Approved!

That is all.

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.

The waiting game

The official letter of complaint went in the mail to the insurance company yesterday, in the hope that they might agree to pay some of the outstanding charges. I've been fortunate; this is the first big medical situation I've had to deal with. I guess this is just the way they do business; right? They deny, deny, deny, then only pay after you put up a fight. The gamble is that most of us won't fight. Silly me, I thought the business model was about pooling risk so that we got the coverage we paid for. Some people pay in and need little care, taking out less than they've put in. And some of us, pay in and take out more than our share. But I left out the profit-making piece.

I know, I know that I should be grateful that the insurance covers any of it. The meds alone were a huge chunk that we didn't pay for. But the frustration stems from the fact that I am paying the entire premium out of pocket. That $9000 would nearly have covered a complete IVF cycle without any of this hassle. So now it feels like I am double-paying.

I'm also waiting for my cycle to rev up again. More than once over the last month I've thought we were just about ready. But I've been temping and using OPKs in vain ... no sign of ovulation, much less my period. If nothing's happened by the end of next week, I'll put a call in to the doc, and see if they'll do an ultrasound and bloodwork to figure out what's happening in there.

In the meantime, the pool is open, and I am going swimming this morning!

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.

Adoption update

That was fast! We got a call this morning from the adoption agency. Good news: "The review committee loved y'all!" Bad news: they won't let us proceed until we've stopped IVF. Not every agency does this, but my sense is the very best ones do. One point the woman made was that it's very hard on birth mothers, who are already in crisis, when parents they've selected discover they are pregnant. And that makes sense to me. I wish I could pursue multiple channels at once because of my need to have a plan B and C ... and Z. But we're in their system, they like us, and we just have to let them know we're when we're ready.

Next steps

Well, I am certainly glad the last week is over! After a rough couple of days, I woke up Sunday feeling all better physically. A long night's sleep in a luxurious hotel bed without a snoring partner (love ya' babe!) after delicious alone time with my brother and his GF, my BFF, and my parents was just what I needed. Not surprisingly, perhaps, Sunday was a more difficult day emotionally. At brunch with my parents, brother, and his A, the hostess presented a rose to my mother. I LOST it and ran out of the restaurant in tears. It was the first time I had really cried about this miscarriage. It was probably good for me; my practical stoicism is not always healthy. After a hug from my dad and some whining about the unfairness of it all, a mimosa perked me right back up. And I was fine the rest of the day, focusing on my mom and grandmother.

And at Mother's Day dinner, all the women got roses. And it's appropriate, I think, because don't we all "mother" somebody or somebodies?

Then we were on to the next hurdle, having some early skin cancer removed from my back. The procedure went smoothly, though the incision now alternates between stabbing pain, burning, and itching. It's fun ... or not. The stitches will be in for three weeks, which seems interminable. But it's for the greater good, and I'm relieved to have the spot gone.

Today was my post-op visit with Dr. R. Mostly he wanted to talk about politics and the Dead Sea Scrolls. I was like, "Dude! You have other patients waiting. This is not a social call!" But we get good treatment because he likes us, so I can't complain. As I expected, he isn't particularly concerned that we've found only bum embryos so far. He said, "The class of July 2010 is different from the class of March 2010" and made an analogy to my law school students. And it's true, some years are better than others. He also reminded us that only 30 percent of fertilized eggs ever turn into babies and we just need to keep trying to find our 30 percent. He did send me for some bloodwork for autoimmune issues and an updated check on my thyroid. But none of us think that's the issue. We're just dealing with old eggs and bunk sperm and we have to be patient.

He said to call when my cycle starts again. The nurse was, again, horrified, "Aren't you supposed to wait SEVERAL months? He's bending the rules!" Aaah, yes, but it'll be fine. After all, there's a rumor that women are more fertile in the months right after a miscarriage. So shouldn't we capitalize on it? Given how quickly I'm recovering, though, I anticipate that we'll wait two months, starting the birth control in early July and doing retrieval and transfer in early August, just before school starts.

In the meantime, we bit the bullet and filled out our first adoption application, for a very old and apparently well-respected agency in Fort Worth. They have a domestic infants of color program, as well as an Ethiopia program, which are our top choices. Even if we are ultimately successful with IVF in the next six months, we are very interested in pursuing adoption for child #2, so we figured it couldn't hurt to get the ball rolling. But I think we should probably fence the swimming pool if we have any hope of passing a home study. The to-do list grows longer.

Nagging worries

Physically, recovery has been a lot harder than I anticipated. I'm still having a fair amount of pain and other discomfort. Although I haven't done anything silly like go to the gym, or even walk the dog, I did have to get right back to writing my final when I probably should have taken a day or two to sleep this experience off. I don't think there's anything wrong: no fever or other signs of infection. It'll just take time. I'm heading to San Diego for Mother's Day. I know the travel will be physically draining, but I think running away to beautiful SoCal will be worth it for the soul.

As committed as I am to moving forward and doing another cycle, I have begun to have a nagging worry. In two years, we've had two pregnancies, both of which have ended in miscarriage. There doesn't appear to be anything wrong with my uterus, lining, or hormone levels; in fact, my body was showing no signs of letting this pregnancy go before the d&c, even though the fetus had passed at least a week before. Almost certainly, both miscarriages have been the result of bad embryos with chromosomal problems. I worry that maybe we can't make a healthy embryo. I worry that even if we get twice as many eggs next time, they'll still be bad and we'll have to go through this again.

I'll probably talk to the doctor about this next week. I suspect he'll tell me it's just been bad luck and we have a good chance of getting a good one next time. But I'm still curious about what he'll say.

I found a cool new blog today, with an awesome video for infertility awareness week. (Warning: if you have epilepsy or are otherwise prone to seizures, don't watch it. The choppy editing is a bit discombobulating.) The video is cool, and I love that the author named her blog after two of the barren matriarchs.

HT: Mo