The Rat-Bastard HMO Giveth; the Rat-Bastard HMO Taketh Away

You know how there’s never a bank error in your favor? Not so for the HMOs! On Friday, J informed me that he had spent $240 out of my account, and that it was going to make me very happy. Couldn’t really imagine what he had bought me (with my money, not that matters, but you know what I mean). He kept asking me to guess. I hate that game.

And then he told me.

$240 just bought my ENTIRE DRUG PURCHASE for this cycle. A drug purchase that was supposed to cost almost $2,400.

Let’s savor this moment, shall we?

My asshole, shitbag, rat-bastard HMO—the same HMO that refused to cover J’s health-threatening hormone deficiency just because we’re trying to get pregnant and I’ve used up my IVF coverage, the same HMO that denied me coverage for a water sono to follow up on my fibroid surgery just because I’ve used up my IVF coverage, the same HMO that guarantees a three-day turnaround on preauths but always requests “additional information” several times until I am forced to pay out of pocket or cancel a cycle—just accidentally covered my hideously expensive drug purchase.

HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA!

We all know that one of the reasons the HMOs suck so hard is that they have no incentive to be competent. Incompetence makes them money, because you eventually get so insane with it that you agree to pay out of pocket just to avoid one more hour-long phone call where you’re told exactly the opposite of the phone call before.

But I guess incompetence occasionally cuts the wrong way. Heh heh heh.

I feel so smug. I feel so vindicated. I feel so frustrated that I didn’t order twice as much.

I’ve been waiting to post this until the drugs are in our hot little hands.

This Just Sucks

I’ve had a strange week, and every time I think I’m ready to write about it something new happens and I don’t know where to start.  The bottom line is that I’m definitely NOT in control of my life right now.  As much as I thought I could handle whatever was thrown at me this time, I was wrong. 

 

Friday was horrible.  Since Monday I had been handling the hormone rush of the pill and the oncoming unknown of a new IVF cycle with considerable grace—I was focused on my work, cheerful, and feeling at peace. 

 

So when Friday came along I thought I had it in the bag.  I had packed up my work the night before so I could work from home, and was all set to breeze through my sounding and water sono (SHG) that afternoon.  Shit, man, I’d done this all before.  Uncomfortable?  Yes, but not anything to get worked up over.

 

The sounding was a piece of cake.  Barely felt the catheter.  One more procedure down and I was free to go.  I emptied my bladder and hopped back up on the table, cheerful and chatty.

 

Twenty minutes later I was sweating, literally.  Turned out that we were doing this a little late in the cycle for someone who ovulates early like me.  Turned out that my cervix was bent into a curvy shape, and that damn catheter just wouldn’t go through.  Turned out that my a-little-bit-uncomfortable procedure was about to get a lot worse.

 

Ever hear of a tinaculin?  No idea how you spell it, no idea what it looks like (in my nightmares it’s a 3-foot wide clamp with big teeth).  A tinaculin is a clamp that goes ON your cervix—it allows the doctor to yank your cervix (an organ not designed to be yanked) all around.  Which fucking HURTS.  Remember the worst pap you ever had?  The kind that made your cervix cramp up and made you want to roll up into a fetal position?  Now multiply that sensation by five, and make it last for ten minutes.  I’m just saying, it fucking sucked.

 

And it didn’t work.  At the end of the day, we just had to give up.  My cervix wasn’t letting the catheter in (never mind that it had just gladly allowed the sounding catheter through) and that was that.  My RE said we could schedule an HSG on Monday.  Which I knew I would have to pay for, because it’s in the radiology office and my shithole HMO won’t cover anything any more.  (They have me flagged now.  I swear to god, I could go in with a broken ankle and my HMO would deny my coverage as “IVF-related.”)  To the tune of another $800.

 

At my suggestion, my RE said the before we take that step we could retry the already-paid-for SHG on Monday, this time with a full bladder.  If that didn’t work we’d do the HSG on Tuesday.

 

My nurse and RE left the room, and I started to cry.  I think it was a reaction to what I had just been through, and how unexpected it was.  It definitely was the most invasive procedure I’ve ever been conscious for.  And seeing all the blood when I cleaned myself up didn’t help.  I didn’t begrudge myself—I thought a few tears were warranted.

 

But I didn’t stop.  I got out to my car and I was still crying.  Five minutes later I was on the beltway and I was still crying.  And then I hit this massive traffic jam and I knew there must have been an accident in front of me.  So I figured I’d get off in Bethesda and take the back way home, which I’d done one before with my husband’s guidance.  But when I got to Bethesda (still sobbing, BTW) I got all turned around.  We spend a lot of time there, but J is always driving and I didn’t know which way to go.  Everything was familiar, but I was just driving around it in circles.  And I couldn’t stop crying.  I emptied out my multiple-pill bottle and realized that I’d never reloaded another xanax, so there was nothing I could take to calm me down.

 

I finally pulled over and called J.  Thank god he got service in the theatre he was in that day.  I tried to ask him for directions but I couldn’t stop crying long enough to talk.  I told him what had happened, and he gave me directions the best he could.  I got home more than an hour after I left the doctor’s office.  I was still crying.  I took a xanax when I got home, and eventually fell asleep.

 

Here’s the weird thing.  I had a bad experience, but it wasn’t like it was bad news or anything.  And I think if the water sono had worked, I would have been quick to bounce back.  I think what upset me more than anything was the complete loss of control over my life.  With no warning, I suddenly had to make arrangements to work from home again on Monday, knowing that I might have to do that on Tuesday or Wednesday too.  It’s just so frustrating.  Here I have a job where people rely on me and it’s important to my own feelings of self-worth to be professional and reliable, but I’m constantly having to ask for special favors and making excuses.  I hate it.

 

On Monday I went back prepared—I had taken a couple of alleve before I left, as well as a half a xanax.  We did the water sono with a full bladder, and it went fine.  It definitely hurt more than it would have if we hadn’t mangled my cervix on Friday, but it was manageable.  All clear, not a fibroid in sight.  I was so emotionally drained when I got home that I took the rest of the day off.  J and I went to see Star Trek again.

 

Crap.  I have to go, so I’m going to post this raw.  (I usually edit a bit.)  Sorry.

A Funny Moment

A Funny Moment 

Last night, J and I were watching the finale of the second-to-the-last season Star Trek Deep Space Nine (the crème de la crème of all Star Treks).    

So Dax (a Trill) and Worf (a Klingon) are trying to have a baby, but interspecies fertility is tricky, and they’re having no luck.  Worf is about to go off to battle, and Dax tells him that the doctor has found a way to make it possible.

“We’re going to have to get to work on it as soon as you get back,” she teases.

 In the stilted manner that amounts to Klingon flirting, Warf replies, “I do not consider that . . .  work.”

 J busts out laughing.  “You will,” he yells at the TV, raising his glass in a toast, “oh, you will.”

 Is romance dead when your husband cracks wise about your fucked up sex life, and all it does is make you laugh harder?  I love that man.

 

IVF Cycle #5, Freakout #1

I’m exactly 24 hours into IVF Cycle #5, and already have jumped headfirst into Freakout #1. Not a promising sign for things to come.

My RE wants me to do a long suppression cycle using Lupron. I sent her an e-mail asking if it really was necessary—I’ve gotten by just fine with a short (2-3 week) suppression cycle on the pill before, haven’t I? (Though I guess it depends on your definition of success, given that I’m still not preggers.) She wrote back and told me that we definitely could discuss this, but that she’d given it a lot of thought and decided to try the Lupron because in my last cycle I had one ovary develop faster than the other, so ended up with only 8 eggs.

I hate this idea for so many reasons:

1. What if this screws up my cycle completely? It seems like introducing a new drug when I’ve produced enough eggs without it is a bad idea. What if my body reacts badly? I don’t know how many more cycles I’ve got in me. Even with shared risk, they cost a fucking fortune. And I don’t know if I can take it physically or emotionally any more.

2. What if this screws me up completely? Lupron scares the crap out of me. Frankly, I have enough trouble with the pill for a few weeks. It makes me depressed and weepy and tired all the time. I’ve heard Lupron can make you bat-shit crazy. I have a pretty high-stress job that lately has been getting harder every week . I know what’s involved in the drug regimen I’ve already taken. This is entirely new. I don’t want new. I want the comfort (can I call any IVF cycle comfortable?) routine I know.

3. What if this ends up costing a lot more? I know I’m going to have to pay for the Lupron, but I don’t know how expensive it is. But what if I also end up needing more stims to counteract the suppression of Lupron? Stims are brutally expensive.

4. And finally: Oh my fucking god, do I really have to increase the total length of my cycle by another MONTH? I’ve been steeling myself for this cycle with the mantra that it’s only about 40-45 days, start to finish. But now I’m looking at being on drugs all summer, just for one cycle.

I really don’t want to do this cycle. I wish I could just knock myself out for the next three months. Wake me up when it’s all over—just tell me the results and I’ll go from there. Because this is all just too fucking much.

Goodbye, Spermies.

Today we said a sad farewell to J’s sperm.  We knew that was how today would go.  We woke up at 6 this morning to a truly epic thunderstorm, the kind of storm where, after your house stops shaking, you ask, “is that the loudest thunder you’ve ever heard?”  The kind of storm that leads you to reminisce about a night more than 10 years ago—when the big fear was not finding a job and infertility was something that happened to other people—where we sat under the large awning of a deserted dorm in Fredricksburg, watching lightning dance across the sky so often we couldn’t tell one thunderclap from another.  The kind of thunderstorm that reminds you that you used to cuddle in bed and talk for hours.  So we cuddled, and talked a little, and listened to the thunder roll around our little house.  And we didn’t talk about the appointment we were about to go to.  No need.  We’re all talked out.

 

J’s sperm count is still below 1 mil.  Almost uncountable.  His hormone levels are fine now, but the sperm just aren’t developing.  Dr. World-Renowned can’t explain it, but he’s done all he can. 

 

So on we go to donor sperm.  I slipped out of the doc’s office a few minutes before J was done to get things lined up with my nurses.  When I told them what the plan was, she asked how I felt about it. 

 

“I’m really sad,” I told her, feeling the tears well up behind my eyes.  “But it’s going to feel so good to do something different this time.  Maybe now, if I get a positive beta, I won’t find myself just counting days until the inevitable loss.”

 

She nodded.  “You’ve been carrying this burden for a long time,” she said. 

 

And that’s how I feel.  Today I’m sad.  And I’m sure I’ll be sad again.  But goddammit, I’m ready to MOVE ON. 

 

Last Saturday we babysat our best friends’ 16-month-old boy.  And guess what?  I still want one.  (It didn’t hurt that he was an angel for us the entire evening; he fell asleep in my arms while we watched John Lester take a no-hitter into the 7^th—what could be better?) 

 

But the most wonderful thing was watching J with that little boy.  Playing with him in the park; feeding him his yogurt that night; holding him on his lap while we watched the game.  So yeah, I’m giving up J’s genes.  But I’m not giving up watching him be a daddy.  And it’s about fucking time that we made that happen.

 

A Strange, Uncomfortable Place

The past few weeks have been strange and uncomfortable. It’s not like I’m in the Pit of Despair—it’s more like I’m standing at the rim of the Pit, thinking how much it’s going to suck when I start the fall.

I’m moody; I’m tense; I’m emotional.

I’m a girl about to go into her 5th IVF cycle.

I’m an analogy girl, so try this one on: it’s like I’ve spent the past 8 months sitting on the edge of a rushing river. I’ve known that, when my time was up, I was going to have to cross that river. It was going to be cold, and scary, and god only knew what I was going to find on the other side, if I ever got there. You see, I’ve been in that river before, and each time I go in I get swept away, only to wash up months later, battered and waterlogged, somewhere downstream on the same side I stared on. I used to be eager to jump in again, get it over with. But this time I was forced to sit on my side of the shore and dry out in the sun and heal my bruises, have a snack. It’s nice on my side of the shore, really.

But when my last period started I knew the break was over. Next period = next IVF cycle. Which means it’s time to start getting ready.

Just thinking about it made me feel panicky, like I couldn’t quite catch my breath. J’s been just as bad. Last week I forced the issue—made him dip his feet in the water, if you will. I told J we had to start looking for a donor. So we spent some time on the website of the cryobank we’d like to use. And it was kind of fun, actually. We made fun of the donors’ stupid cliché answers to certain essay questions. (Most of these guys, when asked where they would “most like to travel,” want to go “everywhere,” because they’re interested in “diverse cultures.” Blech! J and I flagged the guy that said he wanted to travel to the moon. We thought he was awesome.) But when we stopped, I found myself getting really sad. Goddammit, it just isn’t fucking fair. I’ve been willing to accept that I’m going to have to go through a lot more heartache to get a child than other women do. I’ve given up four years to the cause, watching my friends and family raise their children while I stand on the sidelines and try not to grind my teeth down to tiny nubs. I’ve accepted that my dream of having two kids is a fantasy, that I’m probably not going to be able to afford to send the one I do end up with to the college of his/her choice. I’ve given up a LOT. But to give up on having a piece of my husband growing inside of me. To give up on seeing his steady calm take root in a child. To give up on passing on to a child the very traits I fell in love with. And to have it all be about me, about my genes.

But now at least we’ve broken the ice. Oops, mixed metaphor. We’ve waded a bit into the shallows of the stream, felt the cold rocks on our bare feet, numbed our hearts a little bit to what’s to come.

But as our cycle is drawing closer, I am more and more overwhelmed by the rushing waters in front of me. I try to take deep breaths, resolving to handle this cycle better, to stay calm, to not freak over the little stuff, to not let it GET to me the way it always does.

And then I called my RE’s office to get instructions on the next cycle, and suddenly all my resolutions seem like a silly fantasy. Here is what she told me:

1. It sounds like my RE is changing my regimen, adding a Lupron cycle where none was before. I am not happy about this. My cycles have been pretty successful before (except for the outcome, of course), and I can’t imagine why we would add a totally new drug this late in the game. What if it totally fucks up my cycle? J and I are at the end of our rope—if we go straight to donor sperm this cycle (almost certainly, but not yet determined), we’re probably only going to do two more. Because at some point we have got to get OFF this horrible ride. And it adds something like another 3-4 weeks to my cycle! ARRGGHH! Anyway, this is not set in stone. My Favorite Nurse is going to ask my RE about it and we’ll see if she really meant for me to change up. But even thinking about it makes me fret.

2. I need to do another water sonogram (SHG?) and another sounding. I guess because it’s been so long since my last cycle. And neither of these are covered by my shared risk program. Which means I have to get preauthorization from my fucking horrid godawful evil ratshit insurance company. Which means I’m going to have to make sure the request is coded right, because if anyone so much as breathes the word “IVF” in the presence of the preauthorization request, United Healthcare will know and will reject my request. ARRGHHGHH! I THOUGHT I WAS DONE WITH THIS BULLSHIT!!! The one good thing about going into shared risk was NOT having to seek preauthorization from the Evil Overseers. The only good thing about running out of coverage was not having to deal with getting coverage.

I swear to god, when I got into this conversation with Favorite Nurse I started to hear roaring in my ears. And when I hung up the phone and rested my hot forehead on my desk, I felt the water sweep my feet out from under me and wash me away, down into the cold, tense, bitter, angry maelstrom. (That’s right, I just used “maelstrom” in a metaphor. So suck it.)

All I can think is how much I don’t want to do this. I can live with the bloodwork, the sonos, the early mornings. I can take the shots and the heavy swollen ovaries. But the rest of it—the contract with the sperm bank and the preauthorizations and the ordering of the drugs and the timing of the acupuncture with the doctor visits (and don’t forget the chiropractor visits) and having to tell my boss I’m going to be out a lot—but I can’t tell you when—(and oh my god I’m SO scary-busy at work). And then the results. Those fucking results.

Oh, and have I mentioned that I’m pretty freaked out about the end result even if it’s “positive”? I’m finally healing my back, after 10+ years of weakness and pain. What would a pregnancy do to it? What would having to take care of a baby do to it? How will I survive the crying, the sleeplessness, the constant feeling that I’m not doing enough?

Well, I’ve managed to totally depress myself. Cheers, all.