Hope Lives Here

It's been a few days since I posted about my pharmacy drama. It turned out that the day after my cousin (who is still gestating, by the way... come on out baby R!) hooked me up with her friend who had extra meds, my insurance finally came through. I still find it amazing that in four different specialty pharmacies, calls from my husband's HR department to the insurance company and speaking with an incompetent case manager, we managed to get five or six different versions of what our benefits were supposed to be. The overwhelming decision was that although we had them, we were going to have to pay out of pocket and hope for reimbursement. That our policy didn't allow for any direct pay options and there was no contract language that specified how we would be reimbursed or at what percentile of cost. 

It was SO frustrating. 

Imagine my surprise when I got a call asking to set up my delivery. Oh and my copay? $23.61. And that's because the needles/syringes weren't covered and the pills had copays. The injectibles were covered 100%. 

I still can't breathe; I'm in such shock. 

But anyway - now it's the way it should be. I'm able to donate the meds I was given to other IFers trying to win this battle and I can use the meds I am benefited to use. I hooked up my cousin's friend with another friend from online, and when this cycle works, I'll have a ton of meds I can send on to the next girl, too.

Hope Lives Here. 

This is what $8000 worth of meds looks like.

This is hope.

They're still with me.

We don't talk about Smudge's twin very much. I know we both think about the other baby, and plan to tell her about all that we went through when she's older, but that's usually where the conversation stops.

This morning, my extremely pregnant cousin texted me to tell me she has a friend with some extra gonal pens. Her friend had emailed her this morning to wish her a safe delivery and happened to ask if she knew anyone who needed meds. My cousin told me that someone is looking out for me. 

And suddenly I had the clearest vision of my grandmother holding a baby girl (Smudge's twin) and telling me that Smudge was going to have another sibling. I know that they're the ones that made this happen. My guardian angels.

Thanks to amazing friends (and family), I now have enough meds for my cycle. Some are still on the way, and we'll still have to buy some of the smaller things, like estrace and progesterone... but the major stuff (gonal-f, menopur and ganirelix) is all taken care of.

Bring it on, IF. I'm going to beat you. Again.

The saga continues....

I can't. I just can't.

Okay - so my prescription is still at the 4th pharmacy, and my nurse called to tell me that they called her to change one of the meds. They don't have olive oil, so they want to sub my progesterone in oil for sesame. Um. No.  Sesame makes people itch. Olive oil is safe. It works. I want olive oil. So, not too much of a problem. I was told we had a $50 copay per med, it's under $80 OOP, I'll just pay OOP for the PIO in olive oil from my pharmacy and submit it to the FSA.

Then it gets better. I hear back from the "Case manager" who apparently knows more about my body, cycle and IF needs than both me AND my doctor. (Apparently, my ins co has instituted a managed care infertility program, so I get a case manager to help me through my benefits, who is a certified reproductive endocrinology nurse.) Great. So I call this chickadee to find out who I need to talk to to find out where my benefits are.  She says she knows exactly where to find the answers and will call me back.

And she calls me back to tell me that I don't have benefits through medical and I need to talk to my husband's HR people (he carries the benefits).

Well - if I don't have benefits through pharmacy and I don't have benefits through medical, where does that leave me?

Me. Creek. Paddle. Ugh.

This is just ridiculous already. I live in NJ. It's a mandated state. I HAVE coverage for medications But no one is willing to pay for them.  I have never had trouble like this before.

So, I hauled ass to my husband's office, simultaneously having a stroke and a heart attack. We got on the phone with their rep who proceeded to tell us that we would have to pay out of pocket for the meds (which will cost $8k) and then submit them for reimbursement.

When I stopped laughing and crying from sheer frustration, i realized that if we did that, one of two things would happen. We would submit the claim and either they will be denied for using an out of network pharmacy (when there is none in network) or they will be reimbursed at a minuscule fraction of the cost.

I've been given meds from friends who didn't need them for their cycles. Generous generous friends. But I shouldn't have to use them. I should be able to pay a few hundred dollars copay, use my benefits and pay it forward to other friends in need. But now it's looking like I might actually need to use these meds, and I hate that.

Why does there always have to be something? Is it not bad enough that we're infertile, that we have to do IVF in the first place, that we have difficult deliveries, that our children have medical problems? Does even THIS stupid part have to be a giant pain in the ass, too?

Ugh.

Seriously? WTF?

If there were going to be any drama over this cycle, I figured it would be not stimming well, not getting enough embryos or stressing during the 2ww.

Never did I think it would be getting my meds.

My prescription was just transferred to a FOURTH pharmacy. I'm starting to freak out. 

Quick - I need a fix for broken mirrors, spilled salt and walking under a ladder...

Seriously. All I wanted was for everything to go the same as it did in our last cycle. The last cycle worked. So let's repeat it. Step by step, med by med, socks by socks (what, you don't have lucky socks?). 

I should have known... it just will never be that easy. 

First I found out that my acupuncturist is no longer working with Dr Z AND she moved her office AND she can't give me a deal on her pricing anymore. So, now I'm driving further and spending more money (the Amex is getting a workout right now)... but she can't come treat me for retrieval and transfer. I can't drive to her office after because I did that during the first cycle - and that one didn't work. So, can't do that. There is someone new working with Dr Z now, and my acu doesn't want him treating me because she says no one in the acu-fertility world knows him and she thinks he's lying about his experience with infertility. 

acupuncture works

Fortunately, it turns out Dr Z has a new nurse named Rachel and she is a tried and true infertility Acupuncturist and she will treat me for retrieval and transfer. Thank goodness. Acu-crisis averted. 

Then the pharmacy drama started. 

It took three days for the pharmacy that Dr Z always uses to realize that they couldn't fill the prescription because our benefits changed and it doesn't go through our pharmacy benefits anymore. So, she said she was going to fax the prescription to Freedom pharmacy, who can put it through medical.

Then Freedom lost the script. 

Then they couldn't find our benefits. 

And that was last week. I've been so stressed about this. I've been fortunate that some of the more expensive meds were given to me by friends, but I didn't want to have to use them. I was hoping to use my benefits and pay it forward with the meds to some IF friends who are completely out of pocket, as long as our meds were affordable. But now they couldn't even find the benefits. Everyone was denying the claim. It's been a huge headache. 

Then today, Freedom realized that they can't even fill it. They have to send it to Caremark. 

And that scares the crap out of me... because I think CVS is incompetent and now I'm worried i may not even get my meds at all in time to start my cycle. I talked to Dr Z about that today. 

Which brings me to my real panic attack for the week. 

When I got my calendar, it mentioned coming to transfer with a full bladder. Cue freak out. That means he's doing ultrasound guided transfers now. 3 years ago, I asked him why he WASN'T doing u/s guided transfers and his response was straightforward and point blank, "I noticed my success rate was going down once I started doing them, so I went back to the way I was trained, and the numbers went back up". AKA "I wasn't good at them, so i don't do them". I respected the honesty and was grateful for it. 

Image of an Ultrasound Guided Embryo transfer

So, today I mentioned that I noticed the "full bladder" thing on the calendar and asked about what he had said previously. I was really happy with his answer. He said that the technology has changed and you can now SEE the catheters on ultrasound, whereas before you couldn't. So now you can see exactly where the embryos are being deposited. Before, you had to go by feel while looking at the monitor and there were too many opportunities to miss something. 

I also talked to him about my pharmacy situation. He said, worst case scenario, he can get me emergency meds and we can just "replenish" the supply when my order comes in. So, no worries there either. 

The only thing I'm still up in the air about today is whether or not to take baby aspirin. Fran (my nurse) says I don't have to... but I did last time, so I really think i need to again. And Fran, knowing me, laughed when she told me I didn't have to, because she knew what I would say. However, I can't find ONE that doesn't have either food coloring or lactose. Ugh. Back to the drawing board. I wonder if I can get it compounded. 

And now for the interesting information:

My lining is typical. 9mm and homogeneous, meaning it is one layer. Closer to retrieval it will be a triple stripe which is optimal for implantation (i've already started my pomegranate juice spritzers in preparation for that). I have 11 antral follicles (6 on the left and 5 on the right).  And we're trucking along... 3 days ago, I didn't even feel like this was real... and now I'm right back in the zone. Feeling a little fluttery and nervous again.  Last BCP will be May 28th. First monitoring appointment will be May 31st and first stims are June 1st. 

Wishing.... hoping...

Cross everything for us. 

Panic, Fear, Worry... Yep. Must be cycling.

The best thing about not getting my mail until 5pm, is that if there's a problem that shows up in the mail, I can't deal with it until the next day. Normally that's not a problem. A bill here, an EOB there... but yesterday it was something else.

My calendar.

Sample IVF calendar

You would think that for someone who has already done this twice, my calendar wouldn't strike fear in me, but it raised questions of procedure changes since my last cycle and now I'm terrified. I needed so desperately for everything this cycle to be EXACTLY the same as the one that worked, and already so many things are different. I have to use a different pharmacy. It's a different embryologist (a better one, so this works in my favor ;) ), a different in house acupuncturist, so I have to travel now... and now a different technique. It's scary for me. I'm scared the slightest change will make the outcome different.

I have an appointment for my baseline ultrasound today. Poor Dr Z doesn't know about the barrage of questions that is coming his way.

Stay tuned....

Back on this crazy train.

I can't believe it's been almost 3 years since we were on this path. The tears, the grief, the fear, the apprehension, the doctors visits, the shots, the ultrasounds, the retrievals, the transfers and then, finally.... 

... her.


It felt like it took forever to finally get pregnant and carry her. She came into this world in the manner we had grown accustomed to. Stressfully. But an emergency c-section later, she was here. All 5lbs and 8oz, perfect little fingers, crooked little toes, blue eyed, fuzzy headed, peacefully perfect. Her.


And now, 17 months later, we're ready for Smudge to be a big sister.

Daddy dressed me

I can't even explain how this feels. It's like we're right back where we were - with the exception of already having her. But now we KNOW it can work, as much as we know it doesn't. And I can't express my emotions as openly as I did last time either. I can't let her see me in that much pain if it doesn't work again. I have to be stronger. If there's one thing I'm learning, clear as day, it's that having a baby does not make you any less infertile, physically or emotionally. I'm as infertile as I was 3 years ago. I'm infertile and I'm scared to death.

But we're ready - and we're moving forward. I had my HSG yesterday (all clear!!) and my bloodwork is back. As it was in the past, my FSH and other hormonal bloodwork are all normal, but miraculously, my AMH is tripled!! Granted, tripling crap is still crap. But i'll take it. In Dr Z's world, under 2.0 is a low AMH. For our first two cycles, my AMH was 0.5. Now it's 1.49!! He thinks I'll stim better this time. One can only hope.

Anyway - this is us. I blogged our entire journey while we were trying for Smudge and it was therapeutic for me to have someplace to say how I felt. I'm hoping for the same this time. I need to be able to talk about how this feels. I'm hoping you'll be my audience again.

BCPs started sunday. HSG yesterday. First u/s in 2 weeks.

Here we go....