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].

Infertile again 2004-2009

I got pregnant once on my own, so I could get pregnant again, right? That was what I led myself to believe for the 5 years after our son was born. Even as month after month passed I still held out hope that we would be blessed again with another healthy child. I really wanted to believe this…I just couldn’t go back to one of those RE clinics again, I wasn’t sure I had it in me. I had managed to block that period of my life out, and vowed to not go back. One healthy, happy child is such an incredible blessing beyond words. We always wanted to have another baby, but we had decided that what will be, will be. But…as the years past and we were getting older, I found myself feeling a bit more anxious. I began asking myself these questions:

1) How much longer are you going to keep trying?

2) Have you done everything you possibly can? [Wasn't it enough to track my temperature, monitor of my body changes monthly for "signs", buy and use an expensive ovulation predictor kit, watch what I eat and drink, keep my exercise routine to "a moderate amount", not too little, not too much (whatever amount that is), time sex month after month, read books, articles, blogs, try acupuncture....]? Basically month after month I drove myself crazy wondering “if only…..[I didn't drink so much caffeine that month...I didn't overtax my body training for that duathlon....I timed things better in the bedroom]“; the list goes on…

3) Will I forever wonder … did we do everything we could while there was still a chance?

Number 3 weighed heavily on my mind. I needed to know if all our efforts month after month were for nothing, or was there still an opportunity to get pregnant. I needed to know wether or not to press on or just surrender. It’s too hard to be in limbo.

At my annual appointment with my OBGYN [2009], we discussed and went forward with some initial testing [lab work]. This basically identified that I was indeed NOT ovulating. Could this be the only problem or just an additional problem to an already existing issue? Considering my OBGYN is not a reproductive specialist, she referred me to one.

After MUCH consideration, the decision was made to return to a RE [one recommended by my OBGYN], and pursue the answers to my questions [and possibly some treatment too]. I will have to brace myself for the rollercoaster ride, amplified x1000.

The Beginnings

When we got married in 1997, we knew we wanted to have children but also knew we were going to wait a couple of years before we put our big plan into effect. You know, the one where you get married, get a dog, get a house, and have a couple of kids at the time of your choosing. We spent more than half of our 20′s trying to prevent a pregnancy, and then when we were ready to have kids, we encountered difficulty. During the first few months, I was naive enough to think that if you timed sex sometime “around” the middle of your cycle you would get pregnant. When that didn’t happen after 10 months, to the doctor I went. She gave me a copy of a temperature chart, which she told me to fill out for a few months and fax back to her. It showed that I was indeed ovulating. She checked my hormone levels, which were dandy. The HSG test showed that my tubes were open. The semen analysis looked mighty fine too. We were diagnosed with “unexplained infertility”, and referred to a reproductive specialist.

It took 4 long months just to get an initial consultation with the RE, which I anxiously awaited as the months passed by without a pregnancy or a treatment plan. The initial meeting at the RE’s office was a miserable first experience.  ’Dr. Callous’ waiting area was adjacent to the “normal” OBGYN office, in fact there was no real dividing line between the two waiting areas. To throw salt on the wound, it was loaded with pregnant women – which felt very insensitive to those of us trying unsuccessfully to conceive. To top it off, Dr. Callous was over 2 hours late for our afternoon appointment. I understand that he had other patients and may even had a procedure to complete, but damn it, our time was valuable too. I was tempted to leave but since both my husband and I took off work and waited 4 long months for this scheduled encounter, I stayed. I say [I] because my husband had to eventually leave [as a basketball coach you need to show up at practice]. I remember being pissed off in that waiting room.

Most of the details of the 2 long years spent with Dr. Callous are kind of blurry. I do remember how miserable I was. I remember how I felt like a human science experiment. I remember feeling like the staff of nurses and doctors were insensitive, not taking a detailed look at my situation, and just pushing me through their protocols. When more conservative measures didn’t pan out, it was the immediate jump to IVF as the option [which wasn't an option for us]. I remember pills, needles, office visits during the week and on weekends, semen analysis, charting temps, monitoring fluids, reading ovulation prediction sticks, timed sex. I remember trying to juggle working full-time with last-minute appointments across town, which was no easy feat. I remember people around me [friends, family, co-workers] getting pregnant right and left, and people saying stupid shit [more on that later]. I remember writing check after check for all of the testing and treatment, since there was only a $1000 infertility “testing” allowance with our insurance [which basically got chewed up with the HSG alone]. Above all, I remember the emotional roller-coaster.

I remember keeping things private and feeling very alone in this battle – back then I didn’t know of internet blogs to read, and I only knew of a couple of people who could relate to my situation. I was pretty good about keeping my feelings relatively camouflaged and putting on my happy face whenever necessary, so not a lot of people were let in. The family and friends who knew of our struggles [although they never knew the details] tried to help with their caring words and actions, but unless you have gone through it yourself, you just don’t know…

What I didn’t learn in the 1st 2 years with Dr. Callous: the cause of our infertility. If we had a cause, maybe we could focus on a solution.

What I did learn: Infertility isn’t an exact science. I don’t think they always know what they are doing – they are experimenting a lot of the time. There were likely numerous reasons for our infertility, not just one simple explanation that we’d hoped to discover. And I learned it truly is a miracle when anyone gets pregnant considering all of the things that need to be lined up just perfectly for pregnancy to be achieved. Then why is it so easy for some???

In the two years with Dr. Callous, we tried clomid, clomid with IUI [multiple cycles], injectables with IUI [multiple cycles], all without success.  Alas after 2 years, Dr. Callous asked a few questions he had never thought to ask me or discuss before, which led to suspicions of endometriosis [classic symptoms, mind you]. The next step was an invasive laparoscopic procedure. Apparently the only way to diagnose endo is to do the surgery and take a look. That was my first surgery ever, I was 28 years old. They did in fact find some endo, a “mild-moderate” case, not severe – which they cleaned out. Endo isn’t really treatable any other way, and it will return. Was endo the culprit? He couldn’t say it was the only factor considering the location and amount. But Dr. Callous did inform me that both the birth control pill and getting pregnant would help prevent it from coming back – I wanted to drive a stake through his eye.

Dr. Callous told me statistically speaking, my best chance of getting pregnant would be in the 6 months following my procedure. Good luck. He had nothing more to offer us unless we wanted to try IVF.

Unsatisfied, I moved on to yet another “well-known” RE in the area, who was apparently one of the RE pioneers, Dr. Ican’tunderstandawordyouaresaying. I was pretty fragile by then [approaching 4 years of this crap], and cried quiet tears during the entire meeting with the Dr. and his nurse [the interpreter]. I left there more discouraged than ever. He wanted me to be a part of his next experiment – something to do with hamster eggs and checking sperm penetration, for real. Fuck off, find someone else. Money, time, and energy well spent.

After battling what I like to self-diagnose as “situational depression”, meaning I would get into a pretty bad short-term funk when I got my period or was informed of yet another pregnant person, I talked to our family doctor about our situation. He gave me samples of an anti-depressant to try if I started to feel down. I didn’t take them, I didn’t think I needed them, I don’t like to take meds. Maybe I just needed to tell him how I felt.

After finally coming to terms with the idea of life without children, the next month I found myself pregnant [on our own!]. I tear up just thinking about it. It felt surreal, too good to be true. I always thought I would have been jumping to high heaven when I finally saw those 2 blue lines, but I was cautious and I didn’t feel like I could completely embrace it until more time had past and I went to see the doctor. That was a wonderful 9 months – I loved being pregnant. I don’t really remember the fatigue or other symptoms that go along with pregnancy – and if I had any, who was I to complain, for I was finally pregnant.

Our beautiful baby boy was born in 2004, and he was worth the wait.

About Me…and my Bellyaches

I’m a 36 year old who has struggled with infertility for 10+ years.  After 4 years of unsuccessful fertility treatments, my husband and I were blessed with our ‘little miracle’ [conceived naturally!] – our son was born in 2004.  Since then, infertility has reared it’s ugly head again.  This is my journey from infertile, to fertile, and back again…