You see... there's this list and WE'RE on it!

My heart was racing. Palms sweaty. Me, my phone and a small notebook stepped away from my desk this afternoon and snuck off to an empty suite where I would make "the" phone call. The call that makes it officially, official.

When the time came, I was happy and fully prepared to relay my CC # to my clinic; today was "down payment day." Refundable if something happens and we need to back out; otherwise it will be applied to the lump sum. Even that I've learned to accept. By now I've come to the realization that no company health insurance will be there for us in our time of need. It's up to us to turn over hard earned cash accumulated over the last year and will be up to us to pay off the remainder owed during the next several months. It's worth it because THIS - August IVF at SIRM St. Louis - is OUR chance. Our long awaited shot at having OUR baby. I was pumped and ready!

What I was not prepared for was what came next.
I was told final payment would be due July 8. I doubted that in and of itself will be a problem, but it did make me curious. The clinic cycle calendar I was given in early January of this year said final payment would be due July 22 - approximately one week prior to starting meds. My next natural thought was... so, is the August cycle date still August 17th (like my previous post stated)?

To which she said "No. No it's not. The new, correct date is now August 3rd." However, even that date isn't when I'll start meds. That date is for the actual retrieval.

Come again. Retrieval on August 3? Yep. "And you'll start meds around July 15th." :-|

Basically what you're telling me is the entire August IVF process is ONE MONTH SOONER than I'd originally expected?! It was then that my blood pressure sky rocketed, a wave of heat came over me and then cold sweats. THIS IS IT! It's really happening! And SOON!

To celebrate I first did what must have looked like the stupidest happy dance ever (good thing I was in a room by myself :P) and then I told a few close friends and relatives. I don't think the high left me for several hours. I'm not sure I've ever felt this type of combined excited and totally scared in my life!!


That's all fine and great, but what's next?
I was told to call Mary on Day 1 of my next cycle. Since I'm a very irregular cycler, I asked what if I didn't start my cycle by a certain date and she said I should e-mail her to find out what to do in that situation. So, that e-mail will go out tonight.

On a related note, Dr. Ahlering just so happened to e-mail me yesterday to see if everything had been addressed properly during our last meeting, which I think means he had an old e-mail of mine in his inbox and noticed he hadn't seen me come up on any of the recent IVF cycles. I'm just glad he saw my name and thought of our situation, especially for being as busy as he is. I did let him know I will be coming his way soon! I feel so fortunate to be able to cycle under his care!

For tonight, I will rest better knowing that somewhere there is a list with OUR name on it, and that list is titled "August IVF". For the time being, that alone makes me beyond happy.

Say it ain't so... looks like IVF will have to wait :(

Two nights ago me and the hubby sat down to go over, for the billionth time, finances. I could puke finances by now. The idea of money controlling my life just absolutely frustrates me to no end. Even still, my head tells me to consider it. Obviously, you shouldn't bring a baby into this world unless you're prepared to be able to feed it. After months and months of chewing over numbers - we finally laid out our options.

We are certain that we're doing IVF... it's just a matter of when. Do we:
1) Buy a two cycle package and start the first fresh cycle this August. Then, if that doesn't work, we would need to wait until sometime towards the summer or fall of 2010 to be able to buy another package...Or,
2) Do we wait until January of 2010 and buy a three cycle package all at once.

Note that in either case we would buy the stated # of fresh cycles, which also includes any frozen (FET) cycles that would come about as a result of the previous fresh cycle. Who knows if we'll have any embryos left over, but it's nice to know that those costs are included.

I thought it over some more yesterday and really feel like my heart is telling me August is the way to go. I was really looking forward to gauging what he was thinking. Let's just say it was the complete opposite of my view. He'd rather play it super safe and wait until January. Why? Well, by waiting those additional months we'd be able to save about $10k more and he feels like in an extreme circumstance where we get pregnant with twins, we'd be glad to have have the additional buffer.

So... how do I feel about this? Not sure if that question even needs a reply. It's given right?! My heart totally sank. Infertility has a way of making you feel so powerless. Here is this great big meaningful thing (adding another life into our family) and my body is completely taking away my ability to just go with the flow. And then, as if that's not enough, money is now controlling this whole situation simply because our health insurance system is screwed up and doesn't make infertility coverage available to everyone. Oh, and while I'm on my soapbox, my husband's job is playing a role too. This was a fantastic time not to convert him into an employee position AND to cut his salary by 10%.

What a strange powerless position. I guess when I heard him tell me he wants to wait until January it just was another dagger to the heart. I know that if these things weren't affecting us, he wouldn't want to wait at all, but the truth of the matter is that they DO exist and he feels that it would be best to wait. Most people who know me realize that I don't generally take no for an answer ;) (what an annoying trait), but in this instance I would feel awful trying to convince him of something he's not sure about on his own. Not this time. Not about something this major. It just wouldn't feel right.

I went to bed last night telling myself that the only way I am going to be able to make it through these next very long 11 months is to have lots of other distractions. Other things to put my energy and focus towards - otherwise, I really feel like I might not make it out of this thing with my head held high. These past few months have taken their toll on me. I've found myself not really caring at all about exercising, about going out and having fun or even doing regular things like cleaning the house. I'm ashamed to say that up until last Sunday, my house hadn't been vacuumed in 3 weeks. That is totally sick!! I wouldn't say I'm a complete neat freak, but that's just uncalled for.

I think I'll have a long talk with him tonight and lay it on the line. Things have to change. This year has to be a year of progress, fun and a chance to clear our heads and prepare for our baby in 2010.

Diagnostic test follow-up with RE

You're never going to believe this - our follow-up appointment was TODAY, not tomorrow! Man, I really, really think I'm losing it.

I did a similar thing yesterday - went to the dentist and asked for the wrong doctor! One of my fake teeth, yes I unfortunately have three of them, fell out again - fun, fun. Another expense not covered by insurance. (Sorry, just had to whine about that!) Anyway, in my defense, it was the doctor I had seen up until the last appointment when I found out he wasn't in-network anymore, but still. Total brain fart!

I did end up calling him back, however, my husband wasn't able to be there. Basically he said all our tests came back looking good - though he didn't have any specific things to say about that. I think he was away from his desk on his cell and didn't have the numbers in front of him. I'm going to call tomorrow to get a copy of everything.

He pretty much said the same thing as before - we appear to have a substantial pelvic issue, based on the sonohystogram ultrasound, where scarring looks to be an issue. We can certainly try IUI, though he doesn't think we'd have much success. He recommends bypassing the IUI and going with IVF. I asked him about the tubal condition called hydrosalpinx (where it fills with fluid and can spill back into your uterus). He confirmed what I had read - that severe cases can be picked up via ultrasound and that he didn't pick up anything on my sonohystogram. He said it's not a super common occurance and he's not particularly concerned about it affecting IVF results if it's not severe. In his words "In 10 cases with tube damage, 2 will be blocked, and 1 of those 2 will be hydrosalpinx."

I asked him if it was worth considering doing the laparoscopy, since he's 99% sure it will be covered by our insurance, to try and correct any scarring so that we can pursue IUI. He said that we could try that, but again, he doesn't see much success in treating adhesion issues. They used to do this a lot years ago, but in retrospect it just didn't prove to be that successful unless it's super minor damage (which isn't very common) so they don't recommend it any longer. The scarring could be so far gone that the organ never works quite right again. Also, new scarring can occur from the surgery. He's not against going in and looking to confirm scarring and treat a hydrosalpinx, if it exists, if that's what we choose to do. All in all though, he just doesn't see much point in that when we'd probably not have a lot of success with in it and would end up doing IVF anyway.

He's going to have a financial coordinator call us so we can set some time up to learn more about our financing options. In the meantime, we need to chat amongst ourselves and think about if we want to have the laparascopy done, if we want a second opinion, or if we're going to go
straight to IVF without any additional information.

And, in the meantime, I'm going to try and find my brain. I must have left it somewhere in Chicago.

The economy isn't helping our infertility...

These past two weeks have been a whirlwind. Let me recap - in reverse :)

Thanksgiving this year was surprisingly good. Not that it's ever bad, but this year nothing felt rushed and people were in a talkative mood, so it was nice to be able to just catch up. One of my favorite moments was when we had the chance to talk with my Grandma after everyone left to for the annual coon hunting festivities. It was so neat to hear her talk about finances. I've always known my grandparents were money savvy, but it was neat to hear her say... My daddy always said, "It's not how much money make, it's what you do with what you have." It's so true, and in economic times like these, it's nice to hear very basic investment rules. Simple things like this go such a long way... I hope my generation starts returning back to some of the basics.

I was able to skirt by without anyone asking directly "when are you guys going to have a baby", which was a relief. Well, it was, but it wasn't. It was definitely nice to not have to talk about it, but sometimes it's good to just get it out. I don't always feel comfortable just confiding in people, so it's helpful if someone just asks. Don't get me wrong, it's a case by case situation, but I guess I feel like if they ask they must really care, which makes me feel good. It's all in how they bring it up and what kind of week I've had I suppose.

In the short work week before Thanksgiving (remember... working backwards!), my spirits were down, to say the least. My pathetic cycle was making me into a Debbie downer and I was irritated that I was feeling like that right before the holidays. Then, on top of it all, my husband got some not-so-great news at work. It goes like this - we've been waiting for two years now, hoping he'd get hired on by the company he works for (right now he's a contractor and technically works for a middle-man). Normally this wouldn't be the biggest deal ever, except that the company has awesome benefits - great 401k matching and best of all - infertility benefits! Yes, believe it or not, infertility coverage is so close we can taste it. Bad news is that the chances of him actually getting hired on are slim to none now, with the horrible economy. In fact, he just got word last week - here comes the bad news - that he's not only not getting a raise for the second year in a row, he's getting a pay decrease! Seriously - one of the worst scenarios, aside from him getting let go, which goes without saying.

With no hope of a job providing us extra money to save for infertility, or insurance coverage, I felt totally empty. Devoid of any glimpse of what the future might look like - and that, in my little world, is pretty freakin scary. Like it or not, I am the type who much prefers to have not only today pretty much figured out, but at the bare minimum a framework for the future. On one hand I feel like I'm getting carried way with this. I mean, technically, we were fine before the thought of a child came into our lives, right? So why, now, does this have such a strong hold over me? For one, our hearts were never quite in that place before. We'd always wanted children and made decisions in our lives so that we were setting ourselves up to be able to provide a good life for our kids (probably one of the main reasons we up and moved from Illinois, an infertility state, to Missouri, where jobs are more plentiful). Anyway, we are now ready, have been ready, and don't want to give up the desire. I guess we could try to burry our longings and pretend that we are fine either way, but the truth is - at least the truth for me is - that I'm not sure if I would be fine with that. And even though I'm still young, I think of the timing of it all. I want my kids to be fairly close in age, so even if I would get pregnant sooner than later, it might take me quite a while to have the second. I really don't want to be in my mid-30s and still trying to have a child... but you never know. I guess I'm not open minded enough sometimes, admittedly.

Enough rambling. So where does that leave us? That was my big question for the Thanksgiving holiday. In effort to keep this short (I always try, but never quite achieve that), here's the tentative game plan.

1) Go to new OBGYN appt on Dec. 9 - Meet, get her opinion and next step recommendations.
2) If we like her plan of action, we'll proceed as such. As of now we're thinking our push will be for trying to get bloodwork done and other such initial things done (as described in the post below). Not entirely sure about this though, as we still need to have this discussion before our appt.
3) If we don't care for the new OB and/or her suggestions, or if she thinks it's best, we might make an appt. to go see an RE to have some initial testing done.
4) Hopefully at some point in the near future (couple/few months), we'll know more about our infertility situation to get a more solid idea of what we're up against.
5) Then, we'd like to get an idea of the types of things we can try, given our situation. If appropriate (health and money wise), we might stay put with jobs and our home and try those out with what money we can scrape together. At this point, we feel like taking out a loan is not really an option. Scary economic times and an additional $20k or so loan isn't really a good situation. Not to mention, we're already not super flexible with our finances. Yes, we have wiggle room and we are saving, but it's not tons. (I like to spend, but I like to save even more... especially the older I get!) And, I really really want to be able to stay home at least part time with our kids one day. Especially with us not living close to our relatives. With my current job, I believe this would be doable (part time work from home mainly), but I definitely couldn't stay home full-time. I shouldn't be scared by this, but I am a little. I guess I want the ability to do that, but the flexibility to work if I desire. Anyway, the only reason I mention this is so you can get a good idea of my work/home situation. Good, but not the best situation ever. Our home is a bit bigger, and older, than we probably bargined for - especially with kids not being in the picture yet.

See! I told you this wouldn't possibly be short! There is no hope for me I'm afraid.

6) Here's the thing that changes everything. If all signs point to us needing to do IVF (say, for example, if my one and only tube is blocked or damaged, that would be my only option) or if the doc says we can try all the other routes but it doesn't have a high probability of working, then we have to consider what to do next.

It seems almost foolish to not consider moving back to Illinois, given that it's an infertility mandated state. The only problem is that with my husband's current career path, web analytics, there are very few opportunities in the STL area, and absoutely zero opportunities on the IL side (near STL). This means that if he wants to stick with this, we would need to be open to moving to the Chicago area. My family would totally hate me if we moved that far away, and that is one of my biggest fears. It's also one of my biggest heartaches - I know how much it would mean to my Mom, for instance, to have us be somewhat close (where we live now is about a 1.25 hour drive) and I feel like I would be the world's worst daughter if I took that away from her, especially when it would come time for us to have a baby.

That has been one of my biggest struggles from day one, when this thought popped into my head, and one that I continue to loose sleep over.

The only other option is that he give up his career path (which is a bit more interesting and pays a decent amount more), and return to finance. At which case, he could probably find a job in the STL area, probably still not many on IL side, which means we could down-size our home and work our butt off for a year or two to save up as much as we could and then try something. Or, for it to really work, one of us would need to get full-time benefits from an IL company, and I would hate to lock us into a situation where that person is me. Then we're just creating a new problem for after we get pregnant the first time and try for a second.

Do you see how there is no good answer.

And on top of it all, the housing market is also down, which means it will be TONS harder to sell. I'm talking we'd ultimatley be shooting for breaking even on what we paid originally (if push came to shove and we had to lower the price). And, we'd need to save for some type of down payment for our next home, which means if we wanted do to things kinda quickly, we'd probably need to rent for a year or so. Which, if we moved to Chicago, that would most likely be best and would give us a chance to get familiar with the area. The only condition on that - our dogs! What in the heck would we do? I couldn't bare to part with them (the cats I could - sad but true), but never my dogs.

And these are the things that run through my brain from day to day, with no end in sight. No quick turn-around. No easy conclusion. Sadly, the economy is playing a huge role in our ability to be flexible in our lives in order to do what is necessary to provide a way for our family.

Even with the way things are, we arn't giving up hope. We will continue to push ahead and are willing to step outside our comfort zone in order to provide a good life for our family, in the hopes that one day it will grow.


In the meantime, here are a few resources that might be helpful when seeking out companies who offer infertility insurance coverage:
http://www.inciid.org/article.php?cat=&id=243#n
http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppivf&msg=55025.1&x=y

Here is a list of states who mandate infertility insurance coverage, in some form or another:
http://www.asrm.org/Patients/insur.html

Just as we thought - No Infertility Insurance Coverage

The cold hard facts are in. At least we know for certain now and can begin to come up with a plan.

I do, however, want to give a big thumbs up to Fertility Lifelines for helping me sort through it all. I called them on Friday and they got back to me the next business day (this week that happened to be a Tuesday, with the Labor Day holiday). Bonnie, the same benefits specialist I spoke with on Friday, called me personally and let me know the not so great news in a very kind and sensitive way. I was prepared for the news, so it wasn't tough to hear at this point. She let me know that she will be mailing me out a letter with these same findings, so I would have something for my records.

The next day I received a packet with a letter and a couple informational pieces on the Gonal-F injectables they manufacture. In a seperate mailing I also received general information about infertility and TTC that covers basic information and concerns that someone in this position might have. It didn't necessarily tell me anything I hadn't already heard, but it was still a good piece to scan. For those who haven't really looked into infertility yet, it might be pretty informative.

Go here to sign up and get a packet of your own.

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.

Sites I Love

Here are some links I've found to be very helpful in our infertility journey.

Doctors

Dr. Peter Ahlering, with SHER St. Louis, MO - My Reproductive Endocrinologist (RE).

Dr. Geoffrey Sher - Founder of SHER Institutes for Reproductive Medicine (SIRM).

Find an RE in your area - Enter your Zipcode and get a list of clinics in your area.

Vitals - Find or research a doctor.

IVF Clinic Success Rates - Check out a success rates and compare before starting treatment!


General Trying to Conceive Resources

Fertility Friend - Keep track of your cycles online. Offers a basic complimentary membership.

Ovulation-Calendar - FREE, downloadable ovulation calendar program for Windows.


Paying for Infertility Treatments

FreedomDrug Online Pharmacy - Cheap(er) Infertility Meds

Early-pregnancy-tests - Cheap(er) OPK & pregnancy tests, if you buy in bulk. Fast shipping!

IVP Care - Pharmacy that my clinic in STL recommends


Education on Infertility

FertilityJourney - Podcasts, General "What-is" type info on fertility.

Dr. Licciardi's (RE) Blog - Ask questions and get general infertility info from a practicing RE.

FertilityFriend - Learn about your reproductive cycle and start FREE monthly online charts.

Tears & Hope Video - A short video designed to help explain infertility to family & friends.

Resolve's Infertility Etiquette for Family/Friends - Helpful tips on what to say and what not to say to a couple who's dealing with infertility


Infertility Insurance Coverage

FertilityLifelines - Get FREE, confidential help on determining if you have infertility benefits.


Infertility Support & Forums

SoulCysters - A site specifically for people suffering with PCOS.

FertilityCommunity - A forum for all things TTC w/ infertility - lots of specialty forums as well.

IDreamofBaby - A forum for TTC, both w/ and w/o infertility issues, & pregnancy support.

Hannah's Prayer - A non-profit Christian support group for women dealing with infertility.

CafeMom - This is a TTC & Infertility Group. There are MANY more different groups available.


Infertility Blogs

Dr. Geoffrey Sher - Founder of SHER Institutes for Reproductive Medicine (SIRM).

Stirrup Queens - A wonderful resources for all-things infertility.

List of Infertility Blogs, by Category - Stirrup Queens well-organized list of infertility blogs.


Infertility Books I Recommend

Click any book in the navigation bar to the right to read more!


In Vitro Fertilization (IVF) Specific Resources

Due Date Calculator - Gives you a date based on your egg retrieval.


SIRM and/or Dr. Ahlering Success Story Blogs!

sefurlong.blogspot.com - Sara was a patient of Dr. Ahlering's at SIRM, St. Louis, MO

ahopeawishadream.blogspot.com - Jenny was a patient of Dr. Schultz at SIRM in Peoria, IL