Thoughtful Thursday: Hope

February 5, 2009

Thoughtful ThursdayWelcome to Thoughtful Thursday! Three orders of business today, each accompanied by song lyrics.

You don’t know how lovely you are
I had to find you, tell you I need you
Tell you I set you apart
–Coldplay, The Scientist

First, giving credit where credit is due. I would like to introduce a new element of Thoughtful Thursday, The Intelligentsia. People who have commented on every Thoughtful Thursday post for a given month will be added to the Intelligentsia roster and will receive some sidebar bling. For January, our esteemed members are Wiseguy from the outstanding blog Woman Anyone? and Cat B., who makes up for not having a blog by leaving lots of excellent comments on others’ blogs. I hope they will have plenty of intelligent company in the coming months — please join them, if not in The Intelligentsia then with occasional comments. (And, for those of you who are all-or-nothing types, don’t think you need to give up for the rest of the month if you miss a week — thoughtfulness is its own reward.) For the record, every Thoughtful Thursday comment is appreciated — I just wanted to give a little extra bonus for diligence.

Nobody said it was easy
No one ever said it would be this hard
Oh take me back to the start
–Coldplay, The Scientist

Second, an update on my bizarre infertility journey. I went to see Dr. Full Steam Ahead last week to establish a plan for IVF #3 — the one that I hope will be paid for by the Trick Up My Sleeve (still in the works, so no details yet). Dr. Full Steam Ahead, living up to his name, set forth an ambitious plan which involves giving me the Old Lady protocol. Even though I am “so young” (33, to be precise, and not getting any younger), I did not produce as many eggs as he would expect from the IVF #1 and #2 protocols, and even fewer “good” embryos. So he wants to try microdose Lupron plus as much FSH as the human body will tolerate to encourage my ovaries to give a burst of excellence. My husband is pretty horrified at the doses and number of daily injections, but as I always say, “in for a penny, in for a pound.” Actually I’ve never said that before in my life, but it applies here.

But, before the Trick Up My Sleeve can take effect, it is extremely likely that the new insurance company will require me to have failed 3 FSH+IUI cycles. I failed two during 2008, then stopped because Dr. Full Steam Ahead thought it was futile and I might as well move on to IVF and “save some money.” I had numerous Clomid+IUI cycles in 2003-2004, but those apparently don’t count. (FYI, all IUI cycles in 2003-2004 and 2008 were paid out of pocket. Boo.) So…

My current health insurance (the one that was my primary reason for running myself ragged by taking on New Job in addition to Old Job) pays for IUI but not IVF. Trick Up My Sleeve won’t kick in for a couple of months anyway. Therefore, I proposed that rather than waste time later, we get the FSH+IUI cycle out of the way now (since it’s paid for by New Job insurance anyway), and pave the way for Trick Up My Sleeve IVF. Dr. Full Steam Ahead agreed with my plan, so we’re all set to do FSH+IUI whenever my body decides that it’s ready. It will be injectible+IUI #3, or total IUI #7 — I think. Seriously, I can’t keep track anymore. Let’s go with #7, that sounds right.

Some people might feel guilty for “using” one insurance company to do a useless IUI merely to satisfy another insurance company’s IVF prerequisites, but I just can’t feel guilty. I wouldn’t have to play this game that if New Job’s insurance covered IVF. And plenty of people while covered by New Job-style insurance would have done a bunch of free IUI cycles instead of paying fourteen-fucking-thousand dollars out of pocket for IVF+ICSI. I’ve only cost that insurance company one hysteroscopy and one upcoming IUI (plus one flu shot) during the five months that I’ve been insured with them. If anyone is going to feel guilty here, perhaps it should be the doctor who cost me $40,000 last year (that’s my rough estimate… I haven’t had the courage to add it up yet), or the insurance company who, despite receiving over $500 per month in dues from me before I switched to New Job insurance, wouldn’t even pay for my beta when I was pregnant. Assholes.

Dr. Full Steam ahead joked, “Who knows? The IUI might actually get you pregnant! Stranger things have happened!” Ha ha, motherfucker. Just keep laughing all the way to the bank.

No, actually I’m only saying that for effect. I’m not actually bitter about the IUI, though I am bitter about plenty of other things, including the water-under-the-bridge money. I’m actually at a place of true acceptance with the IUI. First of all, this IUI was my idea. Second, I consider it simply a necessary step before the next real try, albeit a step dictated by the bureaucracy of the Bureaucracy Masters: insurance companies. I have zero expectation that the IUI will work. Honestly, it’s no different to me than any other procedure that is necessary before doing an IVF cycle, like an HSG or hysteroscopy. I believe that there’s as much chance of an IUI getting me pregnant as a hysteroscopy. Technically that’s not accurate, but I really don’t think it’s far off from the true odds.

Questions of science, science and progress
Do not speak as loud as my heart
–Coldplay, The Scientist

This brings us to our third order of business, Thoughtful Thursday. This week’s theme: Hope.

Most of us have had cycles (treatment and do-it-yourself) where we were sure that it was “the one.” For me, the first cycle of doing something new has often been infused with extra hope. First year trying to conceive, first Clomid, first IUI, first FSH, first ICSI… Presumably somebody must get pregnant during a hope-filled cycle, but it’s never worked for me.

Many of us have also had cycles where were sure that it wouldn’t work. Maybe we forgot an injection or two, or we were horribly sick, or the timing of sex wasn’t optimal, or we’d just given up hoping. The upcoming IUI cycle fits into this category. Sometimes, thanks to the Murphy’s Law of Infertility, these are exactly the cycles that do work. Both of my BFPs (temporary though they were) have occurred during cycles where I had less hope than usual — miscarriage #1 was going to be the last Clomid+IUI cycle before we stopped trying for a while due to a depletion of energy and money, and miscarriage #2 occurred during IVF #1 when I should have had high hopes but just didn’t.

Unlike me, some people believe in the power of positive thinking. Some of those people even get pregnant by directing the positive energy with their thoughts (probably accompanied by sex or something… I don’t think thoughts are that powerful, at least in this universe… unless you’re one of those horrendous “I get pregnant every time my husband looks at me” fertiles). I have had many hope-filled cycles, especially early on, and it never did anything for me, but I suppose it must work for someone, right? How else would The Secret become a bestseller?

From a cosmic standpoint, I harbor a secret suspicion that positive intentions are good things. I like to imagine the soul of my baby being drawn to my irresistible good vibes, its microscopic body enveloped by my fabulous aura of love. I still think that The Secret is flim-flam, but the romantic part of me feels that hope is better for the universe than cynicism. At the same time, my soul seems to be losing the battle with reality. I have been let down so hard, so many times, that I may have used up all of my hope. Hope hasn’t gotten me anywhere so far, so now I’m substituting Guarded Almost-Optimism and Cautious Could-Be-But-Probably-Not-But-Maybe? in place of hope.

My question to you:
Do you believe that hope can actually impact your outcome? Specifically in terms of a cycle or a pregnancy, or in general if you prefer.

All of this assumes that one’s actions are the same with or without hope, and that attitude is the only variable. Obviously, if you lose hope and give up on treatments, that would likely have a different outcome than doing several more IVFs.

Oh, and after all of my talk about how I have given up on hope, you will laugh your ass off when I tell you where I’m going tomorrow. But that’s a post for another day.

Insured

November 12, 2008

With my hysteroscopy scheduled for Friday, I decided to avoid surprises by calling the RE’s office to confirm that my insurance coverage for the surgery was all set. After half an hour on the phone talking to multiple members of their staff, here is what happened:

“Insurance approved for hysteroscopy, at 100% coverage.” Hooray! Finally a tangible benefit from my new insurance and therefore from my new job. Almost makes the 14-hour days and 6-day weeks worth it. Almost.

“You owe us hundreds of dollars.” What? How come the last bill that I just paid didn’t say anything? “(after 10 minutes on hold) Nevermind, we just forgot to take some old charges off your account.” Phew.

Can I get partial insurance coverage for the next IVF? “We can’t contact your insurance for authorization until after the hysteroscopy.” What if I get my period between the hysteroscopy and whenever authorization finally comes through? Would I have to miss that cycle? “We can’t get insurance authorization or set the cycle in motion or do anything else until after the hysteroscopy.” But then I might have to wait a month for the cycle. Is there any way we can… “We can’t get insurance authorization or set the cycle in motion or do anything else until after the hysteroscopy.”

Uh, ok. I guess I will wait. “(surprisingly sweetly, after a very brusque 30 minutes, punctuated by large blocks of time spent on hold) My name is S. Call me anytime, honey. Bye!”

Primary Care

October 22, 2008

As part of the sequence of necessary events leading up to IVF #2, I just went to see a new primary care physician. With my new insurance, I had to establish a PCP as well as obtain a referral for infertility treatment and for the hysteroscopy that Dr. Full Steam Ahead is recommending.

My main criteria in choosing a new PCP:

  • not too far from my house
  • will sign off on referrals

Preferences:

  • female
  • knowledgeable about infertility
  • competent

I received separate glowing recommendations from my acupuncturist and from a lady who does pottery with me for a female physician in my town. With two recommendations for this woman, and zero recommendations for anyone else, she seemed like an obvious choice. However, she wasn’t accepting new patients. Neither were any of the other female physicians in the entire town. It’s not a big town, but there are several female physicians from whom to choose (or in my case, from whom I could not choose).

Finally I found a male physician in town who was accepting new patients, who would make an appointment in less than two weeks, and who was on my insurance list of PCPs. Good enough.

With REs, I’ve always gone to the kind of doctors who were in the top of their class at their prestigious medical schools. It turns out that if you do the math, even the most prestigious med school has people at the bottom of the class. Apparently that’s where Dr. Primary must have been. To be fair, I don’t know why someone at the top of his class would work in a small practice in a small town, affiliated with a small non-research hospital. The fact that Dr. Full Steam Ahead is a superstar located within 20 minutes (albeit at a large practice affiliated with two larger research hosptials) is very lucky.

Anyway, here are some highlights from my visit with Dr. Primary:

  • I waited over one hour before being seen — for a morning appointment
  • I did not fill out any paperwork. Even as a child I cannot recall a doctor where I never filled out any paperwork. I even have to fill out paperwork when I get a massage — at the airport. I answered a couple of questions for Dr. Primary’s receptionist, and a few for the nurse and doctor. Dr. Primary conducted the most cursory family history and review of systems I have ever encountered, even compared to places like urgent care and university health clinics.
  • In his questioning about my surgical history, I mentioned IVF. Comment #1: “Oh, in vitro fertilization?” Do the letters IVF stand for anything else? I don’t think so, but I guess it’s good for him to double-check. Comment #2: “It’s not really a surgery. It’s more of a procedure. It’s not that invasive.” My response: I was under general anesthesia, so it seemed worth mentioning. Also, it’s actually kind of invasive. If someone were poking holes in his reproductive organs, he might reconsider.
  • He was full of weird assumptions. When I mentioned needing a hysteroscopy because of M/C #2, he asked, “So did you lose the baby around 12 weeks?” No, actually, not even close. Why would he guess that?
  • At the checkout desk to obtain my referral paperwork and hand over my co-pay, I saw referral paperwork for a different patient to a gynecology and infertility office, with the patient’s name in full view. I don’t know whether she was being referred for gynecology or for infertility, but it made me think that my name will be next to be broadcast for all of my neighbors.
  • After the meeting with the doctor, the nurse came back to administer my flu shot (while I was there, might as well…). She asked me how I liked the doctor — a very loaded question. I said he was nice. “Oh, isn’t he? I just love him. I’m not allowed to go to him because the staff can’t be seen in this practice, but if that rule weren’t there, I would definitely see him. Of course, it might be a little strange for your boss to be your doctor, I don’t know. There’s a gal who works here who says, ‘I don’t want my boss to see my hoo-hah!’ (laughs hysterically) She is a hoot. I told her, ‘The doctor doesn’t usually look at your hoo-hah, you see a different doctor for that.’ But I guess she has a point.” Me: “Mmm-hmm.”

In this era of paperwork paranoia and HIPAA hysteria, it’s quaint to see a small-town practice that isn’t a stickler for documentation nor privacy. Slightly bothersome, but mostly quaint.

In the end, Dr. Primary fulfilled both of my main criteria: referrals for infertility and the hysteroscopy, walking distance from my house. He fulfilled none of my preferences, but those were much less important. It’s just a funny counterpoint when the other doctors I seek out have to be the absolute best or I feel like it’s pointless, to encounter a pleasant but decidely mediocre doctor. Thankfully, my chances of reproductive success have nothing to do with him.

…in order of proximity.

  1. I feel empty and frantic inside.
  2. Continuous headache and neck pain for the past 4 days.
  3. Huge amount of work in front of me, brain not functional enough to get it done.
  4. Even if I can muster mental strength, repetitive stress injury to wrist makes work difficult.
  5. Boss just interrupted my brain-intensive work with an incredibly piddly detail that he finds very important, and I have to stop everything I am doing to work on that because no one else is competent enough to trust with this very basic clerical task.
  6. Construction down the hall, drilling, drilling into my brain.
  7. Out of town visiting family have drained my time and my energy, both already in short supply.
  8. Huge amount of work not directly in front of me but deadlines loom large.
  9. IVF cycle being postponed for a month to deal with health insurance.
  10. Scared about upcoming hysteroscopy.
  11. Generally freaked out about infertility, getting left behind while everyone else I know has lots of babies.
  12. Added TTC time pressure due to sister-in-law’s wedding and child-rearing plans.
  13. Miserable state of health insurance in this country.
  14. Civil liberties of journalists and protesters being trampled at RNC.
  15. Many more civil liberties to be trampled in the future if the GOP has its way, including but not limited to reproductive freedoms, which have become ever more salient since I started engaging in medical interventions that some people find objectionable.
  16. Despite all of the truly good things in my life, I feel like I am being fucked over by the fates.
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