Thursday, March 24, 2016

Fertility Journey | First Specialist Visit & HSG

Starting from where I stopped at my last post, if you need to catch up go here. I found out right after Thanksgiving of 2015 that we needed to go see a fertility specialist. My doctor gave me a recommendation of one that was close, but I ended up not being able to go to them.

As soon as I found out about going to the fertility specialist, I called up my insurance provider to see what they did and did not cover. I knew from previous research that they covered some fertility treatments/diagnosis but I wanted to see exactly what was covered and if I needed a referral to go to one. I am really glad I decided to make this phone call because of what I learned from that conversation. I found out that in order for me to have fertility treatments covered I had to enroll in a specific fertility program and have a consult with a nurse in order to get coverage. Basically, it was a pain in the butt and an unnecessary step in my opinion, but I had to do it to get coverage. I had to talk with one of their nurses at an extremely inconvenient time because it was the only time I could get. The nurse did not tell me a whole lot that I did not already know about fertility treatments. The only thing she really helped me with was explaining the benefits of the program and how coverage works. I found out that everything is covered under normal insurance, meaning it counted toward my deductible and then I had 80/20 coverage until I hit my out of pocket maximum. The only thing that is different as far as fertility treatments go is that fertility specific treatments, like IUI's, IVF's and all the injections that go along with that, fall under a specific bucket where I can only spend so much money before I hit a lifetime maximum and they stop covering all treatments. But that number is pretty high, so I have some wiggle room in what treatment options I have. I am extremely grateful that my insurance will cover these treatments as I know many people do not have this luxury. The biggest and most annoying stipulation of this program is that I have to pick a fertility center that they deem a "center of excellence". This essentially means that this fertility center has been selected as a top center based on a number of qualifications, most of which depends on their pregnancy success rates. High rates of success means it is more likely that I will get pregnant and get pregnant faster without costing the insurance company too much money. There was only one center that is close to us, so we did not have any real options as to where we would go. It is not conveniently located, but again I am grateful for insurance coverage and that the fertility center is really not all that far away from us.

So in December 2015, we went to see our fertility specialist for the first time. Before the initial visit, we had to fill out an extensive questionnaire where we gave our doctor as much information as we had, including all of he previous labs that we had drawn. The first visit with the fertility doctor was pretty straight forward. We basically talked about all of the information we knew about our journey so far and then she evaluated the information. She told us that everything they had tested for so far was coming back normal and that we sort of fall in the "unexplained" category. Although not completely because I do not ovulate regularly so there could be something going on there. She decided to have some more blood drawn so that she could check a few more things, like ruling out PCOS. They drew about 10 vials of blood and it was crazy to see all of the vials lined up to be filled. The bill from all those labs was well over $1,500, but our insurance covered most of it so we only had to pay like $200. My doctor also performed so she could see my uterus and my ovaries for herself. She did tell me that some women can have endometriosis and their only symptom is infertility. The only way you can fully diagnose that is to do exploratory surgery, but in most cases it is easier to just fix the symptom--meaning get pregnant. We then came up with a short term plan, which was to have an HSG test done(more on that later), have more blood drawn and then meet to discuss treatments once all the results came back.

Since we knew we had to have an HSG test done before we could start any treatments, this was our next step. An HSG test is a test for them to see whether my fallopian tubes are clear and not blocked. They inject dye into the tubes/uterus and then use an xray machine to see if everything is working as it should. The uterus and the tubes are all connected so when they push the dye into the uterus, as long as everything is clear, the dye should make its way through the tubes. The dye is visible with an xray machine and you can see the dye move through the tubes and if it makes it to the uterus then you know that your tubes are open and clear. When I started my next period, I had instructions to call the doctor to set up an HSG test. I had to come in for day 3 labs to check one of my hormones and then I scheduled my HSG for day 6 since it had to be done early in the cycle. This is not a cheap test, so I was grateful to be able to do it in this calendar year since we can count it towards the deductible.

A few days before the HSG, I had to start taking an antibiotic so that we could prevent infection as a result of the test. I was also instructed to take a pain reliever an hour in advance to make it a little less painful. I had heard really terrible things about this test so I was already nervous and asked as many people as I could how it went for them if they had already had it done. The day of the test, Richard came with me to the office because we had a meeting with the specialist scheduled for right after so that we did not have to make a return trip. They called my name to come back and Richard started to come with me, but they told him he was not allowed in the room because it was an xray. This really freaked out because I was expecting Richard to be in the room so he could help me through the pain. Without going into too many details about the procedure, I will say this. It hurt more than I expected it to, but the pain lasted a lot less time than I was expecting. It was over in less than 5 minutes and while it was painful, it was manageable since it was so quick. It was interesting to see the dye on the xray machine as it moved through the tubes. If anyone would like more details because they themselves are going through this, feel free to contact me. I am obviously an open book.

Once the test was over, we headed back to our doctor's office where we talked through our options. All of our labs came back normal which is great and yet frustrating at the same time. Sometimes I feel like it would be easier if they could find a problem and then just fix it. Oh well. I will talk more about what our options were and what we decided to start with in my next fertility post. My doctor did tell us this that I found interesting. A normal couple starts out with about a 20% chance of conceiving in any given cycle, after 6 months to a year of trying this number drops down to about a 1%-3% chance without assistance. Add in a fertility medication, like Clomid or Femara, and the chance increases to 6%-8%. Add in an IUI and that chance jumps up to 10% -15%. Add in injectable fertility medication and an IUI gets you to about 15-20%. IVF, the big guns, has a success rate at this facility of 58% for someone my age. So the higher the success rates, the higher the cost associated. But it does give me hope that we will get pregnant eventually, it is just a matter of when and which treatment.


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