Revving up -- or rather, revving down

We're underway! Prescriptions have been ordered; the doctor's office will get the pre-approval from the insurance company; and my first appointment (suppression check and payment) is July 13. I'm keeping my fingers crossed that everything goes more smoothly this time around. I'll start the birth control pills for suppression this Thursday. And if I'm properly suppressed (no follicles, no cysts), we're looking at the last week of July for retrieval and transfer.

I've finally made contact with the insurance company. No results yet, and probably not for another couple of weeks. But I have a human being with a name who answers the phone, so that's progress. And the doctor's office is being reasonably patient.

Frustration

All I want to do is focus on getting strong and healthy for cycle #2. But I have been spending hours dealing with the insurance and bills from the first cycle. Despite the fact that we properly obtained pre-approval, the insurance company has denied all but about $600 of the $10,000 charges!!! They paid $600 to my doctor (of the $2500) he billed, with no explanation for the denial of the rest, then proceeded to deny all of the charges from the hospital and the anesthesiologist. At different times I've received different explanations: 1) once the doctor was paid, no one else could be paid for the same services (ridiculous, don't doctors and hospitals bill separately all the time???); and 2) the name of the facility of the preauthorization was the clinic not the hospital (even though the clinic is just a subsidiary of the hospital). Happily, the hospital appears to have absorbed its costs and is taking responsibility for the mix-up. But not so much the doctor's office, and I still haven't heard from the anesthesiologist.

I have a call in to the business office at the doctor's office to see what explanation they received for the denial, and I have an email in to the insurance company about filing an appeal.

And in the back of my mind I keep worrying about how to make sure this doesn't happen next time.

On to IVF

We have completed, unsuccessfully, our fourth IUI attempt, and so we will begin IVF shortly after the new year. We started with an initial round of tests and an IVF class at the new clinic. My blood tests had better results than back in February. There's no good explanation for that, but it does suggest that I should respond well to the IVF drugs. More interesting is that we had our third semen analysis, under more rigorous (and more reliable) criteria. The result was a normal morphology of 6%. Using these criteria, >15% is considered fertile, while <5% is considered infertile and not eligible for IUI. (It would have been nice if either previous clinic had run this test. We probably still would have been advised by the docs/required by insurance to try IUI, but our expectations would have been even more realistic.)

What this means for IVF is that we are currently scheduled for "traditional IVF," where the sperm and the eggs are combined in a petri dish to do their thing. But if day-of results are <5%, we will be converted to ICSI, a procedure in which a single sperm is injected into a single egg. Wild!

When is day of? Early March. I will start the first round of drugs (including one the infertiles on the interwebs call Loopyron for its tendency to induce irrational rages - fun!) in about four weeks. They will completely shut down my reproductive system for a month. Then, if all goes well, we'll begin stimulation drugs to grow eggs, hopefully 10-20. I will have minor surgery to retrieve them, around March 1, followed by embryo transfer (we hope!) 5 days later. And in the meantime, of course, I'll be teaching 5 days a week.

The IVF class was our first real exposure to our new clinic. We were pleased that we were very comfortable with the nurse and embryologist. Not surprisingly, we were the most informed couple there. (We were also the only ones who laughed at the jokes. Apparently other people have trouble seeing the humor in the infertility. But that meant we were a favorite of the nurse, which we always like.) We are also very blessed to have my continuing insurance; we were the only couple not paying a lump sum $12,000 out of pocket. (We are paying $12,000 to the insurance company, but in $500 bites, which is manageable. And if IVF #1 doesn't work, any more attempts in 2010 will essentially be free instead of an additional $12,000.)

I will call the clinic tomorrow to get on the schedule officially!

Another laugh

I had a consult with the second clinic in town last week; I'll post more about it soon. But my favorite part was when the doc said that there was probably nothing wrong with me; it's just the morphology issue. It's not what Brent wanted to hear, I'm sure, but it made me feel better! And coincidentally, Mo & Will's latest Hallmark reject is perfect for the occasion!

A tentative plan

It's amazing how helpful typing out the options is! Within hours of yesterday's post, we had a plan. We've got an appointment for a second opinion at the other clinic in town in two weeks. The biggest question we've got for both clinics is whether they would do the local bloodwork and ultrasound monitoring if we do a cycle at CCRM in Denver. That may well be the deciding factor, more than the stats of the respective clinics here. We're tentatively planning to do an initial IVF cycle here in town in February/March. If it doesn't work, we'll head to CCRM in May and cycle there over the summer, taking advantage of the flexibility that comes with our professorial schedules. In the meantime, we'll probably spend some time this winter thinking about our "Dear Birth Mother" letter to submit to adoption agencies. I can't imagine a more daunting task than writing a letter to convince a woman to let us raise her baby.

Choosing a clinic

Assuming our last round of IUI (whenever that happens) doesn't work, we'll need to choose an IVF clinic. We have four options:
*Our current clinic at the University. We really like the staff and find it to be a calming place that offers personalized attention. But it's a relatively new program.
*The other clinic in the city. It's a much bigger and older program, which means less personalized service but more experience.
*Colorado Center for Reproductive Medicine. It's the number one clinic in the country, according to Parents Magazine. I have a friend who had great success there. It's the place that all the IF bloggers go when all else fails. But it's out of network, which means meeting my deductible and huge co-pays.
*Presbyterian Hospital in Dallas. It used to be the number seven clinic, though the personnel has changed. And it's out of network. So this one seems easy to eliminate.

In patients under 35, all four clinics have roughly equal success rates: 57-65 percent. But in the 35-37 age range, the numbers vary wildly: our clinic had a 38 percent success rate in 2007; the other clinic in the city 51 percent; and CCRM 58 percent.

Technically, we have time for two IVF cycles before I move from the under 35 group to the 35-37 group. But my FSH levels suggest my eggs are old, so I wonder if I should just assume I'm going to behave like the 35-37 age group, which probably means switching clinics.