The Second Opinion

hope

Alright y’all, so we had our appointment this past Wednesday with the new doctor who is the co-founder of the Big Fancy Clinic here in Portland. You know, fancy furniture and red tape galore and higher costs to boot…

The most important part: they can take our frozen embryos if we want to do a 6th try.

The new doc’s recommendation: do the ERA test in December as part of a mock transfer cycle, then do the actual transfer in January with the two “A” embryos. And, if we want (totally optional), have karyotyping for Dan’s blood to see if there’s any translocution issues with his genetics but it’s primarily for men with sperm issues and women with recurrent miscarriage (I’ve only had one m/c, implantation in the first place is my issue).

The opinion about the old doc: they don’t grade embryos the same at all, as my old clinic used – not shockingly – an overly simplistic method.  He also was amazed my doc didn’t do any estrogen level blood testing pre-transfer and just relied on the one ultrasound.

The cost difference: $2,600 instead of $2,000 for the transfer itself. ERA *may* be covered, may not, so assuming the worst we’re looking at an extra $1,000. He’s said he’s seen this make a difference for another DEIVF patient. Worth it. Karyotyping range $500-$1,500 depending on what comes up, and a good chance it’s not covered by insurance. That’d be a no thanks on the last one. We already have the embryos, so the ERA is what would help with

Other protocol differences: even though there’s not a lot of evidence, he does recommend prednisone and baby aspirin in the “hey it doesn’t hurt”. Estrogen is either delestrogen IM (preferred) or patches, as he doesn’t use the oral pill (hasn’t explained why though). Progesterone is PIO IM injections at the start then, if requested after a positive test, can change to suppositories. He also wants me to get a SIS (like an HSG but for the uterus) since it’s been over a year, to make sure everything’s in good shape there. I’ve asked them to refer me to have this done by the radiologist goddess I adoringly refer to as “Jane Goodall”, the lady who did my HSG last year with not a bit of pain (seems everyone’s blog talks about how ungodly painful it was, this gal is one of the pioneers of the process so I’m going to her, non-negotiable!

The question: how the hell do we get our 6 remaining frozen embryos transported the 1.5 miles to the clinic? We quoted it out and it’s a whopping $750 to use a courier. Fuck that. We can transport ourselves, but old RE’s office says we have to come up with a canister and dry ice. Research thus far shows that’d cost about $400 for a RENTAL, so we’re going to see if Big Fancy Clinic will let us borrow the container thingy to transport it in and drive it over to them. How amazing that this appears to be the harder part.

The bureaucracy/red tape: Big Fancy Clinic’s first contact, who I’d sent all of my records to for the past 2 years and more, decided she wouldn’t pass on any and only gave him the ones faxed in directly from past providers (even though what I gave her were copies of the exact same thing), and also didn’t share the embryology lab details that was the reason why we were there – to find out if the equipment matched. When we came in to see the doc, he said “well we need to find out what kind of equipment they have” and I’m like WTF, I provided this weeks ago! Thank goodness the answer was yes as I’d have been pissed to pay for the appointment only to find out we were wasting our time. Then a CNA tries pressuring me to get weighed while I was there even though we were just having a consult (sorry, they already know my weight from paperwork and I don’t need the stress of getting on a scale just for an appointment to TALK about POSSIBLY working with this clinic). Then his coordinator (not a nurse) is asking for all kinds of asinine things that are completely irrelevant for our situation. Examples: 1) a Hepatitis B test for my husband (even we gave proof of immunizatino) as well as an HIV test (which he’s been tested for but don’t have proof) – and are both completely irrelevant as we’re transferring our existing frozen embryos! 2) a letter from our RESOLVE-referred counselor that proves not only we saw her about infertility (which she’d provided for us to give them) but now also asking for notes from our session, which is absolutely not going to happen. We don’t share highly personal counseling session information, that’s none of their business, AND we’ve done 5 rounds of DEIVF so assessing “if we’re ready to use donor eggs” is the dumbest thing I’ve ever heard of. 3) they’re trying to include the cost of Lupron in my estimate, which is not something I need to take and haven’t for 4 out of 5 cycles. The doc said I’d just do the pill and estrogen/progesterone, and yet the coordinator is just reading off a template. I told them I took it for the first fresh cycle and after that we just put me on the pill, as I rarely ovulate anymore and with an AMH of .003 there’s not exactly a risk. It’s a significant cost difference adding this unnecessary drug and I’m not going to be bullied by a person who has no medical background or clear understanding of my situation. The worst part is dealing with this “patient intake coordinator” instead of just directly with the doctor to determine what’s actually necessary/required to do a 6th DEIVF at their clinic – it’s like playing telephone over and over and over with the “let me go ask the doctor” rather than me just talking to him to determine what’s realistic for our unique situation, and making this go much, much faster. Fucking bureaucracy.

The Next Steps: Coordinator emails me today that doctor is out til Tuesday wants to have a call with me next Wednesday evening, with no explanation why (I’m assuming because I don’t just blindly comply and have questions about things, gasp!). My period is due before then and I don’t have any prescriptions from them for BCP or anything else because it hasn’t been made clear if I’m starting BCP for a month or if I’ll go straight to the meds to prep for ERA. I’m dealing with a non-MD and am not feeling cared for one bit.

The Verdict: Honestly, I’m so fucking tired of DEIVF and the apathetic/callous treatment of the people who are involved, making a shit-ton of money. Part of me just wants to stop now. Why the fuck do they think this is OK? Did I mention the other woman-owned smaller clinic in town couldn’t be bothered to respond to me after promising a same-day call back, 3 weeks ago (and I’ve tried twice, to no avail, to contact that doctor)? I don’t want shitty service to be the reason I don’t get pregnant, but I also don’t think I should be treated like a worthless number.

I don’t trust anyone anymore. Maybe this wasn’t meant to be for me. I don’t know. But I open up the top drawer of the credenza in my office/dining room and see the baby clothes that I once wore, and my heart hurts. It hurts so bad.

It’s been a hard week. My commitment is waning. I need comfort. I need inspiration.

Advertisements

  One thought on “The Second Opinion

  1. November 12, 2016 at 3:06 pm

    I can see why you need some inspiration right now, reading your update I’m frustrated for you at the bureaucraziness of it all. I’ve always felt that the majority of women doing IF treatment I follow on blogs, administratively are treated like a number in the queue rather than for what infertility truly is – everyone of us is unique & different in our treatments – every attempt is another experiment with new hurdles. It sucks that it is this way when we give them so much money. How much more would it cost to get a really good personalized service?? I don’t know 😔

    I don’t think there is anything I can say that will help with inspiration, but I do wish you find the strength soon to keep fighting and be reunited with your embryos. 💪

    Liked by 1 person

  2. November 12, 2016 at 5:12 pm

    The new doc seems to be very knowledgeable, but I can understand how frustrating the bureaucracy can be. If you want it bad enough though, I say just go along with it…

    Like

    • November 12, 2016 at 5:41 pm

      There’s gotta be a happy medium there between ” going along with it” and making sure we’re not bankrupting ourselves or taking more risks with my health that are unnecessary, know what I mean?

      Like

      • November 13, 2016 at 4:40 am

        Exactly. Good thing you know so much about this process now to pretty much know what is necessary.

        Like

  3. November 12, 2016 at 5:29 pm

    So sorry to hear that people are making this journey so difficult for you. We’ve often complained about communication between our clinic and us and have often found they don’t read up on our case before we come in. It’s so frustrating when they make you feel like a number. My doctor however has always been amazing and for that reason, I’d never leave our clinic.

    When we did our transfer at the end of Sept, the nurse was telling my husband to put on the procedure gown “like last time”. Um, this is our first ever transfer. She then proceeded to say, “oh sorry, just like you did for egg retrieval then. ” Um…. Donor eggs over here, we’ve never had a retrieval! Had she read our file, she may have known a little more about us – something I would consider pretty significant.

    I’m sending lots of positivity and strength your way ❤️

    Liked by 1 person

    • November 12, 2016 at 5:43 pm

      Yeah you think for all the money that they’re making that they would at least take five minutes to review your information and make sure the doctor has everything you gave them. I honestly don’t think the coordinator has any idea of what donor egg IVF involves particularly if you’re using existing embryos. As my husband said, I’m not even unzipping my fly, why do we need to pay for extra tests? 🙂 so it will be interesting to see what the call is like on Wednesday!

      Like

  4. November 13, 2016 at 2:37 pm

    Oy what a mess. I’m still glad you got a second opinion though, since after your last transfer you seemed super dissatisfied with your clinic.

    IF bureaucracy sucks. I have to deal with it a little bit, but the good news is that when I push back they most often listen/let me have my way.

    I still really think you should have an ERA- it seems to be the new standard for many clinics for people like us with implantation issues. However, its my understanding you won’t know when your transfer will be once you do the ERA- bc it could come back pre- or post- receptive and then you have to biopsy again to see if they got the right day. So it could take between 1 and 3 months extra.

    Liked by 1 person

    • November 13, 2016 at 3:15 pm

      Yep I’m definitely having the biopsy, doc says he thinks all then have the transfer in January so maybe he knows something I don’t which is very likely 🙂 No use in going to a new doctor if we don’t try a new protocol for this probable last try.

      Like

  5. November 13, 2016 at 2:55 pm

    Gah! I feel your pain. It makes me mad to hear that the clinics over in the US are just as shite as the ones here in the UK about communications and bureaucracy. I’ve pretty much lost all respect for most professionals in the fertility business myself. The ERA does sound worth pursuing especially if implantation is the suspected issue. Hope the call on Wed is fruitful.

    Liked by 1 person

Comments are closed.

%d bloggers like this: