Proof That I'm the Cool Aunt

My oldest niece and nephew, Gabrielle and Ben, decided to dress up as Mike and I for Halloween--Chucks, tattoo sleeves and all. They looked so cute! Gabrielle even put a fake Monroe piercing on her face, exactly where I have my real one. Some people joked that they even managed to get the height difference to scale--Mike's three inches shorter than I am. Haha.

 

 In case you're wondering, I have actually had pink hair a few different times in my life. Thus, the inspiration for Gabs' pink wig. Mike actually had bihawks when I met him, which is why Ben has a purple mohawk. Mike's bald now and I tease him that all his hair fell out because of all the hair product and dye he used growing up. 

I managed to survive Halloween. I spend the evening at a friend's house on post and HOLY COW, talk about procreation city!  She lives in the same housing that we'll be moving into in a few months and I made a mental note to buy costco size bags of candy for next year. I nearly teared up when I first saw the couple of little cuties but I drank a beer and told myself that I was going to enjoy the evening. I wish Mike would have been here though.

Gabrielle is calling today "Gilmore Girls Day." 11-1-11. If you get the reference, you're a true fan! Haha!  Today is also the day where I would normally bust out the garland and Andy Williams, but I'm not feeling all that festive yet this year. I already started listening to good ole Bing Crosby on Pandora but I don't think I'm ready to tackle the totes and totes of Christmas decorations in our garage all by myself. Maybe this weekend!

I never heard from my doctor or the pharmacy yesterday so I just called Freedom Pharmacy to inquire about my prescription. Right away they asked me if this was for an IUI or IVF cycle. Well, crap. I wasn't going to LIE. I know there are probably some women who would lie, just to get their meds covered by Tricare, but I couldn't do that without feeling insanely guilty. So now I'm just waiting for them to call me back and tell me that Tricare denied coverage so that I can pay for the meds and get them shipped sooner rather than later. It stinks but I suppose that I should be thankful that everything up to this point has been covered, which the exception of the IUIs.

Gabrielle is calling today "Gilmore Girls Day." 11-1-11. If you get the reference, you're a true fan! Haha!  Today is also the day where I would normally bust out the garland and Andy Williams, but I'm not feeling all that festive yet this year. I already started listening to good ole Bing Crosby on Pandora but I don't think I'm ready to tackle the totes and totes of Christmas decorations in our garage all by myself. Maybe this weekend! Are there any other crazy people who decorate for Christmas super early like me? Christmas lovers unite!

Here's to Renewed Hope

My brain is working overtime right now, trying to process all of the information and happenings of today.  We had our consultation with the civilian clinic this afternoon. We had really high expectations for this appointment....and we were not disappointed. We had a wonderful experience and it really makes me question why we did not seek care outside the Army months ago!


We arrived rather early, since we had never been there before we wanted to make sure we allowed plenty of time to get there. The nurse, who I had never met before and had only spoken with a couple times on the phone, knew who I was right away and had some information for me.  Shocker! I've been a patient on post for 13 months and the receptionist still doesn't know me from Adam.  I had the typical intake form to complete and then we waited, but not for long. We got called back into the doctor's office--plush leather chairs instead of an exam table? I'll take it!  Dr. C, the embryologist, sat with us and took our history.  There were no comments like, "Oh you're young! Don't worry..." but rather he said, "Wow, it's been a long time, huh?" Based on my diagnosis, endometriosis with a blocked left tube, he agreed that IVF was our best course of action.  Then we waited some more... As it turns out, the RE, Dr. M, is also an OB/GYN and had to deliver a baby at lunch so he was running a bit behind.

When Dr. M came in he introduced himself and very quickly sat down and got right to the point. He's from NY, speaks very quickly and with a lot of incomplete thoughts and sentences. I got the impression that he is an incredibly smart man (M.D. and PhD in Embryology!)  and has difficulty having conversations with people of average intelligence.  He took the time to literally go over every single page of my chart and highlighted things that he felt were pertinent to my case.  He commented that my treatment up to this point has been, "Cost effective but a waste of time."  I couldn't have agreed more!

For those of you who aren't familiar with the military insurance Tricare, they cover nothing for IVF. They'll pay for endless drugs as long as we're having timed intercourse and they'll pay for breast augmentation and vasectomy reversals but not IUI or IVF--we are entirely out of pocket for this. At first, it sounded like the IVF program on post was a really great deal.  All my meds would be covered thanks to a grant program given to the hospital, my ultrasounds and meds would be covered and done on post too. However, we'd still have to pay for the actual retrieval and transfer since those would be done at an off post facility in Seattle and will cost several thousand dollars. From what I've read on various military boards, this fee is significantly higher than most military IVF programs.  Dr. M, bless his heart, gives a substantial military discount which makes IVF at his clinic, meds and all, even cheaper than on post....and without the long wait.   We can receive even further discounts if we choose to participate in his embryo/implantation research study.  He is working on developing a sort of "embryo glue" that has shown to have added success with implantation during IVF cycles.  As we were leaving, Dr. M saw me trying to pay for the consultation and he stopped me. He told the nurse to bill Tricare since they should cover it. I thought that was really nice of him, even if we do still end up with a bill in a few weeks.  This clinic is seriously a God send and I felt like Dr. M genuinely cares about his patients and he is not restricted by Army red tape.

When we left the clinic we were already 95% sure that we were going to switch, just based on our initial impression in compared with the overall experience we've had with the Army infertility clinic.  It's a bit of a drive (an hour away) but we really liked the small, intimate setting of the clinic compared to the hustle and bustle of the large Army hospital. When we got home Mike and I had a very long talk about everything--the odds, the risks, the research study, financial aspects, how soon we'd like to try, if we want to leave the clinic on post entirely......everything.  We came to this decision:  I am going to call the clinic tomorrow and get the ball rolling.  We are going to shoot (and pray!) for a December IVF Cycle, which means that I will need to start BCP in two weeks. Here's hoping that the powers that be (and Uncle Sam) allow it and here's to renewed hope!



For your viewing pleasure: A 3D animation of the IVF procedure. 

Post-op Follow Up

I had my post-surgery follow up appointment this morning. My shiny new Windows Phone makes waiting in the horrible waiting room so much less awkward. You see, the geniuses who planned the clinic set it up so the ob/gyn clinic is right next door, with the reception for both clinics in the middle of the two. So when I'm waiting for my appointments, I get to hear people on the other side of the desk booking ultrasound appointments and scheduling their prenatal care. The grass is always greener, right?

While I was waiting, a female soldier sat across from me in the waiting room. A few minutes later her husband came from the back holding a biohazard bag and exclaimed rather loudly, "Wow. That was awkward." Hahaha! I don't think he expected me to be in the waiting room. His wife handed something to him and he said, "Should I go back in the bathroom and do that?" It was all I could do to keep myself from laughing. Poor guy. I wanted to tell him that it was okay, that we'd all been there. Oh, the joys of infertility....

My follow up appointment went well. I wasn't expecting to find out anything I didn't already know since I had already seen my RE for the alien plastic two weeks ago. What I wasn't expecting was to be seen by the idiot resident who left the plastic inside me! At first I thought Dr. C. sent her in so that she could apologize to me but I was wrong. She didn't even bring it up! She checked out my incisions and made a remark about my bruising--  if only she'd seen me last week! Ouch.  When she was done checking me out she brought in Dr. C. and we discussed what our new plan of action is going to be.

If you remember my first post that I made after surgery, you will remember that the laparoscopy revealed a substantial amount of endometriosis on my left side. I was informed that my left ovary  is covered with endometriosis and is adhered to my pelvic wall at such an angle that my left fallopian tube is partially blocked. It was too risky to remove the adhesions because of their location and removing the endo from my ovary is not an option at this point, as they would likely have to take part of an otherwise healthy ovary along with the affected tissue.  As if that wasn't enough, today I found out that my left side is basically worthless and that my left tube is also partially adhered to my bowels. As much as this totally sucks, it is so incredibly refreshing to finally have some answers. EVERYTHING from our infertility, my spotting before periods, my intense menstrual cramps, my painful intercourse and the incredibly painful bowel movements during my period finally makes sense!

So, where do we go from here? Dr. C. put my mind at ease and said that my pain is normal since I'm still healing and that we won't worry about it unless I'm still in pain after six weeks. Although the majority of my endometriosis has been removed, my left side is basically unhealthy and unreliable. While I may in fact produce follicles on my left side, there's no guarantee that the eggs will go where the need to go since my tube is partially blocked. The good news is that my right side is perfectly healthy and always produces rock star follicles. Dr. C. is confident that now that our chances of conception are higher now that most of the endo is gone. Mike and I are going to continue to do ovulation induction but stick with timed intercourse for now and see where that leads us. Who knows, we may end up doing a few more IUI cycles too.

I really have a gut feeling that we're going to end up needing to do IVF to finally get our baby. I'm praying, of course, that this is not the case but I can just feel it. We're still on the waiting list for the IVF program through our military hospital and as of right now we won't be able to cycle until July of next year. They've told us that there is a good chance we could cycle in as soon as 6 to 8 months though, which would be fantastic providing we have the money saved by then. For now, we've decided to stick with the infertility clinic on post and see how the next few months go. Let's hope that we won't even have to decide between infertility clinics but instead choose between an OB or midwife!

Megan vs. Tricare: Round Two

Yesterday I changed my PCM (Primary Care Manager for you non-military folks) to a civilian provider, one that has nothing to do with Madigan. Hopefully one that will send my referral directly to Tricare instead of Madigan and I can be seen at the RE in Olympia.  He's in the Tricare Network. I don't  I still haven't heard from Patient Advocacy. I'm not going to bother fighting with them until I see how Round Two goes first. I may have to break out the heavy gloves! I really need to write down  everything that I've had to put up with. Most recently, I got my CD3 blood work results which confirm that I do, in fact, have Diminished Ovarian Reserve. Do you think that I found this out from the IF cilnic? No. I had to call my PCM's office and they gave me the results over the phone. I've diagnosed myself based on the research I've done.  I haven't heard a word from the RE. The results of my CD3 labs (the labs that I had to fight for since they kept insisting that it'd be really rare for something to be off) came back in the normal ranges. However, the normal ranges cover a broad spectrum and a few of my hormones are actually a little high for my age.  These tests should have been the first thing the doctor did when I became their patient last September. I hate myself for listening to them and allowing them to keep telling me that I didn't need the blood work, that everything was fine.
 CD3 Lab Results:
Thyroid: 1.8
Estradiol: 55
FSH: 8.02
LH: 4.14

Coupled with my AMH of .85, it is very likely that the next time (when I actually get an appoitment) I see my doctor that I will be given the official word that I have DOR.  As far I know, this just means I have less eggs than I should at my age.  Because of my age, the doctors still expect my eggs to be of good quality but that's something they can't really know until we get to the IVF stage.  

I'm having doubts about moving right to IVF. I'm second guessing our decision to forgo the injectables and IUI. One of my RE's, Dr. B. said he doesn't like to do injectables and IUI because you can't control how many eggs actually fertilize. Makes sense. After all, this is the same treatment that allowed Kate Gosselin to become pregnant with sextuplets! The other RE, Dr. C., did give us the option of doing this treatment but said we would not have increased success, so we decided to opt for the lap/IVF route.  Now that I've been researching it, I don't understand why we wouldn't have an increased chance of success? You have the greatest chance of success in your first three rounds of IUI but since we'd be switching the protocol (i.e. drugs/treamtnet) my success rate should start fresh.  I've got a call into the IF clinic to discuss my lab results and I'm going to pretend I don't know what the results were. They probably won't give them to me over the phone so hopefully I can make an appointment and talk to them about everything.

So for now, I'm waiting for Tricare to approve the PCM change before I can make an appointment with her  Fingers crossed. If the referral doesn't come through then Mike and I are going to have to talk to Tricare again and have everything spelled out to us as far as what's covered and what's not covered if we switch to Standard. I still don't know what we'll do since we'd essentially be giving up our spot on the IVF waiting list.

I'm still having my laparoscopy on the 25th and am so happy that my mom will be flying in to be here for me.  Mike's having a crazy time at work right now and doesn't even know if he'll be able to get off for my surgery so I'm really glad my mom will be here.  What girl doesn't need her mommy every now and again?

Is it weird that I'm actually hoping they find endo or something? At least we'd have an answer as to why I'm not getting pregnant. Unexplained infertility is so incredibly frustrating! Maybe they'll find something, fix it and I'll be able to get pregnant without IVF. I know it's wishful thinking. Hope for the best but expect the worse.

First Sale!

Some of you may remember that I started an Etsy shop called Works of A.R.T. to help raise money for our IVF.  At the time, I was in my 2ww fom IUI #3 and really didn't think we'd actually have to start saving, that the IUI was going to work. But here we are a few weeks later, we are officially moving on to IVF and I just made my first sale!

My new online buddy, Carole, mailed me a shirt to embroider for her daughter to wear to a celebration commemorating her doctor's 20th year of doing IVF. Carole is the one that told me about the clinic in Olympia and has been a huge help with guiding me through the steps. 

Oh...I still haven't heard from Patient Advocacy. Nice, right? So, here's our plan as of right now. Laparoscopy 25 August. I'll have the surgery and discuss our options at the Post-Op. If the Lap fixes" the "problem" and increases our chances of conceiving without IVF then we will most likely stick with the clinic on post for a few more months.  If the results of the lap are normal and we need to move to IVF then we will switch me to Tricare Standard so that we can see whatever doctor we want--without a referral. I need to call the doctor in Olympia confirm everything price-wise before we do the switch. What's the difference between Standard and Prime?  Mostly, the co-pays.  With Prime, I am seen on post and we pay nothing out of pocket (except for the IUIs, which we do at an off-post clinic). All my meds from the on-post pharmacy, where I always have to wait at least an hour I might add.  With Standard, we get to pick our doctor but there are co-pays for office visits, procedures and meds. I think our catastrophic cap would be $1,000 a year. I would not be allowed to go on post for anthing medical anymore which means we would be forfeiting our IVF slot at Madigan. Technically, Tricare doesn't cover any meds for an IVF cycle but I know several people who have had them paid for. It's all about the way the doctor codes it for billing purposes. So, I guess we'll see. If any of my readers have been through a laparoscopy, I would appreciate hearing your stories!

Denied.

This morning I had my appointment with my PCM to seek a referral to the off-post RE in Olympia.
 I saw my PCM less than three hours ago and my referral has already been denied. The head nurse from the IF clinic on post just called and said that they won't refer people off post because "Tricare doesn't cover infertility."  That's only partly true. How can that be true when I know PLENTY of people who are seen at off-post infertility clinics?! They will cover EVERYTHING except the actual IUI or IVF procedures.  The clinic in Olympia says they bill Tricare all the time and that I just need a referral. Madigan is refusing to give me one. This is so incredibly frustrating. I don't want to burn any bridges with the clinic on post, especially with my laparascopy scheduled for the 25th of August. It's a Catch 22 because I'd have no problem getting a referral to a civilian infertility clinic if we were at a duty station without one on post.  First, the IF clinic jerks me around for months because they can't see me when I need to be seen and now we have to wait an effing year for IVF. It's especially ridiculous because there's a perectly good RE who is ready and willing to see me NOW and who charges less for IVF than the cost on post, but I need that damned referral. So I'm stuck and right now I'm waiting to hear from the Patient Advocacy office. I really, really hope that they are able to help us.

Oh! I did finally e-mail my "not an apology" friend back. She called me today and we chatted for awhile. She asked me what was going on with us and as I was telling her about all of our procedures, tests and failed treatments she said, "Yeah. I can't believe we got pregnant on R&R. We were like WHAT THE FUCK?"  I started to tear up. How could she be so fucking insensitive? i wish I was a stronger person and that I would have told her to pull her head out of her ass.  So obviously I was right. She doesn't get it. If it doesn't affect her than it doesn't matter.  She is a good friend and we always had a lot of fun hanging out with them so I don't want to burn bridges, especially because they might be coming to Lewis, but I will not be talking to her about infertility anymore if I can help it.

It Should Be Called Tri-Doesn't-care

So we went to the Tricare office on post to seek a referall to be seen at an off-post IF clinic. We were told that we can not get one since we have a clinic we can be seen at on post. First she tried to tell me that Tricare doesn't cover anything IF related and I had to tell her that she was wrong.  It's the same song and dance that we went through with Mike's knee only he had no choice but to be seen on post.  We have a choice--we can switch to Tricare Standard.


Right now I am on Tricare Prime and am seen at a MTF (Military Treatment Facility) and everything is covered 100%. Tricare will cover everything that is diagnostically relative to IF. They won't, however, cover anything once we start doing ART. The financial aspect of this option is great but we all know how well everything else has worked out. I saw my OB in MAY of last year to seek a referral for IF. I saw the RE in September and have not seen him once since. I may or may not have my hysteroscopy this cycle but who knows how long it will be before I can see the doctor for a follow up.

If we switch me to Tricare Standard then I will get to choose my RE but we will be financially responsible for $150 deductible, 20% co-pays (15% if they're a Tricare Network Provider but the IF clinic we are looking at is not in the network), and a $1,000 catastrophic cap.  The RE will have to call Tricare before every procedure to make sure it is approved by Tricare and if it isn't, we will have to pay for everything completely OOP.  I will not be able to be seen on post for anything anymore so we'd have to find a family practice doc and would have co-pays for that as well. I would no longer have access to the pharmacies on post and would have to get my meds either off post or at the satellite pharmacy on post which is often over-run with retirees.
 If we switch to Standard then we wouldn't be able to switch back to Prime for a year, which means if I DO become pregnant we would be responsible for those co-pays as well.  She said Tricare Standard will cover 100% of a routine pregnancy but won't cover any extra ultrasounds or anythign like that. We'd have co-pays on anything "not routine."


It's so incredibly frustrating and we don't know what we're going to do. When you're talking about IF testing a 20% co-pay is a LOT of money not to mention the drawback of being locked out of Tricare Prime for a year.

For right now I think we are going to wait out this 2ww and see what happens. If they can get me in for the hysteroscopy then we are going to do it at the MTF and let the Army foot 100% of the bill. If they tell me that I have to wait again then we are going to switch over. I'm going to call Triwest tomorrow and speak with someone else just to confirm everything with another source. I'm also going to call Seattle Reproductive Medicine to talk to them about becoming a patient. Wish me luck! This whole situation sucks.

It looks like I'm going to have to do a pro/con list a la Gilmore Girls. 

What a Shocker

AF just came so I called the IF clinic to schedule my hysteroscopy. No surprise but they can't get me in this month. What a shock. =(

Mike and I are going to make an appointment with the Tricare office on post next week to discuss switching our insurance so that we can start seeing a civilian RE. I'm tired of dealing with the IF clinic on post. As if the IF roller coaster wasn't enough, a shitty RE's office make it 1000 times worse.

Does anyone have any experience with Tricare Standard? Any advice?