Archive for the 'Infertility' Category

Mar 08 2011

IVF Part Three: Drugs and Money

Published by under Infertility,IVF,The Man

IVF requires a lot of different drugs. The Man and I have prescription drug coverage, but just like everything else, coverage has been cut and more hoops have been added to make getting drugs somewhat of a chore. My IVF angel (aka nurse, liaison, counselor, etc.) , Kris, made obtaining the drugs so very simple. At first, we were planning on just using the mail-order pharmacy recommended by WSU, because that pharmacy specializes in the drugs necessary for IVF – they understand the timelines and urgency involved and are easier to work with. However, when the pharmacy contacted me for help in dealing with my prescription drug coverage company, I knew we were in for a bumpy ride. I ended up having to call the member services number of our drug insurance place and talking to an apathetic service rep who basically told me that my two options were 1)Mail order the drugs directly from them or 2)Pick up the drugs at my local pharmacy. I didn’t even know what drugs I needed, or if my insurance would cover them. I foresaw a long, confusing process of getting the list of drugs from WSU, going through it line by line with some rep, and then putting in the mail order forms for every drug I needed. However, one phone call to Kris cleared all of the worry and hassle away. When I told her that my insurance company was making me order through them, all she said was “OK, my dear, no problem. Which company is it? And is the account in your name or The Man’s?”

Of course, the next day, some “helpful” person from a branch of my prescription drug place called to let me know that my claim was denied “by the insurance company” and my doctor was appealing. I said to her, “I thought you guys were my insurance company”, and her response was “Oh no, we’re just the distributor.” And, at that point, I had no idea what was going on, who I had insurance through, what my name was, or what. I called Kris again, and she assured me that they would file appeals on the decision. It turns out that we won appeal…on three of the drugs I would need. That left three other drugs that The Man and I had to pay for out of pocket, not to mention the progesterone-in-oil injections I’d need to take for a minimum of days after embryo transfer (and if I got pregnant, I would be taking PIO for 10 weeks or more). The  three that ended up being covered were no hassle – they called us, we paid the remaining balance that wasn’t covered, and they shipped the drugs. The three that weren’t covered were a bit more of a hassle.

First of all, I didn’t realize that the pharmacy was waiting to hear from me to tell them to go ahead and process the order. I assumed Kris was going to handle it again. After I talked to her, she told me to go ahead and call, so I finally called them about two weeks before my cycle was set to begin. That conversation was really fun. It went sort of like this:

Me: *dials the number clearly printed on the letter I received, telling me to dial this number for my drugs*
Authorization Rep (AR): Thank you for calling Pharmacy’s Authorization Department.
Me: Uh, yeah, I have this letter that says my claim was denied. However, I still want to order my drugs, so that’s why I’m calling.
AR: Your name and date of birth, please.
Me: *gives her that stuff*
AR: Well, this claim was denied. Your appeal was also denied. I mean, this goes all the way back to March. So, Insurance Company is not going to pay for these prescriptions unless you submit another appeal. If that gets denied, then you’ll have to pay out of pocket.
Me: I don’t want to appeal. I know the drugs aren’t going to be covered. But, I still need them. I want to order those drugs. I only called this number because it was the number the letter I received told me to call to order drugs.
AR: Oh, all right. Let me get you to a pharmacy representative.
*hold music*
AR: Jas, I have Pharmacy Rep (PR) on the line, she is going to assist you.
PR: OK, so you need to order some medications? Do you know the names of the meds?
Me: I don’t know…my doctor told me you would still have the prescriptions on file. I have some letters here, let me see if I can find the names…OK, I need Follistim, HCG, and Menopur.
PR: All right…uh…those are specialty fertility drugs. Let me get you over to the specialty pharmacy.
*hold music*
PR: Jas, I have Specialty Rep (SR) on the line, she is going to assist you.
SR: OK Jas, you need three different medications?
Me: Yes: Follistim, HCG, and Menapur.
SR: And do you know your dosage and quantities?
Me: What? No. My doctor told me that he submitted the prescriptions and that you guys should still have all that on file. I never saw them.
SR: OK, hold on for a moment.
*hold music*
SR: Jas, thanks for waiting. I have your prescriptions here. I will go ahead and submit that order for you right away.
Me: I need these by May 5, is that going to be a problem?
SR: Oh no, ma’am. We can overnight them.
Me: And when I call for refills, who should I call? Because the number I had wasn’t right.
SR: You call us here in Specialty. Here’s the number: 800-xxx-xxxx. That gets you right to us.

So, I thought that was over. Except, three days later, someone called to tell me exactly how much these uncovered drugs were going to cost. The Man and I are not stupid; we know IVF is expensive. However, we were led to believe (by everyone we talked to, including our doctor’s office) that the price of drugs per cycle would be around $4000. Let’s just say that it ended up being more than that. The final cost for these uncovered drugs ended up being more than we thought we could afford, leading to a night of totally freaking out for both of us. However, after we both calmed down, The Man looked at our finances again and we figured out that we could, in fact, afford our drugs. Barely.

Then the pharmacy called two days before they were supposed to ship the drugs to let us know our payment didn’t go through. That was another fun evening of a low grade freak out fest before we figured out where the missing money had gotten to, fixed everything, and asked the company to run the charge again. The rep assured me they would run it that night and it would ship that night or the next day.

When I called the next day, the rep told me that the charge hadn’t been run, for no good reason that she could see. She was going to send it over again and also e-mail the supervisor of the billing department to get it processed ASAP. It was now May 3. I HAD to have these drugs by May 5; they were all the stimulants I needed to begin my cycle. The three drugs I had sitting around were not to be used until later. Lucky for me, when I called again on May 4, the rep assured me the payment had gone through and the drugs would be overnighted to me. I would have them when I got home from my doctor’s appointment.

The doctor’s appointment was the blood work and ultrasound I needed to do before we could officially begin our IVF cycle. If everything was clear, that evening I would begin my stimulant injections.

The full list of drugs I needed for my cycle:

  • Menopur (follicle stimulating hormone, injection)
  • Follistim (follicle stimulating hormone, injection)
  • Ganirelix Acetate (ovulation suppression, injection)
  • HCG (“trigger shot” meant to force eggs into the last stage of maturation in preparation for retrieval, injection)
  • Methylprednisolone (low dose steroid, pill)
  • Doxycycline (used to help prevent infection during egg retrieval, pill)
  • Valium (taken on the day of transfer, I’m sure to help keep me confined to my bed, pill)
  • Progesterone In Oil (used to support pregnancy, injection)

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

Comments Off

Feb 25 2011

IVF Part Two: Flurry of Tests and Consents

Published by under Infertility,IVF,The Man

The Man and I had both had a bunch of tests done when we were first starting treatment for infertility, but once we came under the care of Dr. Singh at WSU, the testing had to start over, because it had been about three years since the initial tests were performed. For The Man, this meant another semen analysis and getting a vial of blood drawn. For me, it was slightly more involved. I needed:

  • Blood work requiring nine vials of blood. I’m not totally sure of everything they were looking for, but I know one of the things was making sure I was not a carrier of the gene that causes Cystic Fibrosis. If I was a carrier, The Man would also have to be tested to see if he was a carrier. (I ended up not having the gene).
  • A regular pelvic ultrasound
  • A Pap smear
  • A sonohystogram – boy, was THIS pleasant. Or not. My advice is that if you’re having this done, take three ibuprofen about 30 minutes before the test. It might help with the cramping.
  • A trial embryo transfer, which basically is them pretending to transfer embryos to make sure they’re not going to run into any issues.
Because WSU is near Detroit (actually in the city of Southfield), and we live about two hours away, a lot of those tests were consolidated to save us driving. On one day I got my blood work and pelvic ultrasound. We drove back a week later to do the Pap, sonohysogram, and trial transfer. I was quite glad that I had The Man with me after the second day of tests, because for about 30 minutes afterward, I felt like someone had punched me in the guts, repeatedly.
If I had been over 35, I would also have had a Clomiphene Challenge test. If I were over 40, I would have had to have a mammogram done within the past year.
After all of our tests were completed, we had to meet with Kris, who is one of the nurses at WSU who works with patients on what to expect and guides them through the process. At the meeting, we went over everything that would happen during the process, including all the drugs I’d have to take, and all the tests that would be done during the process to monitor me for ovarian hyperstimulation. The class was overwhelming, because you’re covering a ton of information in under an hour, but the point is not for you to come away having memorized all the steps you will be taking. The point is to give you an overview of what’s coming up, and to answer any questions you might have. WSU also gave us a big packet of information including a timeline and all of the information on the drugs I’d be taking. Kris gave me her direct number and told me to call her immediately with any questions.
One important piece of information we got from the class was that once we started on the stimulation drugs, I’d have to be at WSU every couple days in the early morning for testing. This led us to decide to book an extended-stay hotel for the duration of the stimulation/implantation period. We just couldn’t see driving back and forth to Detroit, leaving our house at 5 AM every other day or so.
The final step is signing the consent forms. I’m not sure if all places are this form-heavy, or if WSU’s lawyers are just overzealous. Dr. Singh told me that they were working on consolidating the forms, which would be nice. We had about five separate consent forms to sign, and each consent required multiple signatures. The forms we had to sign consisted of:
  • Informed Consent to IVF Procedure: Outlining the general risks and possible outcomes (or lack of outcomes) in undergoing IVF
  • Informed Consent to Gonadotrophin Therapy: Because the injectables you use during IVF may cause ovarian hyperstimulation, which is a potentially serious condition, and can be fatal if left untreated (in rare cases), we had to sign this consent saying we understood the risks.
  • Informed Consent to Micromanipulation: Not every IVF procedure requires micromanipulation, which includes Intracytoplasmic Sperm Injection (ICSI), which is using a needle to inject one sperm into one egg. Micromanipulation may also include assisted hatching, which is chemically weakening the cell walls, allowing the embryo to more easily hatch. But, Dr. Singh recommended ICSI in our case, so this consent was necessary.
  • Informed Consent for Cryopreservation: This is if you want to store your excess viable embryos for later use, in case the procedure doesn’t work or you would like to try for more children later. This form contained a lot of decisions like: what do you want done with the embryos if you both die? Or divorce? Or one of you dies?
In addition to these four, we had to sign a separate agreement with the cryopreservation facility, basically agreeing to their storage fees and saying that we know that not every embryo survives cryopreservation.
Once the consents were signed and the tests were done, we were ready to go, theoretically. In reality, we had to wait for a month or so for our financing issues to be resolved, which was fine with me. I needed to gear up for the next phase: stimulation. But before that, we had to get a whole bunch of drugs.

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

Comments Off

Feb 25 2011

IVF Part One: Making the decision

Published by under Infertility,IVF,The Fam

For us, the road to IVF was probably longer than most people’s, and that was completely our doing. It took us a long time to get through all of the diagnostic things and other treatments that couples try before they come down to deciding on IVF.

Our infertility journey started on November 1, 2007. That was the day we first met with our first “infertility” doctor. This doctor I have referred to in other entries as “Dr. F”. He was a member of the same physician’s group where my normal gynecologist practiced. He took us through a lot of the earlier testing: The Man’s sperm analysis, my blood work, and an HSG. Everything came back normal. After the initial rounds of testing, he recommended that I go on Clomid and we start doing intra-ueterine insemination (IUI), which would boost our chances of pregnancy. I think we ended up doing six rounds of Clomid and six IUIs before we called it quits on that treatment. All of that testing/treatment had taken about a year, and we’d had no results. We waited for a few months before going to another office visit with Dr. F, and at that time he basically told us that his belief was that I had endometriosis and that I needed a laparaoscopy.  Since we had pretty terrible insurance, that meant we’d be paying the cost of the procedure out of pocket, an expense of about $10,000. I was skeptical that I had endometriosis, because I had exhibited absolutely no symptoms. He also told us that if we were going to do IVF, that a laparoscopy wouldn’t be necessary, because IVF would bypass the problems caused by endometriosis. We decided after that appointment to stop seeing Dr. F, because he didn’t want to do anymore testing, and he also didn’t do IVF. It’s worth noting that his bedside manner was also deplorable and he never made us feel comfortable or like he was in control of the treatment. It was discouraging, because we didn’t know what we were supposed to do next. A comprehensive plan was never outlined, and we never felt like we knew where we stood.

After a few more months, my friend Julio recommended I go see her doctor, so I did. This doctor, Dr. S, worked in the same group as Dr. F. She was nice, but basically all she did was get me an ultrasound to check for Polycystic Ovarian Syndrome (PCOS), and when that was negative, she said the same thing as Dr. F: we can do a laparoscopy if you want, but I would recommend IVF because that will get you a baby.

It was at that point that we contacted Wayne State University Physician Group, who set us up for an appointment with Dr. Singh, a reproductive endocrinologist. This was in February 2011, which meant we had drawn our treatment out for over three years. I don’t think that, looking back, I would have necessarily moved any faster. I knew that since all of the tests we’d had done indicated no problem on either of our ends (our official diagnosis is Infertility of Unknown Origin), we would either just get pregnant out of the blue, or wind up needing IVF. I think I needed to take everything slow to get my brain to process the fact that I would eventually be undergoing IVF, which is by no means a simple process. Also, both of us were young enough that we could afford to take our time. In November 2007, when we began treatment, I was 29 and The Man was 32. If we had been closer to our mid-30s, we would have felt more urgency to move the process along.

We began the testing and assessments associated with starting IVF in February 2011. By the end of that month, if we had wanted to, we were ready to proceed. However, our finances required us to delay beginning for at least a month. It was nice to have a month of breathing time to process what we’d been through and what was coming next.

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

Comments Off

Jun 23 2010

Protected: Left out.

Published by under Infertility

This content is password protected. To view it please enter your password below:

Comments Off

Feb 12 2009

No lasers for me.

Published by under Infertility

Well, I had a rather odd doctor’s appointment today.

The Man and I went in to see our infertility guru, for what I sort of thought would be the last time.  I mean, the last time we were in there, he kind of told us that what we’ve got left is laparoscopy (for a condition I don’t even think I have) and IVF (which I’m not sure I want). So, I was kind of betting that this was it.  No other place to go.  Done, done, diddy.

Instead, we ended up having a rather nice talk about our options – ruling out laparoscopy altogether, and setting a goal for four more cycles of IUI, which I had thought we were done with.  And SURPRISE! when I told him that I had had my last LH surge two days ago, we got whisked into Exam Room 1 for a round of IUI right then and there.   When we also told him that we no longer had “real” health insurance and instead had been forced into the crappy territory of a HSA, he told me to contact the local IVF clinic in a few months, because he believes they’re starting a new trial soon, and I might be able to get in.  I’m still not 100% sure how I feel about IVF (not for any moral reasons, but because I’m terrified of multiple births), but it’s good to know that even if we can’t afford to do a round right away, we might be able to do this trial.

He also told us about a place near Detroit that does a newish version of IVF, where you pay about one-and-a-half times the normal going rate and you get three tries at it.  And, if you don’t get pregnant within three rounds, they refund their part of the fees (they can’t refund the fees for the drugs and lab work, obviously).  So, that’s also something we’re contemplating.  That one, though, we’ll need to save our money for.  Because the IVF, she is not cheap.

Comments Off

« Prev - Next »

Tags

allergies allergy animals baking bees cat cats christmas church commercials cooking Destiny doctor doctors dog dogs Dr. Mom family food garden gardening holiday humor Infertility IVF kitchen kitty mackers Moll parenting pet pets politics pregnancy recipe recipes shopping stupidity television The Boy The Man Travel vet weather wordpress

Search