an entirely different organ of my employer. Since IVF meds are by and large injectible drugs, this third plan is the place to go for such drugs. Cool! Still, last night the website indicated that while yes, I have some sort of coverage through this plan, “plan details are not available online.” Crap! But I made the call this morning, and good news: we must pay a $100 deductible, plus anywhere from $10 to $45 in co-pays per medication, depending on whether the drug prescribed is a brand name or not, but we do NOT have to pay everything ourselves. COOL!

This is really good news, because at the class yesterday, the nurse said that meds for one cycle can cost upwards of $5,000. Whoa. We certainly don’t have that kind of cash on hand, especially right now, with the tax man knocking.

Apropos of that, I have also been thinking a bit about timing. Yes, I know I have already vowed NOT to try and “time” our journey into IVF, and that is still true, but after learning more about the typical protocol, I have been thinking hard not about the best possible due date, but about when a good time actually to cycle will be. The first two weeks or so of the process, the Lupron phase, don’t require too much monitoring, but once the ovarian stimulation gets underway, there’s daily or every other day monitoring, which means getting from our apartment in Queens to the clinic in Manhattan VERY early in the morning (as in, getting up, showered, dressed, and out of the house by 6:30 or 7:00am). Not to mention, they recommend taking the day of retrieval completely off of work. It all seems like something that should happen after classes are over, or pretty close to the end of the semester.

We’ll see. I’m thinking maybe a cycle starting on day 2 of my next period, which should be around April 22nd. To play it completely safe, it might even be better to wait until day 21 of that cycle, which will be around May 11th (the last day of classes for me is May 14th). I will keep you all posted. For now, G and I have to track down our consent forms and have them signed and notarized. Idiotically, we managed to forget to sign them in front of a clinic staff member while we were both there yesterday! I guess the nurse’s endless repetition didn’t work so well after all.

RE update

March 21, 2008

Hi again!

So, the meeting yesterday with Dr. No-Nonsense went very well, as did G’s repeat SA–his numbers, while still low, were better this time. Last time his concentration was 1.5 million per ml, and this time it was 6 million per ml. I’m not sure, yet, what his total volume was (“normal” volume is at least 2 ml, and last time G’s volume was twice that, at 4 ml), but assuming it was at least 2 ml, that makes his total count at least 12 million, more than double last time’s total count. Yay! Dr. No-Nonsense attributes this to the longer abstinence time–five days instead of three–before the second test. She suggested that when we do the actual IVF cycle we should shoot for that, so his count will be as high as possible going in.

Dr. N-N also said ICSI, in which the best and brightest sperm are hand-selected and injected into the eggs, will be a definite for us. She explained the whole IVF process: two weeks of Lupron to suppress the normal cycle, eight to ten days of Gonadotropins to stimulate egg production, and then egg retrieval, fertilization via ICSI, and then transfer back into my uterus after either three days or five days, in hopes that one or two of the fertilized eggs will implant. She said in someone my age they are likely only to transfer two fertilized eggs, which would put twins risk at 25%. I thought, but didn’t say, that I see that number as a “chance,” not a “risk,” as I still sort of would like to have twins. I know I’m probably being naive about that, though.

I did ask about day-3 versus day-5 transfer, and she said they have good results with both; pregnancy rates for day-5 are somewhat higher, but that I shouldn’t stress out if we ended up doing day-3. We also talked, briefly, about cryopreservation of embryos–she said the clinic only freezes embryos if they are of extremely good quality, but that if we ended up with even a couple of extra that met these quality standards, she highly recommended that we grant permission to the clinic to freeze them. FET cycles cost less, are less invasive, and because quality is so important to the clinic, their pregnancy rates on FETs are almost as high as those on new IVF cycles. So that could be good news if we want a second child a couple of years down the road.

As far as downsides, we talked a bit about OHSS, which she said she doubted would be an issue for me because I don’t have PCOS and I do ovulate regularly, so I have average rather than unusually large egg reserves. But she said this was still a slim possibility, and to be aware of it as a reason for cycle cancellation. We also talked about the reverse, under-responding, and why we might have to cancel a cycle as a result of that–she also said she suspected this would not be an issue, because of my young age, but we should be aware sometimes happens. Basically, she first let us know some of the things that could go wrong, before saying that she actually thought our prognosis very good. Why? Well, I’m young, my eggs are young, and G has at least some good sperm to work with. She actually said that she is “optimistic,” which has me pretty excited!

Now G has to make an appointment with a urologist, because she said that while there are a lot of potentially unworkable genetic reasons for low sperm count, there are also short-term fixable things, like hypothyroidism, and it might make sense to hold off on IVF if his issue is something like that. Honestly, I don’t know what that means in terms of our timetable; the urologist that Dr. N-N recommended happens to be on vacation this week, so I’m not sure when we’ll hear from his office on getting an appointment, and I’m not sure what G’s diagnosis, ultimately, will be. Still, the impression I got was that we could start a cycle as soon as we wanted after taking the IVF class next week. My only concern with going ahead before having the urologist weigh in is that if G’s sperm count issue is caused by something treatable, and Aetna got wind of it, there might be some question as to whether IVF should be covered for us or not. I definitely don’t want to start down this expensive road, only to find out that my insurance isn’t covering us after all!

So we’ll see. Either way, though, I’m pretty psyched about our ultimate prognosis being good. There *may* just be a pregnancy and a baby at the end of this for us after all. Woot!

Tomorrow!

March 19, 2008

Drive-by post to say that G and I are meeting with the RE tomorrow! G is also repeating his SA, the process of which he has described, in terms that are somewhat politically incorrect, as “like an Indian burn” on his, um, you-know. I guess because of the lack of lubrication? Ye-ouch. Sorry, dude.

For some reason (in spite of G’s upcoming discomfort) I am super-excited to sit down and talk to Dr. No-Nonsense about our next steps. She’s a great RE, or has been so far. I really like her practical and calm bedside manner. I actually talked to her today, because she called to tell me the results of my follow-up blood test. Definitely negative for sickle-cell, and no other related hereditary issues, but she said I am anemic–my red blood cell count is around 32.8%, and they like to see it at least at 35% (according to Wikipedia, 38% is even better). So she recommended that I check in with my primary care physician about it. Sigh.

Anemia has been a problem for me over the years, and now that I’ve been off the Pill for a while and my periods are back to being super heavy, I’m not surprised that the situation has worsened again. I suspect that I’m going to get put back on some kind of awful iron supplement, as my daily multivitamin is clearly not doing its job. Hmmm. Maybe I’ll try to look at this as preparation for taking all of those big prenatal vitamins. 🙂

More on all of the things we learn at tomorrow’s appointment in my next post, which hopefully will be on Friday…

Some good news, thankfully.

February 27, 2008

THANK YOU ladies for all of your kind words of support responding to my post earlier today–I was SO upset when I wrote all of that, just beyond frustrated with the whole situation. And it means so much to know that there are folks out there reading along and commiserating.

I am feeling much better now, in no small part because I talked to Dr. No-Nonsense, finally. She’s so great, very very calm and reassuring. Talking to her reminds me of why I chose this clinic in the first place. And she came bearing good news: sickle-cell is not going to be an issue for us, because only one of us is a carrier. It turns out, though, that G is the carrier, not me. I can’t believe the on-call RE I talked to yesterday misread the results! Dr. N-N said that she wants me to get tested for a few other types of anemia, to make sure there aren’t any other potential genetic issues that might crop up because of G’s sickle-cell trait, but actual sickle-cell disease isn’t a concern. Whew.

While we were on the phone, Dr. No-Nonsense confirmed that IVF would be what she recommends for us next, which didn’t surprise me. With G’s numbers, she thinks it’s the best option. She asked us to make an appointment to sit down with her and talk about the process. She also suggested that G see a urologist, I guess to get a specialist’s advice about the possible medical reasons for his sperm’s lackluster performance.

So, that’s where we are as of tonight. Sickle-cell is off the table, and I am VERY happy about that. We’re going to take the rest one thing at a time. Next up: injections/IVF class on Tuesday the 4th. Will keep you posted!

All-around bummed.

February 27, 2008

I just got off the phone with the RE’s office; my chart is in Dr. No-Nonsense’s office, so the nurses can’t get to it, apparently, to give me more info on G’s sickle-cell results (clearly that means that Dr. No-Nonsense is not in yet–I don’t know whether she’ll be in today). The best they could do was promise me a call back when they are able to get their hands on the chart.

So, naturally I am frustrated. Hence, I am blogging instead of working; I have meetings back to back starting at 11:00am, one of which I need to make some photocopies for, so I don’t have much time to write a real post. Still, I’m really annoyed and upset, and not just at the clinic for being so (seemingly) incompetent.

Some reasons why I am bummed:

1. I’m wondering if I made a bad decision on going with Columbia over NYU in terms of choosing an RE. I am not liking how they’ve handled this situation at all; if you are going to make me worry about sickle-cell by informing me that I have the trait, the least you could do is have my husband’s blood test results ready at the same time, so I will know for sure whether it’s a concern or not. And to be unable to locate my chart when I call back for information? AARGH.

(Clearly, overnight I’ve become one of those “hysterical” infertile women that I didn’t quite understand before I got to the treatment stage, railing against insensitive nurses and disorganized clinics. I was always sympathetic, but I never really “got it” until now. Stop jerking me around, Columbia! Just give me the information I need so I can know what is what and stop feeling quite so helpless.)

2. My doubts about parenthood are back. Maybe this just isn’t for me. Or maybe I don’t deserve to be a mom. It’s not my lifelong dream, becoming a mom, as it is for some women. (Hello, Jennifer Garner in Juno). I don’t feel I was “born to be a mother.” So why should we even go down this road, which seems to be such a difficult and complicated one so far, if I’m not even 100% sure that parenting is right for me?

I know a lot of people who are ambivalent end up happy parents anyway, but in those cases often their bodies or their partners’ bodies decide for them–an accidental or unexpected pregnancy means they’re on the road to parenthood, like it or not. Maybe our bodies are deciding for us too, just in the opposite direction. Which seems so unfair, since while I don’t feel born to be a mom, I do feel like I’d like to give it a try anyway, especially with G. But it’s hard not to feel like the universe is telling me bio-parenthood is not for us. (I need to write a separate post with my thoughts about adoption, but I’m not ready to go there yet)

3. I am also hating the hurry-up-and-wait aspects of this process. Not just the clinic snafus, but also, as I alluded to at the end of last post, the other bureaucratic stuff that means we really need to wait until May or June to do a cycle. Why? Because my institution has no maternity leave policy.

This means that if I give birth in January, when school is not in session (which is when I’d be due if we did a cycle in April or even late March) I would be expected to use January break as my “leave.” If I give birth in the summer, I would be expected to use summer break as my “leave.” If I give birth in the fall semester, I could take 6 weeks paid using my sick leave (or up to 12 weeks with a special doctor’s note that I needed extra time to heal), but this would not cover the entire semester. So I’d need to be back to work when the 6-12 weeks were up. And then I’d have to work spring semester, when said kid was 2-4 months old.

The only good time to give birth (especially now that we can’t afford for me to take unpaid time off) is early spring. Then I could use sick leave for 6-12 weeks paid, and have the summer paid, and go back to work in the fall when my kid was closer to 6 months old. Which is still too young for daycare in my opinion, but what can we do?

See what I mean about the universe conspiring against us?

I have to go to my meeting, so I’m going to post this. I may edit later.