Nothing Goes Better With Turkey Than Whine.
There have been many lovely Thanksgiving posts about gratitude, etc. in the blogosphere in the past day, but I am bucking the trend. You know how the night before a fast (or lent or whatnot) you do the opposite of what you will be doing the next day? Eat vats and vats of the things you will be giving up? Well, it is the night before Thanksgiving, and while I shall be properly thankful in, oh…7 hours, until Thanksgiving is actually here I am going to whine and pule my hard little heart out.
Complaint#1: I am sick. I don’t understand how my throat can be so dry/scratchy/cough-making and still be seemingly filled with mucous. I woke up feeling as though somebody had thatched my throat in the night, and then poured a bottle of syrup over the thatch. I was too busy coughing to get more than a few hours of sleep, and this morning was spent busily retching into the sink. Delightful.
Complaint#2: My period finally graced me with its presence yesterday, on day 40. As you may recall, this upcoming cycle is the Cycle of Nothingness. Day 3 of the following cycle I will rush back into the arms of Dr. Doctor for more tests, a monitored cycle, the Nearly’s SA, and possibly (though hopefully not) an HSG. If my cycle this next time lasts its usual 36 days, guess when my day 3 ultrasound will be? One year, to the day, from the ultrasound that told me that my last pregnancy was failing. If it is a day or two late, day 3 will fall on one of the days last year on which I was waiting to miscarry. This would be the best scenario, because if it is 3 days late, it will fall on New Years Day, the day I did miscarry, and a day on which the clinic is closed.
Complaint #3: I miss the Nearly. He is out of town until Saturday.
Complaint #4: This is the true source of all this anti-bonhomie. Complaint #4 is more than a complaint, it is a horrible soul-sucking piece of knowledge, about which I need your advice.
Once upon a time, I read my company’s health insurance coverage details. I was pleased to find a proud paragraph about how they cover ART—IVF! GIFT! ZIFT! Any acronym your heart desires—they cover it! I believe I even boasted about my excellent insurance company. There was a lifetime maximum of $15,000, which I fretted mildly about—if we did non-IVF things, there might not be enough left to cover a whole IVF cycle, and we would have to pay for part of it out of pocket. And if it didn’t work…But I would think about that later. Maybe it wouldn’t get that far. And $15,000 is a lot of coverage.
Only I don’t have $15,000 worth of coverage.
Yesterday, I dug out my policy to look at it again, and noticed something. That lifetime maximum? That I read as $15,000? Well, I read it wrong.
There’s no “1.”
It’s $5,000.
And that includes medication.
So, their gushy paragraph about how they cover ART seems a bit disingenuous, non? Few people go straight to IVF without a few obligatory IUI cycles, after which there would be no insurance money left for IVF. And even if the Nearly turned out to have grieviously deformed sperm and we went straight to in vitro, $5000 wouldn’t come close to paying for a cycle. So my insurance policy does not so much “cover” ART as is offers a slight defrayment of costs. {I even looked ahead to the insurance I will have in two years, when I plan to have a graduate teaching assistantship—that insurance doesn’t cover IVF at all, only IUI.}
Also, I have not been able to get a straight answer about whether my $1000 ticket for the Diagnostic Tilt-a-Whirl is included in the $5000—if so, I actually have only $4000 worth of coverage left.
What this boils down to is this: IVF is out of the question for us financially, for now. If the Nearly’s SA comes back indicating bad things…we are fucked. Hard. Really, really hard up the ass. We can save and try to get financing for IVF—but if we did manage to finance a cycle and it failed, there would be no future cycles for a very long time, and no money left for adoption.
Assuming the SA comes back satisfactory, we have $4-5000 to spend. {Two years from now, when I have different insurance, we would be able to do additional IUIs but no IVF.} I cannot tell you how much I appreciated all of your advice on this post I wrote previously. Now I am asking for your advice again, greedy slut that I am. I figure we have enough money for three IUI cycles. Does that sound right to you?
I am comfortable being fairly forceful with Dr. Doctor about what I want to try, so riddle me this, my dears—if you had $5,000 and ONLY $5000 to spend, what would you use it on? What type of protocol might you try? I am attempting to be hopeful—after all, I have been pregnant twice without intervention. Of course I miscarried both pregnancies, so perhaps that isn’t so cheering after all.
And now, because I promised pictures, I hereby present you with a photograph of one of my cats, Irma:
6 Comments
I, for one, am on the gratitude bandwagon. I got the other 364 days to bitch…oh well.
I won’t assume you have been keeping track of what Jerry and I have gone thru and the insurance- and lack thereof, -nightmare. The problem that we didn’t know we had until we were well into the game was count and motility (C&A for future ref). After we went thru 6 mos of trying naturally to get pg again after the MC, Jerry had a SA done. Some of his numbers were borderline low, but not enough for anyone to get concerned about, so the 1st IUI on Follistim took place. It wasn’t until the point-of-no-return that I was told that Jerry’s count was “kind of” low. Due to some miscommunication on my part, Jerry ended up abstaining somewhere around 10 days. Yes, that’s right. 10. whole. damn. days. Alas, IUI #1 failed.
We had to skip the next cycle due to overstim. The following cycle we went for IUI #2, again on Follistim, but dialed up. We made sure everyone was on the same page and Jerry’s abstinence before the IUI was only 3 days. Not only were we told again that the C&A was low, but it was almost 1/2 of what it was on IUI #1. Not good.
So NOW we find out that we should have just started with IVF and skipped the whole bullshit process before which ended up taking a lovely 4 months out of our lives. And here we are on the cusp of an IVF that we have no insurance for but are tapping into the funds that were designated for the house. The IUIs were not covered either, so instead of budgeting for, say an add’l $9000, we have to budget for the full $12,000 (plus the $3000 my ole’ cooter already ate up).
So, to make a long story short, (yes, do please) if our scenerios were switched and even if the insurance max is $5000 I would bypass all the b.s. and jump right into IVF…but be careful that your insurance doesn’t have a clause that requires you to try clomid or an IUI cycle first. Some do.
What sucks more is I feel like when I complain about how much we have spent and what we will be spending that I’m putting a price on a viable pregnancy. That’s not at all what we’re doing and anyone who’s been there gets that.
I would also advise you to look into “financing”. Some RE facilities are enrolled with certain programs that allow this. Ours doesn’t and we must fork over the cash first; PLUS I’m providing the peep show. Doesn’t seem fair, does it?
Yes, I rambled, but I hope this can help you. It’s going to really hinge on how Nearly’s SA stacks up. BTW, I would ask Dr. Doctor if some of the diagnostic tests they are talking about doing can be done in relationship to your MC, not IF. For ex., our HSG was completely covered b/c they used a diagnosis of MC, not IF. That may get you a little more bang for your buck.
This is a very tough call. My bet is that diagnostic stuff isn’t included in the limit. It’s usually treated as a different category from treatment, especially if there’s reason to think there’s a medical situation that would merit treatment regardless of whether you’re trying to get pregnant.
So… first find out about whether you have diagnostic stuff covered. If it is, do every possible test. Especially all sorts of advanced semen analysis.
Then, well… I’d say go ahead to IVF, but that means only one shot, possibly with an extra FET thrown in.
Before making a decision, find out from your RE’s office exactly what the charges would be for each protocol (the financial coordinators often have some sort of price list available). It’ll be tricky to figure out whether and at what point you get the self-pay “discount” that a lot of clinics offer (really just the actual price not inflated for insurance purposes). Usually the financial coordinators are chock full of helpful info if you can catch them on the phone (they seem awfully busy).
At my clinic, I was allowed to finance IVF, so I had to pay $2000 up front, and the rest will be paid in monthly installments of about $250. You have to completely pay off all previous cycles before you’re allowed to cycle again though. This plan did not include the meds, which had to be paid for up front. Or the hospital bill, which I haven’t yet recieved, but normally those will allow for some sort of installment plan too if you talk to the hospital’s financial office.
I’m pretty confident in recommending that you skip clomid/femara/IUI because it’s not that much cheaper than injectables/IUI but with much lower success rates. But I don’t know what to tell you about injectables/IUI vs IVF. Dr. Doctor sounds like she’d be able to take the time to fully discuss it with you once all the test results are in. It really depends on the SA results and how well she thinks you’re likely to respond to injectable meds.
Sorry I couldn’t give you a more clear answer.
I’m not far enough through this to know what’s been successful or not, but I’ll share this (and, granted, I had some insurance coverage for treatment up through IUIs): definitely definitely do all the testing you can. Especially the detailed SAs - we didn’t do the Kruger until after a couple of failed cycles, and it was the indication that we needed to shift to IVF/ICSI. Though I’m not sure we’d have been ready to jump to IVF immediately, especially since we had a bit of coverage for less involved treatments. That said, I somewhat wish I’d done a lower pressure injectables cycle before moving to IVF becuase we had no information about how I’d respond to injectables before we did the IVF. So far (crossing fingers and doing a little, sore, dance) it seems to have turned out okay anyway, but I did wish I’d had a sense of how I responded to the meds before the stakes were so incredibly high, y’know?
The previous posters have some great info - I agree wholeheartedly with DD. Especially since you’ll have IUI coverage in a couple of years - I would skip straight to ivf. You can see about getting into Serono’s something care (compassionate care?) program where they give you a cycle’s worth of drugs for FREE. And, if you do respond well, you may have an FET or two to play with. If the SA comes back bad, you might want to think about (although it doesn’t really sound like an option) a shared risk program where you pay $13 or $18 k and get three ivf’s - refund of your some/most of your cash if you don’t take home a baby. I guess it also depends on how desperate you are now or if you feel like you can wait.
Did you ever do the repeat pg loss panel? If you can pg on your own and you find that you have a blood clotting something or other, it might not be worth getting into full fledged ivf debt - just up the b6, b12, folic and spread ‘em (I kid, I kid - kinda).
I don’t know much about US insurance, but from my experience I’d go straight to IVF. IUI just doesn’t increase your chances enough to be worth it.
Everyone’s so smart. I’m just stopping by to say good luck making this decision, Irma looks like an angel dropped straight from heaven, and I can’t wait to see you in SIX DAYS.