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.