Fun with Insurance!

I know there are quite a few people around here whose insurance does not cover IF treatment and we are fortunate that ours covers the amount it does. But they really make me skip a heartbeat once in a while!

I almost started crying at my local pharmacy today! I went in to pick up my Prometrium and Metformin and I was told that I cannot get my Prometrium till June 12th. I was like what the heck (I almost felt like they were taking "this" away from me), I really need it now! The pharmacist mentioned that my Prometrium quota for the month had been met and the insurance wouldn’t cover anything more. So, I asked how much it would cost to pay out of pocket. 600+ freaking $$$ for 50 something pills! I explained that I take the medication 4 times a day (Rx’ed by my RE) and there is no way 50 pills would last me a month. So she decided to look in to it. It seems my insurance will cover 2 Prometrium per day… she asked me to call my doctor, who would then communicate with my insurance. In the interim, I decided to pick up at least 3 days worth of supply for $85… just in case this was going to take some time. After leaving the pharmacy, I called my nurse and left her a message. After exchanging a few phone calls (between the nurse, insurance and myself), the nurse told me that she has taken care of the issue and it would take 3-5 days for the approval for the increased dosage! She mentioned that I could stop by and pick up some different brand of progesterone supplement that they have at the clinic. I might do that on Monday or just go buy some more out of pocket for continuity sake!

While I was talking with the nurse, she was not negative, but I could sense that she was trying to tell me that lets pull through this coming Tuesday (when I have my b/w and u/s) and then see how things go with the insurance and Prometrium… as in I might not need the Prometrium after Tuesday!!! I have been doing okay for the last 4 days (trying to stay strong, positive and hopeful)… but this just hit me below the belt! I know my HCG is low (though it has tripled once) and we are still not sure about the viability… but I want this baby, I really want this child of ours! I hope I can stay P! I want time to fly by and want Tuesday to be here right now. I hope I can stay strong on Tuesday! My weekend is supposed to be super busy, so hopefully I will pull though this extended 2ww!

Just a little...

After the IVF consult on Friday, my nurse decided to reschedule the beta test from Sunday to Saturday! I guess she wanted to lessen my anxiety of waiting for beta (after BFN @ HPT).

So, I went in this morning for b/w... and got a call back this afternoon. The test is not negative! The HCG value is 8.6 and they normally like to see at least a 50 by this time in the cycle! So, I am just a little pregnant!!! I am supposed to go in again on Monday for another beta test. Not sure how viable this pregnancy is. But I am very happy that we at least reached this far! I see some hope for the future! :) For now, we are hoping and praying for the best and I am continuing the Prometrium suppository. I feel more cautious than excited!

For the symptoms this cycle: Besides the regular bloating, twinges etc (during/after medication)… My boo.bs have been super soar (like never before), I have had a consistent head ache and leg pain. Two days ago, nerves on my boo.bs started showing (just a little bit… something I had never noticed before). Last Monday, I had severe cramping twice in my uterus which lasted for a minute or two… the pain started from my uterus and went all the way down to my groin area. The pain/cramp was so sharp that I was breathless and felt disoriented. This had never happened to me before!

IUI # 3 - Progesterone Check

I went to the clinic this morning for my progesterone b/w and just got a call back from the nurse. It is 7.9 (Atleast I know I O'ed since its above 5)! The last two cycles it has been 6 (at 3-4 DPO). I start Prometrium suppository today (4 times a day) untill beta. So what does this mean? Am I doing better than before or it is an insignificant increase? Is it just higher because I had more follicles this time as compared to IUI # 1 & 2? Is there something wrong (quality?) with me (my eggs/follicles) which is leading to the lower numbers, which in turn is also leading to BFNs? How does my progesterone level impact a future IVF? My progesterone levels during beta for IUI # 1 (with Ovidrel) was 6 and for IUI # 2 (with Prometrium) was 9... how much progesterore is required for implantation (I have read anything above 9) and for sustaining a pregnancy? Do I need to increase my dose?

I guess, I need to discuss this with the RE/nurse... or am I just making a big issue out of it!? I just don't feel very positive about this thing! :(

---

Update: I guess I was just having a panic attack because I was seeing the same pattern that I have had for the past two failed IUIs. I felt like I knew what the answers were to most of my questions, but just needed some reassurance! Though any new detailed information is always welcome!

I spoke to the nurse later on and she said... progesterone level up from 6 to 7.9 is not a significant change, they like to see a 9; she has seen BFPs for women have had progesterone levels as low as 4-5; progesterone levels do not indicate quality of the egg; Prometrium should help with implantation (if pregnancy occurs), since its still early in the DPO. She encouraged me to discuss this issues with the RE when I meet him next week.

Dr. Google mentioned that progesterone levels can fluctuate from day to day and is not always the best indicator... though the doctors prefer giving you supplement if it appears low. It seems checking progesterone 3-4 DPO is also not the norm... but thats what my RE does!

IUI – Cycle # 2

…And so, day 35 came (of the break cycle) and I decided to go to the RE’s office and get my bw & us done to see what’s going on! Guess what, just like January end/February beginning, my lining was thin and hormones were low enough for it to be considered day 3 (without AF). So here we go… IUI # 2! I was still afraid that my cyst would pop up again and we would have to cancel the cycle. I wasn’t at peace till my day 7 us (which is when they found the big cyst during the previous cancelled cycle). Day 7 arrived and things looked okay. In fact, one of my follicles had already started growing in my right ovary (by day 7 us) and was 12 mm and estrogen was 63 units. That was a quickie as compared to the first IUI cycle! It had taken me almost over 8 days to respond last time. During this cycle, I took 75 IU Follistim for 8 days followed by 150 IU for the next 2 days. I triggered on day 13 (of the so called non AF cycle) using Ovidrel. The “big follicle” kept growing up to 18 mm before I triggered. Only 2 more follicles in my right ovary were around 12 mm before I triggered (none >10 mm in left ovary). I forgot to ask about estrogen on the day of the trigger. I know things can be very different every cycle, but I still asked my RE as to why I had such less follicles… he mentioned that this is normally what they expect (& not the "n" number follicles I had last time). I was ready to deal with all the side effect of Ovidrel (with last IUI cycle experience). But fortunately (?) things were much better this time. Slight tiredness, slight cramping and the rest was smooth sailing. I had mentioned to my nurse about my OHSS like symptoms from last time and had asked if I could take an Ovidrel alternative for my progesterone boost if required. I was told that I could take Prometrium (http://www.drugs.com/pdr/prometrium.html) vaginally if the progesterone was not as per the standard requirement (of 9 units or higher).

IUI (insemination 1 & 2) went well. Sperm count was great and it looked like I had one healthy egg (for sure)! With the (minor?) aches and pains that keep coming with all the medication, I wasn’t very successful in telling if I had ovulated (couldn’t identify ovulation symptoms). 5 Days past first insemination, I went in for my progesterone check… level was 6 units (just like IUI # 1). I was prescribed Prometrium vaginally 4 times a day till my next bw (pregnancy test). So, currently I am at the 2WW!

This progesterone suppositories– Prometrium is supposed to help with implantation (progesterone > 9 units for implantation). It’s very easy! Just that it can be messy. Progesterone from the pill is supposed to be absorbed by the vagina/uterus, though some of the ingredients leak out. (Sorry, if it’s TMI!) A panty liner is a must.

I am hopeful, yet even more cautious this time. I am trying hard to not look up every symptom online… trying harder to not look at online (baby) shopping websites… and trying even harder to not be disappointed, frustrated and bitchy! My ovaries have not cramped much this time, though I have felt some twinges once in a while around my uterine area. I feel a little something in my chest/throat… may be heart burn… I am too scared to call it nausea. My inner thigh (mainly right) feels strained. I am hungry a lot and get tired very easily. Approx 7 days past ovulation (DPO), my cervix is soft & low, and my body feels warm. I think my brain is on an overdrive... it’s probably all the medication! May be the next time I will learn to ignore these new symptoms as well (though I truly hope that this is the lucky cycle)!

My Acupuncture routine is the same as IUI cycle # 1. Twice a week while on Follistim; followed by day before and of the insemination; and once a week during 2ww.