WTF Appt. (Long)

StacyLH24

Ok...here is the run down from my appointment.  I've been spending some time processing it all.

- I make great embies/blasts.  This isn't a problem at all.  My grading for all four was great and couldn't be improved on a whole lot.  So, this also means that my eggs are good.  He said that lower AMH and the endometriosis could have an impact on egg quality, but that it doesn't seem to in my case.  He said that the embryologist was very happy with the quality of my 4 and that the embryologist follows very strict guidelines. 

- He said that we could go back to IUIs, but he would only recommend 2 more before IVF becomes the only option he would recommend.  If we do this, we may do a med hybrid cycle with Femara and Gonal-F to make sure that I don't over respond.  Or else he would start me on a lower dose of Gonal-F.  He did say that we could be more aggressive with these IUI cycles though since things haven't worked out in previous cycles. 

- I was given the option to have another HSG, which was one of my many questions.  We are going to move forward with that for this current cycle.  CD1 is imminent as today is CD 0.5 I would say.  So I'll be having the HSG probably next week some time.  He wants to make sure that my ute is still clear and of course my tubes if we're going to do more IUIs.  

- We will do the endometrial scratch as well, with whatever cycle we do next - no matter what office we do it with.  This will not only help with implantation but they will also send off the sample to make sure that it isn't infected and that it doesn't have any inflammatory issues.  They did this last year when I had my surgery and everything was fine then. 

- He's going to order more blood work.  He wanted my A1C tested and apparently this didn't make it on the lab order.  He might order some other things as well, but definitely the A1C. 

- We talked about immune issues and the blood flow to my ute.  The blood flow isn't something he is concerned about because my lining is always great.  He said that if my lining wasn't where it needed to be, then he would be concerned about that.  He's not real keen on the immunology piece.  He does have a colleague who is moving in that direction some.  He saw him recently at a conference, where immune issues were discussed, and he said that there just isn't enough data out there to support it, considering the cost.  He has used some of the treatments before for a few clients but he said that it hasn't definitively shown to be successful, and they are expensive (I knew this) and insurance typically won't cover them due to the lack of definitive data. 

- In the meantime, I received a note on the patient portal of the new office.  They checked on my insurance coverage, and it shows that I have a lifetime max of 6 IUI cycles that would be covered.  Technically, I've attempted 8 IUI cycles with 5 being completed.  My understanding was that I had unlimited IUI coverage.  I'm going to call tomorrow and find out for myself.  That will make a huge difference in what we do moving forward.  We could only have one covered IUI cycle left if they only count the ones that were completed.  Or we could have none I suppose.  If that's the case, then the last fresh IVF cycle is our only option at this point. 

- I did get his agreement that I can use PIO for every cycle from this point forward, no matter what kind of cycle it is.  PIO is the only form of progesterone I feel comfy with and confident that it's working properly for my body. 

- If we do end up doing the last fresh IVF cycle, we will only transfer one embie/blast at a time.

I feel like there's so much more, but that's everything I can think of right now.  So, now I see about my insurance coverage, get the HSG done and see about the options that the new office offers and decide how we will move forward.  AND I need to pick a new donor...

I feel better after this appointment.  I also was sad.  It was hard to hear that I made two great embies and two great blasts and that they're all gone now.  I made it fine through the entire appointment except for that part.  I held it together, but it honestly is something that I struggle with often, so I try not to think about it a whole lot.  I've decided that I probably need to see a therapist who specializes in infertility.  I'm not sure the guy who I see right now is really going to get what I'm talking about when I process that, and I know that I need to process it properly. 

2MamazInSeattle

Whoa! Big update but mostly good news it seems. I'm glad you have son go -forward options. You might want to ask about the mthfer gene test (or whatever it is). Seems loads of the IFV women have weird copies, end up doing low dose Lovenox and get take home babies. Incidentally I did Lovenox with Simone's pregnancy...and I'll do it again if we ever ttc again. Anyhoo, glad to see the updates!

Officerofthelaw

Sounds like you have a great plan. So fortunate that your insurance covers any IUI's. Most peoples insurance do not cover anything related to fertility. Good luck:)

KH826

Stacy - I was thinking about you a lot yesterday, and I am glad that you got a lot of useful information at your meeting with your RE. It certainly is a lot to process. I am glad to hear that you are thinking about talking to a therapist that specializes in IF. You need someone who gets it -- so true! In terms of your next steps, from a glass half-full perspective, at least it sounds like you might have some options. Some new things to try. Some additional things to investigate... this all just sucks. I get that. So I am not trying to comment with a "way to go!" type message. I get the sense that isn't what you need right now. So I am offering optimism and support.

Please keep us posted on your HSG and what you learn from the insurance company.

It is hard to keep the faith that things will work out how they are meant to in the end, but sometimes holding onto that hope can give peace.

Oh, and the fact that you don't have egg quality issues is a great thing. While it does not immediately promise you a sticky baby, it leaves more options open to you. There are IF issues you can fix/work through, and there are those issues that really can't be helped. Knowing that you aren't battling against egg quality issues hopefully gives you a bit of optimism.

At any rate, I won't pretend to know how you feel. I will say that we are here for you, and will support you through whatever next steps you choose.

Big Hugs!

ATXmommas

I'm glad you had such a productive meeting and were able to get many of your questions answered and that there was some positive news that came out of it. I'll keep my fingers crossed about tour IUI coverage. Will you be meeting with the other RE for a second opinion before moving forward? Either way, you know we're here for you and sending you positive thoughts every step of the way.

Karlamo

Sounds like a comprehensive plan moving forward.  If you have unlimited IUI coverage that would be amazing!  It's hard hearing that the eggs are good and they're not sure why you are not getting pregnant.  I've heard great results with the scratch test.  It gives the embies something to grip onto.  Hopefully as more time passes you'll have a clear view on the path you want to take.

wishiwaspreggo

I hope you're able to try IUI again before another IVF cycle!  Who knows, it may end up working after your HSG and endometrial scratch.  I'm thinking of you and really hoping for the best with your upcoming cycles.  Hang in there, you got this!

StacyLH24

Thank you everyone

@KH826 - The fact that we don't have to worry about egg quality is a huge relief.  I was prepared to hear that my eggs suck.  I was very happy to hear that this isn't the case. 

@ATXMommas - If I do have unlimited IUI coverage, then we will be going for the second opinion consult. 

My HSG is scheduled for next Friday, the 14th - fun wow.  This time around I'll be taking the ibuprofen beforehand.  It was extremely painful for me afterwards. 

I called my insurance company today and am waiting on a call back from a supervisor.  I imagine I will get that some time tomorrow.  The woman I spoke with could not find that there was a lifetime max for IUIs.  She said that it wasn't even documented in the note from the phone call that the new clinic had made.  I'm leaning toward the idea that I don't have a lifetime max, but we'll see. 

At this point, our plan is to probably do one or two IUIs, with whatever office we decide on, if I don't have a lifetime max.  If I do have a lifetime max, then we will move to the last IVF cycle - in an effort to make sure that my meds, ultrasounds and blood work will still be covered.  If that all doesn't work out, then we'll consider that last IUI at some point in the future. 

StacyLH24

I spoke with the woman from our insurance company today.  She said that I only have guaranteed coverage for 6 IUIs.  Any after that would need to be justified, basically, in order to be covered.  She had a hard time explaining it to me, but what she was trying to say is what the research shows - anything past 3-5 IUIs isn't as likely to work.  So, for anything after that, they want a medical reason as to why it was necessary to continue - which would need to be different from the initial medical reason as to why we started IUIs. 

I stopped to see C at work when I got out of work and we discussed it briefly.  More than likely, we will move forward with the IVF cycle to make sure that everything gets covered and leave that last guaranteed IUI cycle as a last resort option.  I'm going to discuss it with my RE during my HSG on Friday and see what he thinks as well. 

Twochickshavinachick

It's good to hear that you are getting a fair amount of information to work with out of this appt.  Fingers crossed for the best possible outcome on your next cycle, whatever you guys feel is right for you.