The Big “O”

At the advice of my acupuncturist, I called my OBGYN and begged to have my progesterone level checked.  If you remember from previous posts, ONE of my issues is lack of ovulation.  I have been wondering if my body is starting to respond to the acupuncture treatments or not.  I have to admit, I was a bit surprised at the results the nurse gave me……….PROGESTERONE LEVEL OF 12!  Which means I ovulated!!!!!! [>10 = ovulation].

I had to ask her twice, maybe 3 times to repeat the number to make sure I heard it right.  The last time I had it checked [October 2009], it was a sad 1.56.  The time before that [February 2009] it was 3.  So this number was quite shocking to me.  I have to say the results have given me some new hope.  I am well aware that just because you ovulate, doesn’t mean you get pregnant; but one can’t get pregnant if they don’t ovulate.  So maybe we are on the right track, maybe this acupuncture is doing what it’s supposed to do, and that makes me hopeful.

Acupuncture, it is…

I feel as if I’m embarking on a new adventure; that is to say, I’m happy I’m taking some steps, doing something outside of what I can do for myself.  I met with my ‘new’ acupuncturist on Friday – remember, the one who ONLY works with infertile people.

The clinic had an Eastern flavor to its atmosphere; very calming, soothing, warm, and overall comfortable [unlike the clinics I have been to or worked in]. As you know, filling out paperwork is a must everywhere you go: medical history forms and liability forms.  My first appointment with my new acupuncturist [E.] went much like I had previously experienced: very thorough review of my medical history, history of present issues, discussion of my goals, listening to/feeling my pulses, and looking at my tongue. I was given an explanation of what sort of sensations to expect from the needles. After I took off my shoes and socks and hopped on the table, the sticking began: forearms, hands, lower legs, ankles, feet, stomach, head – not bad, most I didn’t even feel…maybe just a little prick. Once the needles were in, and the heating lamps placed over me, I was left alone to rest in the darkened room with their relaxing music playing. The sensation was very unusual, but pleasant. My body felt kind of heavy, yet light…I didn’t have a desire to move [although I did have to resist my initial temptation to look at , play with, and take pictures of the needles ]. My mind was restless at first, but cleared by the moment, and I felt totally relaxed.

Before all of that, a few of my questions were answered.

We discussed my uncertainty about pursuing further IUI treatments or IVF at this time.  We also discussed the option of acupuncture as the sole treatment for a while.  E. briefly reviewed the anatomy/physiology involved in developing a follicle, and how it takes at least 90 days to do so, before you ovulate that egg.  Obviously she was hopeful that acupuncture could help with the nourishment/development of a healthy egg, as well as help balance my system and hormones in the process.  She works with many women who use acupuncture in conjunction with Western medicine, as well as with women who use acupuncture alone.  Either way [if I decide to pursue IUI treatments in the future or not], she would have recommended acupuncture alone for a couple of months, just to give time to nourish that follicle.

I’d have to say she was optimistic yet somewhat guarded [or is it realistic?].  She mentioned many times that there are always a lot of factors to consider that must fall into place for pregnancy to occur; and she needs some time to get to know me and my body/system.  She mentioned it’s hard to isolate what it was that worked for couples [meds, insemination, acupuncture, herbs, vitamins, change of lifestyle, etc], or if it was the combination of treatments and things we do on our own that resulted in pregnancy – she was empathic that this is a very frustrating issue.  She mentioned we can definitely improve on the things that are bad, but the cycles that may not be good [factoring in a magnitude of possible reasons in a given month], just might not be good.  I guess there are no guarantees for anything.

E. didn’t think my FSH levels were THAT high or alarming.  She reiterated that FSH levels can change cycle to cycle [so maybe mine COULD be better some months].  She said she has worked with women in my situation which resulted in ‘natural’ pregnancies, although the length of time varied.  She took a look at my temperature charts – she thought I was ovulating by looking at them; except for the month that I took the clomid, interestingly.  But based on my 2 most recent progesterone labs taken in 2009, I’m not ovulating.  Hmmm….

Her recommendation at this time:

-Acupuncture 1-2x/week for 3 months [for monetary reasons alone, it will have to be 1x/week].

-Follow-up labs to check my progesterone [at my MD clinic] for a couple of those months

-She mentioned that she would not recommend another cycle of clomid and IUI for me, stating that clomid does not work well with someone with high FSH levels; if I were to pursue IUI again, she would suggest IUI plus injectables.  After a few months, we will discuss combination therapies as a possibility, if I’m interested.

She mentioned herbs, but didn’t want to push them on me at the first visit.  E. did say that she typically combines acupuncture and herbs – although I’m totally undecided about the herbs.  I don’t even like to take tylenol when I have a headache, so the idea of herbs kind of frightens me.  Has anyone ever taken any?  How did they make you feel?

Rants and Raves…

I have to admit, I am not immune to having days where I get angry and bitter about the struggles with infertility.  Today is one of those days, so bear with me, if you will.

1)   No Insurance

Both my husband and I work, qualify for insurance, and pay a hefty premium every pay period to have insurance coverage.  It frustrates the hell out of me that our insurance doesn’t cover any treatments for infertility.  Apparently they don’t consider having a family medically necessary, or something like that.  But they seem to have no problem covering issues where people make poor lifestyle choices – congratulations on your open heart surgery – can you pass me one of those bacon double cheeseburgers and light me up one of those heaters?  Oh, I know I’m supposed to be managing my diabetes, but “I don’t feel like” checking my blood sugars.  I guess I’ll have to be re-admitted to the hospital [again] and spend thousands of dollars on medical care, treatments, wound care for that non-healing foot ulcer, and maybe an amputation along the way – should have chosen to check those blood sugars and monitor my diet…no worries, I have insurance coverage.

What can be fixed, should be fixed.  Shouldn’t there be some equality here?

2)   Rollercoaster ride

Cycle after cycle of careful monitoring of fertility signs, checking temperatures, using ovulation predictor kits, taking meds, office visits, procedures [poke here, prod there], timing sex.  Although I’ve learned to expect the let-down on cycle day 28, I’m not sure it has gotten any easier.  What did I do wrong this cycle, what could I have done differently?  All frustrating unknowns.  Infertility really fucks with you, doesn’t it.

3)  The Annoying and Ever-present Question:  When are you going to have a baby?

Although it appears that Everyone around me is able to not only choose the number of children to have but also when to have them, most of us reading this do not.  I can’t even relate to their presumptuous planning.  Some days it’s more maddening than others.  I am going to get pregnant/have a baby:  after I lose 10 pounds, when my daughter goes to pre-school, after we go on vacation, in the month of June so I can have my summer off…And it usually happens that way.

Usually I just conceal my irritation and smile.  They don’t mean to be insensitive, they just have no idea/appreciation of the hurdles they crossed so easily to become pregnant.

4)  People say stupid shit

It’s maddening to listen to my pregnant friends and co-workers complain about ‘petty’ pregnancy things that some of us would be more than pleased to embrace, such as: healthy pregnancy weight gain, fatigue/needing to take naps, giving up wine and caffeine….

Equally annoying are the complaints about the ‘wrong’ sex of the baby, having to spend money on the basic needs of their child like diapers/formula/daycare, ‘only’ have 12 weeks off for maternity leave, not having ‘the right months’ off, the list goes on.  Obviously they don’t understand that some people spend tens of thousands of dollars just at the chance of becoming pregnant [remember it was free and easy for you!].  Suck it up, you’re pregnant so quit your bitching.

Another of my favorites is, “you’re so lucky you don’t have to …[fill in the blank:  deal with daycare, spend you whole day running the kids around, help out at school, deal with fighting kids all day...].  LUCKY???

Again, I don’t believe they are trying to be malicious or insensitive, they are just unaware.  How I react to the comments is variable, depending on my mood.  Sometimes 1)  I ignore them and don’t comment, acting as if I am totally unaware of how insensitive and selfish they sound,  2)  I half smile and respond kindly, trying to be empathetic to their situation, and 3) sometimes I’m a little bold with my reactions and give some sort of truthful and honest summary of the world of infertility, in the process reminding them that the things they are belly-aching about would be more than welcoming to an infertile couple. [This last way usually ends up making me regret my decision of possibly OVER-reacting].

I typically stick with the first or second route, mainly because I don’t want to feel or sound bitter – it’s not fun for me and it just makes this whole process worse; and secondly, I don’t want people to feel like they are walking on eggshells around me, because MOST days, they shouldn’t .

Fortunately, most of the time I don’t let things bother me, and I am a happy person who doesn’t spend her day obsessing about fertility issues.  I am incredibly blessed with the most amazing family, that I know.  But some days, infertility changes your whole frame of reference, you know what I mean?  Some days, I’m tempted to feel bitter [like today], but fortunately the better half of myself quickly resurges.  Despite my difficulties with conception, etc. etc., I’m still happy and excited for others, still rooting for the best for them.  Their happiness does not equal my sadness, I know that.   In fact, their happiness contributes to mine.  I just wish that I became pregnant as easily as they all do.

Since I do not have any friends/family going through this, I’m glad to have this outlet in which to learn from, share, and bellyache with once and a while!

Short-term Decision = Acupuncture

Yesterday, I met with my acupuncturist [J] and discussed the results of our fertility work-up.  I have to tell you, she wasn’t impressed with the statistics either.  I mentioned that my RE said FSH levels can not be changed.  J and I discussed this and not to my surprise, J didn’t agree with that statement.  J feels that acupuncture can and does change FSH levels, other hormone levels, can balance my system, nourish my eggs and uterus, etc.  This brought a smile to my face.  Check out this article that I got from Infertility and me for more information:  How Traditional Chinese Medicine (Acupuncture) Enhances Fertility and another site that provides a good reference.  It is difficult to be in limbo without a plan – I’m ready to delve into a treatment plan and have some direction again.

For the short-term, I’ve decided to put acupuncture on the main stage of our fertility plan.  There are a few reasons for this.

1)   My husband isn’t looking at the statistics very favorably

2)   At this point in time [without insurance coverage], the fertility treatments that we require aren’t affordable

3)   I have an obvious goal in mind for pursuing acupuncture, but along the way it can provide me with many other benefits to my body/mind/spirit.  I suppose I’m taking comfort in this option because even if I don’t get pregnant, I’m still benefitting from the treatments.  This is in comparison to all of the medications, hormones, US, office visits, and invasive procedures I’ve tried in the past without success and without any real benefit to my system [actually, some of the meds made me a little edgy].  I am still willing to consider medications and other reproductive assistance again in the future [when we switch insurance plans - ? likely  in 2011], but for now I think acupuncture may be the best choice for us.

That leads me to the bitter-sweet news.  J offered me an opportunity to switch providers.  She feels that although she can help me with my fertility issues, she recognizes that individuals with infertility issues aren’t her only [or her primary clientele].  Therefore she is referring me to another acupuncturist who ONLY treats infertility.  I’ve made an appointment for next Friday, and I’m actually quite hopeful to start a new plan.  Likely I’ll be encouraged to make some lifestyle changes too, which will be good for me.  I’ll be interested to hear what she has to offer…more to come.

ROLLING THE DICE: The Stats

My husband and I met with our RE to discuss the results of our testing, our options and our chance of becoming pregnant.

After reviewing our results, Dr. H informed us that “the issue with your egg quality is concerning…that combined with your age”.  I wasn’t too thrown off by this because I had heard it before when I received the results of my clomid challenge test.

Here are our options and their respective stats:

1)     Clomid + IUI =   8-10% chance of conception

2)     Injectables + IUI =   10-15% chance of conception

3)     IVF = 30-40% chance of conception

*Dr. H said that those with ‘normal’ egg quality have a 50-60% chance of

conception with IVF

4)     Natural conception = very low…

I have to admit, I was a little shocked by the odds.

To add fuel to the fire, next we were presented with the cost of our options.  Keep in mind, we have NO INSURANCE COVERAGE!!! for treatment.

1)     Clomid + IUI =   $1,553/cycle

2)     Injectables + IUI =    $3,618/cycle  plus

$1,500 for medication

3)     IVF =   $14,088/cycle   plus

$2,500-5,000 for medication

$682.00 for cryopreservation of embryos

*** Estimated Total for 1 cycle of IVF = $19,770!!!

Naturally, the best odds of achieving a pregnancy is IVF, which is also the most stressful on the mind, body, and pocketbook.  Overall, none of the odds are great.  I’m not sure many would bet on those odds in Vegas.  That’s a lot of money to spend on just the “chance” of becoming pregnant.  Don’t get us wrong, we would consider taking out a 2nd mortgage and spend the money if we could be certain the end result would be a success story.  My husband equated those odds to “it’s like putting $5000 on the Colts and hoping they cover” [we got the stats news the week before the Super Bowl game, if you hadn't guessed].

Clomid + IUI, and injectables + IUI hadn’t worked for us in the past [when we were in our 20's and didn't have issues with egg count/quality or hormone imbalances], so this choice doesn’t seem the most promising for us either.  Considering a ‘normal fertile couple’ has only a 20% chance of conceiving in a given month, our 8-10% and 10-15% odds respectively [with meds and IUI] don’t give us the most hope either.

We haven’t yet decided what to do…I thought by the time I posted the stats, we would have made a decision on the direction we are going.  Of course, affordability is a huge issue that needs to be factored in to our decision.  We struggle with knowing that we will literally be putting all of our eggs in one basket.  We will have one shot at this, if we decide to go the IVF route.  How does one control their stress when so much is at stake?  I don’t know that I could handle the let-down if it didn’t work.

I feel and sound like a pessimist as I write this post.  Like all infertile people, I have my ups and downs.  Perhaps I should have posted on a different day…either way, the statistics don’t change.  Soon we will have to make a decision and roll the dice.

We live in southeastern Wisconsin – has anyone had a positive experience with a doctor/clinic in the area that they would like to share?  Are the prices for this clinic out of the spectrum, or are they considered the norm for these services?

I’ve been going to acupuncture off and on, which I really enjoy.  I need to do a little more research into protocols for acupuncture related to infertility.  Does anyone have any experience with acupuncture?  Dr. H said they often use acupuncture in conjunction with fertility treatments.  I asked her if acupuncture and herbs could change/alter my FSH levels and she said no.  This is a question I plan to pose to my acupuncturist at my next visit.

The Night Before the Big Meeting

January 25, 2010

Tomorrow we go to see the RE to find out what our odds are for getting pregnant, if there are any at all.  I have mixed emotions heading into this meeting.  Since I already know that becoming pregnant on our own is near impossible, I know our only options will be stressful, expensive, and emotionally/physically draining.  But just how stressful, expensive, and draining those options will be is still unknown today.  Do I want to put myself through that again?  Because all treatments in the past have failed, does a small part of me  secretively wish that there is no chance of becoming pregnant with all of the resources available, just so that:   1)  I can make peace with the fact that we have done  EVERYTHING we can,  2) I don’t have to put us through the emotional and physical roller-coaster again, 3)  We don’t have to deplete our savings with only a possibility of conceiving, or 4) I don’t have to internally struggle [and live with] the conscious decision to continue or stop trying.   Will I ever make peace with this madness they call infertility?  I’m just not certain what lengths we are willing to go to without knowing our “statistics” yet.

Infertility Chronicles: Test results

I’ve been waiting for my infertility work-up to be complete before I updated things.

I did the clomid challenge test last month, here are my results:

Day 3:  FSH level 9.23 [<10 ideal, normal], Estrogen level 53

Day 10:  FSH level 11.4, Estrogen level 402

From what I was told, my FSH levels are elevated [10-15 elevated, 15-20 high, > 20 = moving toward menopause and no egg production]; the FSH is telling us about my ovarian reserve – my ovaries have to work a lot harder to create a follicle, and egg quality/count may be an issue too.

Apparently a clomid challenge test that shows poor ovarian reserve is predictive for women who won’t get pregnant.  Therefore, it is unlikely that I will get pregnant on my own naturally.

My estrogen levels are good – I had a normal response to the clomid.

Another thing to keep in mind is that I’m not ovulating on my own [actually I'm not sure if I ovulated with the clomid challenge cycle as they didn't choose to check my progesterone level - this is not part of their protocol].  Has it been standard to check progesterone levels during this part of testing in anyone else’s experience?

[By the way, I got a BFN after this cycle of clomid.  It teased me a little - my period was 4 days late, which is a typical response to the clomid medication apparently.]

As previously mentioned in early January, I also had the hysterosalpingogram test – good news, my tubes are open.

My husband had the joyous experience of collecting a semen analysis in the doctors office.  I think I was more bothered by this than he was – it’s one thing to put myself through the testing, and another to subject someone else to this madness.

His results were fine:

Count: 220 million little guys

Motility: 77% [Normal is >50%]

Morphology: slightly less than normal [Dr. H said this wasn't concerning]

We meet with the doctor next week to discuss our treatment options and statistics related to those options.

I have tried acupuncture in the past, and have done some research on the benefits of acupuncture related to infertility.  I was wondering if anyone out there knows of cases where acupuncture treatments help turn these things around?  The nurse at the clinic said FSH levels can’t be changed??? Any thoughts?

Infertility Chronicles: Hysterosalpingogram

1-5-09

Hysterosalpingogram

My husband came home from work to watch our little guy while I headed off to my procedure.  Even though I had pre-registered, they didn’t have my insurance carrier listed, which meant more time [that I didn’t have] once I arrived.  For a brief second, I contemplated remaining listed as a self-pay.  Why?  Considering the crappy insurance coverage for this sort of test, I thought I might be better off being listed as a “self-pay” and getting the marked reduction in fees that one gets if they can’t afford insurance.  But in the end, I decided to make the change.  At least I’ll have met my $300 deductible for the year today, right?

The radiology department was quite busy this morning, patients both sitting around and registering in the little space available.  Apparently the desk staff doesn’t abide by HIPPA regulations, asking me to announce my name and reason there in front of a wide-eared group.  After the insurance info was straightened out, they ushered me into a woman’s locker room for me to change into a hospital gown.  I was asked to take “everything” off.  I’m not certain why my shirt had to come off, as the procedure was below the waist, but whatev.  There I was standing in a semi-private smaller waiting space, patiently waiting my turn on the xray table.  Finally, a very nice xray nurse came to get me, apologizing for the long wait, “they didn’t tell me you were here”.  Communication is apparently lacking at this facility.

The procedure was explained to me as I lay on the hard table awaiting Dr. H. and the radiologist.  I did my research before this test and had a few questions to ask.  I was assured by the nurse and Dr. H. that this procedure wouldn’t have any negative effects on my body, my ovaries, or my already older eggs; the amount of radiation is apparently minimal.  After both doctors arrived, the contrast material was injected, and to my surprise, I didn’t feel any cramping.  None.  Nada.  Zilch.  This was unexpected – the first time I had this done it was more than “moderately uncomfortable”.  Maybe it was the 600 mg of ibuprofen they recommended I take before I arrived.

The discomfort [or lack of] didn’t account for my tears while on the table; the culprit instead was the overwhelming emotions that occur when living the life of an infertile woman.  No, I wasn’t anxious about the results or nervous that it might hurt, I was simply overcome with emotion at the idea of being in this position AGAIN.  I had put an end to this testing, poking, prodding, and the emotional rollercoaster of repeated failure a long time ago.  Yet there I was doing it all over again, repeating exactly what I said I wouldn’t put myself through again.

And the results?  The procedure showed I have no blockage in my fallopian tubes, and my uterus looked fine too.  Dr. H. said this will probably be considered a “normal” test; her only hesitation was the fact that my right fallopian tube turned inward and [according to the radiologist], “spilled the dye over to the left…which is different”.  Does this mean the right tube is positioned so that it can’t pick up an egg from the right ovary?  Dr. H. said it’s hard to tell if the tube was just positioned this way during the test, or if there is scar tissue or endometriosis holding the tube in that position.  Is anything said with absolute certainty?  I even asked if changing my position on the table would make a difference in the position of the tube [so we could see if it moved into its proper location or if it was scarred], but Dr. H. said not likely due to the positioning of the rest of my organs/bowel.

Next step = semen analysis, and only then will Dr. H. meet with us and tell us our options and “statistically speaking”, the likelihood of getting pregnant with these given options.

More to come…

Insurance Coverage Sucks!

1-4-10

I spent a lot of time on the phone today with both my insurance carrier and the staff at the clinic trying to get an estimate of how much this one test will cost us, and if we can afford it.  It was a very frustrating experience let me tell you.  First of all, since it is a new year, I will be paying my $300 deductible with this procedure for sure.   I was also informed that if the facility charges the cpt code for HSG [same code Dr. H will use], I will owe an extra $250 as a copay, as the HSG is considered an “outpatient surgery” if billed by the facility.  No one could tell me what cpt codes would be used by the facility, so it was very difficult to find out what my insurance would cover of the facilities fees.  If the facility only charges for the equipment used, xray, and radiologist, then I won’t be billed the extra 250 bones.  It didn’t matter how many times I explained that this isn’t a surgery, but the insurance company said that they interpret “anything invasive to the body” as a surgery in that setting.  So basically, if Dr. H. had an xray machine in her office, then it wouldn’t be interpreted as a surgical procedure and I wouldn’t owe another $250.  But since this procedure is taking place in the hospital xray dept, and I am an outpatient…surgery it must be.  This is absolutely ridiculous to me!  How many women have vaginal US and it’s not billed as a surgery [this procedure was no more invasive than that!].

So basically, after calling multiple depts. [billing, radiology, the estimator, Dr. H. office, the insurance company], I didn’t get anywhere.  Apparently no one knows or can find out how this procedure [that gets performed daily] is coded/billed.  So I have to wait and see.

Likely, this is what I’ll owe:

HSG [billed by Dr. H.]

Radiologist fees

Facility fees

$300 deductible, $250 copay, then 10% of all of the above.  Pocket change.  Sucks.

The Infertility Chronicles: The Initial consult

November 2009:

I couldn’t believe that I was spending part of my day off at a fertility clinic, but I suppose I better get used to it again. As I descended the stairs in the parking ramp, I felt like I was walking down the stairway to hell, a journey I was still not completely convinced I wanted to repeat.

My first impression of Dr. H’s office was positive: updated, quiet, and somewhat relaxing. First I met with nurse M. She took some time to review my history with me [basically reading back to me what I had made efforts to fax from other clinics]. I had to make a few corrections – interestingly, sometimes the doctors get it all wrong. In one note my OB wrote: “patient was unable to conceive without use of medication”, which was not accurate at all!   The inability to document important information accurately is infuriating – get your head out of your ass and listen to your patients!

The meeting with nurse M. was basically uneventful. I’m guessing she’s new to her job, or just bad at it. She had that air about her, you know – she gave off a certain impression immediately – the one where she didn’t really want to be there, isn’t invested in my situation yet, and is basically just going through the motions with yet ‘another’ patient. I’m not sure I like her, but I’ll give that relationship some time.

Dr. H came in next to further review my history and explain to me the course events for the next month or so, as well as to answer any questions that I may have. Basically, I need to re-do all of my lab work and tests, which I understood, since most of them were over 6 years old.

At this stage in the game, Dr. H. was unable to enlighten me at all or provide any statistics until after our testing is complete.  At least I had a plan and would hopefully find some answers [good or bad] to our endless difficulty getting pregnant.

Next steps:

Me: lab work, clomid challenge test, HSG procedure

Hubby: semen analysis

By the way, I held it together pretty well at this visit – only shed a few brief tears during the meeting [much better than the last time I was in this situation with Dr. Icantunderstandawordyouaresaying].