Does my insurance cover infertility treatments?

That was one of my first questions when I knew I was going to have difficulty getting pregnant. The cost of TTC can be very expensive and it's sad, but most states and insurance companies don't cover much, if anything at all. If you happen to be in a state that does cover infertility, please, and I mean this honestly, consider yourself blessed.

I remember the day, not so long ago, when I took a look at my insurance health certificate and saw this statement under Non-Covered/Excluded Services "for testing or treatment related to fertilization or infertility such as diagnostic tests performed to determine the reason for infertility and any service billed with an infertility related diagnosis." It also stated it that it didn't cover infertility drugs under prescription drug benefits. My heart sank to the soles of my feet.

Recently, I've started facing the fact that I need to make 100% I know exactly what's covered and what's not. I hate to totally assume there is NO coverage, without asking them more specific questions. The trouble is, I am not even sure what to ask. Or, if I ask, can I be penalized in some way - like maybe they'll refuse future treatment of things related to PCOS.

Then I came across a resource that just might help make this a little easier.

http://www.fertilitylifelines.com/paying/insurance/index.jsprtilitylifelines.com/paying/insurance/index.jsp

Fertility LifeLine (a resource provided by EMD Serono, the makers of Gonal-f and a few other infertility related drugs) offers various free resources to those TTC w/ infertility issues. I was a little iffy at first, but I figured I would call and see what they were like.

Their website states that among the various things they offer, is free assistance with a benefits specialist who can help answer any insurance related questions you have, as well as actually call your insurance company (with your consent of course) and ask all the key questions pertaining to your infertility related insurance coverage and then report back to you on their findings. They'll even send you a write up with the collective info for your records. How awesome is that?! Right now it seems almost too good to be true, but I am having a wait and see attitude.

The woman I spoke at Fertility LifeLines, Julie & Bonnie, were VERY easy and pleasant to talk to. They made me feel exteremely comfortable in sharing my infertility woes - they didn't ask too many questions, but just enough to make sure they were directing me in the right manner. They said that I should hear back from them within 1-2 days to go over the information. At that point, depending on what they find and if I'm interested, they would share with me some other financial assistance options (also listed on their site), if I was interested.

At the very least, it's worth visiting their site just to utilize a few free downloadable resources they have available, one of which is a Word template letter you can use to request a predetermination of benefits (and another for drug coverage) through your insurance. They list a lot of specific questions that I would have never thought to ask.

Anyway, I'll be sure report back. I'm hopeful we'll have SOME infertility insurance coverage, but I'm not counting on it.

When enough is enough with your doctor

I was really looking forward to my yearly exam this past Monday... not something that I normally look forward to, but with us TTC, I was excited about the opportunity to talk to my doctor again about next steps.

For about three weeks now I've had a plan - I wanted to get her thoughts on if the metformin should be upped to 1500mg, if I should have a full set of bloodwork done (to check key hormones like progesterone and estrogen), and possibly to have another ultrasound done to find out what cysts I might be dealing with at the present time (in case she wanted to start me on clomid soon).

And what did I get out of the appt? Nothing. Zero. Nadda. Actually, I didn't even get to see my OB in person, rather I'm guessing it was her nurse practicioner (NP). Which, would normally be ok - maybe not the best scenerio, but I know OBGYNs are busy professionals and that happens from time to time. What I DO have a problem with is the lack of professonalism I received from the NP. Not once did she introduce herself. I still have no clue who actually stuck those things in me, which is a bit frightening. The other thing I found a bit alarming is that I'm guessing she didn't bother to open my file up before she came into the room b/c when she was doing the breast exam she pointed to my stomach and asked "what do we going on here?", referring to my vertical scar beneath my belly button. Well... you see... I ONLY HAVE ONE OVARY AND FALLOPIAN TUBE for crying out loud. Shouldn't a OBGYN of all people know that when they're talking to you?! I'm thinking I should get a black marker and put it on the top of my folder for them. As much as I like my primary OBGYN, it was pretty common for me to have to remind her about that as well. She did, however, appoligize for not remembering that right off the bat, which is nice, but still - not really very acceptable.

The best part about that appointment is that I actually tried to briefly explain my story and ask questions to which I was given what seemed like text-book replies and suggestions, at best. I could respect if she didn't feel comfortable giving me a hard-fast answer b/c she's not my primary OB, but the I would have appreciated if she would have been straigtfoward and told me to reschedule or phone the doctor. Instead, she gave me blanket replies or answers that didn't seem very accurate. Among these were "you know, it really does help to just relax and not stress about the whole situation" (thanks, I haven't heard that a million times) and "you don't need an ultrasound b/c cysts on your ovary really arn't that bad" (which I don't believe is totally correct).

There was lots more, but truthfully, I'd rather not think about it any more. Monday just wan't a good day and this whole week has been way too long as a result. What really didn't make things better is that I don't have many people who I can truely talk to about this and it just gets too much to bare on my own at times.

I DO know that I need to find a new OBGYN. Not because I don't like my doctor, I do, but only when I have her undivided attention, which is VERY hard to come by b/c she's just so busy. Other than that - her staff is not the friendliest and the NP thing just really rubbed me the wrong way. I would hate it if I actually WAS pregnant and had to work with her, so maybe this all worked out in the long run. I mean, I guess now is probably the best time to find someone who I'm totally comfortable with so that when I do get pregnant I feel comfortable and am as stress free as possible!

Why do PCOS women have a higher chance of miscarriage?

Yes, I am trying to get pregnant, but I am also extremely concerned about sustaining a healthy pregnancy once I DO get pregnant. Similar to the fact that there is no known cause, or genetic marker, that tells us why a woman gets PCOS, it seems that there is no known cause for exactly why a woman's miscarriage rate is higher if she has PCOS, which is extremely frustrating.

There are, however, some ideas as to why one might miscarry and they are:

1) This may be due to the quality of an egg (source: http://www.isletsofhope.com/diabetes/print/polycystic_ovarian_syndrome_pcos_1.html)
2) Low progesterone levels. Progesterone is one of the important hormones during the first trimester of pregnancy that cause and "hold" the implantation of the fetus. Women with PCOS that become pregnant should have their progesterone levels monitored. (source: http://www.isletsofhope.com/diabetes/print/polycystic_ovarian_syndrome_pcos_1.html)
3) Excess Androgen levels (source: http://www.medscape.com/viewarticle/573733_1) Many studies alsosuggest that women on Glucophage (metformin) who become pregnant have a lower incidence of miscarriage if they stay on the drug at least during the first trimester of pregnancy. The safety of Glucophage during pregnancy and nursing has not been fully evaluated.

Putting two and two together... While most PCOS women are prescribed metformin in effort to encourage ovulation in effort to get pregnant, it should be noted that ovulation most likely returns because certain levels in the body are returned to "normal", including androgen levels that were in excess. According to a study outcome conducted in May of 2008, "An elevated Free Androgen Index (FAI) appears to be a prognostic factor for a subsequent miscarriage in women with recurrent miscarriages (RM) and is a more significant predictor of subsequent miscarriage than an advanced maternal age (≥40 years) or a
high number (≥6) of previous miscarriages (in this study)." (source: http://www.medscape.com/viewarticle/573733_1)

So far, that is the bulk of my findings. I'm not sure if it tells us a whole lot, except for it seems that every woman with PCOS should seriously consider being on metformin while TTC and, perhaps, continuing it through the pregnancy to some degree. It also seems that each woman should have their progesterone levels tested when they are TTC and may need to be put on progesterone during the last part of a cycle (http://pregnancy.lovetoknow.com/wiki/Prometrium_to_Prevent_Miscarriage). Continuous monitoring after getting pregnant to insure levels are at an acceptable level, and if not, should ask her doctor about staying on progesertone through at least the first part of pregnancy.

Obviously, I am not a doctor, so please take this info as purely an opinion. You should always consult your own doctor as to the best course of action for your personal health needs. These are just some of the things that I'm beginning to find as I collect information that might help me get pregnant and stay pregnant.

I will update this post, should I find any new information that might be useful. Please comment if you have additional details that would be helpful for those reading this blog. Education is power!

Free Online Yoga Videos for Destressing

Tonight I was having serious acid indigestion and sour stomach due to the metformin. I've read this is fairly typical, so there's no reason to be alarmed, but it's really very annoying. I remembered that the last time my stomach felt like this, I had a yoga session that really seemed to help, so I figured why not give that a shot again. I googled "free yoga online" and came up with a couple good videos worth checking out. I just finished up the first one and really ended up liking it a good deal. While my stomach is still a bit upset, it does feel slightly better. I'll take what I can get :)

http://video.google.com/videoplay?docid=-4628036076291757842

http://video.google.com/videoplay?docid=3225997721700737829&hl=en

Live Radio Interview with PCOS Expert

Information about this was posted to a group I'm a member of and I wanted to pass along the info:



Today's Creating a Family internet radio show, August 13, 2008 will be on Polycystic Ovarian Syndrome (PCOS), and the guest will be Dr. Marcelle Cedars, director of the University of California at San Francisco Center for Reproductive Health. Dr. Cedars specializes in the diagnosis and treatment of PCOS. As always, the show is live from 12-1 Eastern Time, but you can listen to it anytime after it airs at the radio page of www.creatingafamily.com (click on radio page, then click on the play button) or download it as a free podcast from iTunes.



Update: Here is today's PCOS show from the archive.

PCOS-friendly Herbs for TTC

Herbs seem to be one topic that no one really wants to touch, especially when it comes to TTC. I'm assuming this is because there is little regulation on herbs, however, it's a shame that more doctors don't include them into their treatment plan.

I, for one, would love to try a few more natural methods out in effort to regulate my cycles and balance hormones, but am afraid to take something that might be in contrast with other factors I have going on. I am not taking any as of yet, but wanted to have a place to collect information as I come across it. I will update this post as I come across new information.

Dislaimer: Please note that I am not a doctor or medical professional and you should use this information at your own discretion and always refer to your OBGYN or physician before beginning or modifying any treatment you might currently be on.


PCOS-friendly Herbs for TTC

• A formula to support glucose metabolism and insulin production, some of these would be: Gymnena, cinnamon, and one could use chromion as well. (source: http://www.theafa.org; Chat session 4/22/08; Stacey Roberts of Natural Fertility, Australia)
  
  
• With PCOS we usually support progesterone production using a herb like Agnus castus, depending on the situation. Note, Vitex agnus castus is the same as Agnus castus or chaste tree. Regarding usage: (most of my patients)... use agnus castus up until they become pregnant and then stop it, but again depending on the situation I might have them continue (source: http://www.theafa.org; Chat session 4/22/08; Stacey Roberts of Natural Fertility, Australia)
  
  
• ...herbs go a step further, targeting any problems involving hormone balance. Herbs can also be very beneficial in encouraging the function of your liver, in order to make sure that it is metabolising the hormones efficiently and then eliminating them.
  

  Agnus castus (Vitex/chastetree berry) This is one of the most important herbs for PCOS because it helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH (luteinising hormone).

  Saw Palmetto (Serenoa repens) Saw palmetto is a herb that is traditionally considered in light of its success in treating prostate problems caused by an imbalance of hormones (including excess testosterone). It is a small palm tree found in North America and the berries of the tree are used in tinctures or capsule form. Research has shown that saw palmetto works as an anti-androgen, which can be very helpful given the high levels of testosterone in PCOS. I would suggest that you add saw palmetto to your treatment plan if you have excess hair growth, orhave been told you have high levels of androgens. Otherwise, take agnus castus on its own.
  

  Milk Thistle (Silybum marianum) This is one of the key herbs for the liver, which
  acts as your waste disposal unit,, and it is therefore essential for the treatment of PCOS. It helps to protect your liver cells against damage and to promote the healing of damaged cells, so improving the general functioning of the liver and all its detoxifying properties.
  

  Caution:You should not take any of the above herbs if you are taking, The Pill, Fertillity
  
  drugs, HRT or any other hormonal treatment or other medication unless they are
  recommended by a registered, experienced practitioner.
  (source: http://www.marilynglenville.com/general/polycystic.htm)