Tips and Suggestions

Before starting my first IVF, I googled symptoms and things to know. I found blogs, articles, youtube videos, and countless message boards that had a plethora of information. Many, many women have gone through this before and they were all happy to share their experiences so that it may help someone else.

 

Helpful things that were suggested included Gatorade and heat packs for after the egg retrieval; expecting discharge after the trigger shot; staying off Google; not being afraid to ask questions; common symptoms; and much more. 

 

To add to those, here are a few things I now know after going through three IVF cycles and two FETs


IVF tips:

• Write things down during stim stage/monitoring: dosage, time, where injected, bloodwork results if available. This will come in handy in keeping track of injections and appointments. It was also helpful for comparison in future cycles.
• Stim shots aren't so bad.  Stay calm, find a routine, keep track of your meds to reorder as necessary.
• Have the nurse draw circles on your upper-butt for the trigger. Take a mental (or real, if you're into that) picture so that you can refer back to it for PIO shots later on. After a while the person injecting knows the area, but for the first few times when you're nervous and hyper-focused on everything, it helps to have a visual aid.
• Under normal circumstances, bloating after egg retrieval starts to feel better after about 2 - 5 days. Take the day off for egg retrieval and the day after. It's worth the rest.
• Invest in a heating pad for after the egg retrieval. Heat helps relieve some of the discomfort.
• Don't be a hero: take the pain meds if you're uncomfortable after the egg retrieval.
• Don't lie on your right side after egg retrieval for first 36 hrs. After lying on my right side in an earlier cycle, my shoulder hurt for a week. I don't quite get it, I just know it happened and the doc said it's normal. The next time I avoided lying on my right side and it didn't happen.
• Gatorade helps with getting electrolytes and sodium, but some people get stomach issues from it. Once I figured out this was what was giving me issues, I limited Gatorade to less than one 20 oz bottle per day. Instead I substituted lots of homemade chicken soup which was prepped and frozen in advance.
• Drink lots and lots of water, especially the first two days after egg retrieval.  It will make you have to pee a lot, and peeing is so uncomfortable after the retrieval, but do it anyway. It will flush out whatever crap you have in your system and help you feel better sooner. Drink! I aimed for 70 oz the days following retrieval, beside for the Gatorade/soup. It really helps.
• Message boards online can be really helpful, but don't get sucked in.
• Waiting is hard; prepare for it
• Have a strong support system - find a friend or family member for the tough days you need a shoulder.

Tips for FET:

• PIO shots are uncomfortable, but a lot more efficient than the inserts. I've never used the inserts but general consensus says they're messy and icky, so I've opted for the shots both times.
• Warm up the PIO in your hands or bra for a min or two before injecting. This helps make it more viscous and easier to inject.
• Have someone else do your shots if possible. My husband is the most squeamish person when it comes to blood, but he sucked it up and did his part. Since IVF is mainly all about her, this was a good way for him to be involved in a helpful way.
• Rotate the injection spot! My husband gave me the injections and we found a comfortable rhythm in injecting the right side with me lying on my stomach on the couch and taking all the weigh off the side being injected. We would do 3 rights to every 1 left. Pretty soon, the right side started feeling weird and numb - I didn't like it at all! It took 8 weeks after the negative beta to get back to almost full feeling.  So, make sure to rotate.
• Once you inject, massage. Really deep tissue circles. It was uncomfortable for a minute but it prevented those lumps everyone talks about. I noticed the difference on days we got lazy and skipped the massage.
• I didn't ice or heat the spot and injections were fine.  In my mind, icing the area defeated the purpose of warming up the oil. Going in to a cold muscle might make it congeal and leave a bump. I don't know the science behind it, but that was my thought process.
• Technically, you can inject yourself, but they say if you're doing it on your own to do it on your thigh (specifically in your quads). Getting the right angle in your own upper-butt is hard enough, but once you inject you also have to draw out slightly to check for blood and make sure you didn't hit a vein (if there's blood, you have to pull out entirely, change needles, and try again). Unless you're super flexible, that's pretty hard to do, and if you get the angle wrong it hurts more the next day. 
• In addition to the awkward angle, injecting yourself with a big-ass needle is hard!  My husband was out of town one night during our 2ww and I needed to take my shot. I did it in my thigh and not only did it take FOREVER for me to work up my nerves to stick myself with that enormous needle, but it huuuuuuurt so much. I felt it go in the muscle and nearly gagged. It was a numbing/pain that became soreness in the next hour and settled in for a two days.
• Del Estrogen shots weren't so bad - I did those myself in the thigh. Luckily it was only every third day so I'd throw a tiny dance party right after, knowing it's the longest possible time until I needed to do that again.
•  It's so hard to wait. Be prepared for it: fill up your queue with good TV, set up outings with friends, find an engrossing hobby, do your best to keep your mind off of it.
• For the times that distraction doesn't work, try to manage your expectations. I was never good at this.
• As hard as it is to wait, it's even harder to avoid taking home pregnancy tests. I've never been able to avoid it, but I want to say that next time I won't test (yeah, right).  It was so hard to keep doing the shots when I didn't see any results in the pregnancy tests.  I had a meltdown after FET #2, sobbing that it didn't work because there was nothing on the pregnancy tests. It was still a week before the beta and there was no guarantee that it did or didn't work, but I worked myself up and I'm sure the stress didn't help anything. 
• Stay positive and be nice to yourself!

IVF #3: Embryo update

Of the twelve eggs retrieved yesterday, eleven were mature. Seven were fertilized and survived to today.  We want to stay positive but can't help feeling disappointed and worried about the low number.


IVF #1 we had 20 eggs > 9 fertilized > 4 survived to biopsy and PGD testing > 2 healthy embryos
(one transferred at FET #1, negative beta; the other transferred at FET #2, also negative beta)


IVF #2 we got 23 eggs > 13 fertilized > 6 survived to biopsy > 0 healthy to transfer


Logically, I know that it doesn't matter how many eggs are retrieved, rather what matters is how many come back from PGD testing as having tested healthy.


As for recovery, I'm doing ok from the egg retrieval.  I felt sore as expected but not nearly as bad as previous times.  Is it possible because I was expecting what was to come? Maybe because they retrieved less eggs so less poking down there? Maybe because we had Chinese food for dinner and all that sodium helped?  Maybe the massage the night before?  Maybe because I'm used to drinking so much water that it helped to flush things out? Who knows. 


Whatever the reason, I'm happy recovery seems to be going smoothly.  I'm not a fan of drug side effects so I try to avoid them, but in previous cycles I used one or two of the prescribed pain meds and then followed up with a day of round the clock Tylenol. This time I haven't even needed the Tylenol.


At this point we're discussing whether it might be better to "batch" the embryos and do another fresh cycle before sending them off for testing. To clarify, I want to discuss it and my husband prefers to wait and see what happens. I like discussing the what if's and he likes to deal with facts, so we agreed to table it until we hear back on day 5.

Egg Retrieval

There were a few bumps along the way this morning (sample collection from him, transportation to clinic, etc.) but luckily nothing too bad. We arrived on time, got checked in, signed paperwork, and everything was going ok.  Moment of truth when they checked my blood pressure and it was totally normal. I get high readings in doctors offices so it always skews the numbers, but I'd like to believe yesterday's massage may have helped relax me.


The anesthesiologist tried to be a hero and attempted a different vein even after I told him there's only one that cooperates.  Of course the first place he tried didn't work. He went back to The Vein they've been bleeding dry for the past two weeks and it worked on the first try. He was good natured and knew what he was doing. At one point my doctor came in while they were getting the IV set up and they were joking with us and each other - my cube became a party.


I love that the clinic is so efficient. They got me set up and ready to go. Seconds later, or what felt like it, I was back in recovery. As soon as I woke up I felt sharp stabbing pain I hadn't had the first two times. I couldn't help it and started tearing up. My nurse gave me pain meds and more heating pads which helped make it better almost immediately.


They retrieved 12 eggs. More tears.
Just 12?
Last time it was 23.
I knew the bloodwork was low.
Would it have been different if we waited a day? Doc said no. 


My husband made me feel better by saying that it only takes one, which is true. He also reminded me that last time we may have had 23 eggs retrieved but none to transfer, so what does that number matter anyway. Truth.


What's meant to be will be.  If I have to do it again, so be it.

Day 13: Trigger

Follicles measured large enough at today's ultrasound, and bloodwork confirmed, that I'm ready to trigger tonight, which means Friday retrieval. While I'm happy we're avoiding a Saturday retrieval, this means I'm missing a major meeting on Friday to take off work. I haven't mentioned treatment to anyone at work so I have to take a random sick day which makes me seem flakey.  I'm not complaining; this is still the better case scenario.


I have to take the HCG shot at 11:45 PM tonight. Since it's way later than I'm used to staying up, I'm setting two alarms. As previously mentioned, I made up my mind to try a massage before the retrieval so I'm sticking to my word. I did some research, found a few recommendations, and scheduled a massage for tomorrow evening.


I'm nervous for the retrieval. I'm worried about going under anesthesia, making sure vitals like BP are ok, getting enough eggs, the quality, etc. My bloodwork measured lower than last time but if they said I'm ready then I just have to trust it, right?

Day 12

Ugh. Just ugh.


Went back for bloodwork and ultrasound this morning. There was no snow like they predicted, but it was raining which somehow translated into terrible traffic. The traffic caused me to be 15 min late to my appointment which bumped me to the back of the line. It took over an hour to get out of there, including 3 sticks to get blood. I was over an hour late to work.


As it stands now my nurse estimates trigger on Thursday, putting the egg retrieval on Saturday. We would prefer not to do a retrieval on Saturday and even though I know that they can't control it, I figured I'd ask anyway. She assured me that they will avoid Saturday as long as it doesn't jeopardize the cycle which is what I wanted to hear.


According to halacha it's preferable to avoid having this procedure done on Shabbat, but when we spoke to the rabbi he said that if it's unavoidable then it's permissible to have it done assuming we ourselves don't purposely break Shabbat.  That means no driving to/from the clinic so it helps that there's a hotel within walking distance. 


There's still a chance trigger might be tomorrow night or even Friday night, putting the retrieval on Friday or Sunday. I ran out of meds after today's dosage so I placed another order so I have enough for another 4 days, just in case.


The Cetrotide bruises and the Menopur burns. I'm anxious about forgetting a shot or an appointment so it's always on my mind. I'm bloated from the meds and I constantly have to pee because I'm trying to stay hydrated for the bloodwork. I'm exhausted and distracted, and can't stop the negative what if's rolling around my head on a mental hamster wheel.  Even with all that, I feel that I have no right to complain, especially when others are suffering so much, like dealing with a devastating setback or remembering a heartbreaking anniversary. What are my complaints in comparison? I don't even know these women and my heart aches for their pain.


Does it suck to have to go through this whole process? Sure. But if I have to go through it, I'd rather try to stay hopeful, keep an upbeat attitude, and focus on the positive. I'm lucky the clinic is close enough that I can make it every morning and still get to work reasonably on time. I'm lucky that the medication is easily accessible and gets delivered to my door. I feel lucky and grateful that we have access to this care and can afford it.

Not for sale

There's a hashtag I noticed on Facebook that bothers me: #babynotforsale.


Posts using this hashtag range from parents showing off their babies outfits to businesses promoting sales with a baby as the center of the ad. Am I sensitive to it because of the fertility treatments? That probably has a lot to do with it.


It just doesn't sit right with me that some people take their babies for granted.

Day 10

No-fuss monitoring today!  I made sure to drink plenty of water all day yesterday in addition to 32 oz. this morning as I was getting ready. Yesterday I got an automated e-mail reminder from my clinic reminding me that weekends tend to have longer wait times and to arrive within 15 min of my scheduled appointment.  It's true; in the past when I had to come in on a weekend or a holiday for monitoring, the entire waiting room of 50+ chairs was full and the wait time was over 45 min to be seen.  This morning I arrived at 7:35 AM for a 7:45 AM appointment and was out the door and back in my car by 8:10 AM.  It seems as though they hired extra staff to help move things along.  When I came in the waiting room was reasonable, but as I was leaving it was getting crowded.  I was happy to get out before the rush.


Follicles look good with largest one at 15 mm.  They're aiming for largest ones measuring 18-20 mm before triggering, so I still have a few days of stims. When I got the call with results this afternoon, I was told to start Cetrotide this afternoon, as opposed to starting it the next morning as in previous cycles.  The way it stands now, my nurse guestimated about three more days of stims, though I'm not sure if she was counting today. Following up with bloodwork again on Tuesday, and of course the weather is calling for some snow/ice/rain mix in the morning.  After the Tuesday appointment they'll know more of an accurate timeline so I'll know whether I need to reorder meds. It always gets tricky this time in the cycle because you don't want to run out but you also don't want to unnecessarily order extras.


I was thinking about how embryos from this cycle would be a fresh start for us.  The last two FETs were frozen from IVF #1 and while they were both strong blastocysts that tested normally for PGD, neither stuck even though "everything looked fine" with regard to lining, etc. It got me thinking that maybe IVF #1 was a bust and all embryos from it were somehow tainted so it's good we only had two and are now getting a fresh batch. 


With IVF #2, I had a master plan all laid out: get new embryos to test and store in the freezer for future babies, and do an FET transfer on the second embryo from IVF #1 on day 5 -- basically doing IVF and FET back-to-back without waiting in between, since the embryo had already been genetically tested. This plan failed miserably: not only did we not get any new embryos to transfer from IVF #2, but the FET also didn't stick and we were literally back to square one. Just goes to show that you can plan all you want, but if it's not part of His plan it's all for naught.


I'm hoping and praying we are more successful this time around, not only with the IVF but also with the FET.  I want to believe that we are doing everything we possibly can on our part to make this a successful cycle. I'm even watching my exercise and food intake carefully. Jenna Wolfe's new book, Thinner in 30, has a few tips on how to make small changes that make a big difference.  I read it over the weekend and have decided to adopt 3 of her tips:

1. Drink 1/2 your body weight in ounces over the course of the day. If you weigh 160 lbs, that would be 160/2 = 80 oz. I can drink that much water in a day but only if I'm mindful and keep refilling my cup.
2. Take 10,000 steps a day. It seems simple, but because I work at a desk job I have to remind myself to take breaks to stretch and stand up so this would be a good motivator. I have a pedometer app on my phone which might not be so accurate but it's a good enough estimate. If I don't work out, I average about 5,000 steps, so I have to pay attention to adding the difference.
3. Plan and prepare your meals in the beginning of the week. This is such a no-brainer and the weeks that I've done it in the past have been successful. It takes time and effort which is the last thing I want to do on a lazy Sunday afternoon.  Even so, a little planning can go such a long way in setting us up for success the entire week. Knowing the ingredients are in the house and that we've already agreed on what we're eating makes dinner prep so much easier.

The book has a bunch more tips but if I'm being honest with myself I know I won't commit to more than this at first. I'll give these a try and if I stick to them, I can always add or swap some of her other suggestions.


I believe that willpower is a finite resource that you use up throughout the day, as opposed to what others believe that it's like a muscle and the more you use it the stronger it is.  If I have to spend my willpower being good all day and watching what I eat and do, I have no energy left at the end of the day to make good choices and if there's nothing readily available, we resort to junk food or take out.

Day 8

Monitoring today was less than fabulous. The doc on-call today is known for being on time but less gentle. He rushed through the measurements and when he couldn't get a good pic of the right ovary immediately he kind of pressed down on my belly while getting the wand in place. Very uncomfortable and mildly painful.  

Bloodwork was the next challenge. My favorite phlebotomist who had never failed me wasn't able to get my one vein working. Since it's the only one that works they've been bleeding it dry all week and it's starting to get bruised. She stuck me once and nothing was coming out so she tagged out and let the other person take over.  The other person was more experienced and tried to see if any other veins would work but eventually she came back to the original spot and stuck me there again. Luckily it worked and that was the end of it, but it seems like no matter what I do, it gets tougher to give blood every time.

Now I'm waiting to hear back results and as of 12:30 PM still nothing but that's not unusual. If things follow the same path as the last two cycles, I'll probably be starting the anti-ovulation meds tomorrow on day 9. I've taken Cetrotide or Ganirellix in the past and I hate them because they burn and it's another shot at another time of the day.  Bookending the day with needles sucks, but at least that means we're getting closer to the retrieval.  I still don't have a date for when it is, but I placed another order for medication because I only had enough to last through tomorrow, and I know it'll be longer than that.  

Along my research for acupuncture/massage/relaxation, I found various sources talking about keeping your feet warm after a transfer. It was interesting to see that it was a common suggestion across multiple articles regardless of what they were advocating for otherwise. My feet are normally freezing, even with socks on.  Even though that's comfortable for me, it's something I can definitely control easily and have no problem trying out.

I went on Amazon and looked for heated slipper boots. I didn't find any, but wouldn't that be a cool invention?  Instead, I invested in a pair of cozy fun slippers, pictured below. I also got a pair for my husband in a more mild pattern so we can have warm feet together. I wanted something I can easily get in and out of bed/couch with so these seemed to work. I love fun slippers and these make me happy.

I'm trying to stay positive and optimistic, but the bloating and other symptoms are reminding me of last cycle where we ended up with nothing. I'm trying not to be bummed out  but I feel like if I expect the worst it might not hurt as much if that's what ends up happening.  For starters, it's unlikely that it will affect the disappointment at all. Beside that, it's clearly a defense mechanism and I know I need to cut it out. We're going out for dinner tonight so spending time with other people (with wine and possibly some candy) should help clear out of this Ramona Raincloud fog.


Update 3:20 PM: Got the call back from my nurse and I was wrong about starting Ganirellix.  They're keeping me at the same dosage for tonight and tomorrow with bloodwork/US scheduled again for Sunday. 


Shabbat shalom!

Day 7

I started feeling crampy toward the end of the day. The meds feel like they're really starting to kick in and bloating has fully settled in. I forgot this part of the cycle, where you feel like you're holding two grapefruits as ovaries. At least the headaches are gone, thanks to the new eye drops.


I'm trying to figure out when egg retrieval will be so I can plan for it, but I know that it depends on how I respond to meds. As it stands right now I'm estimating it can be anywhere from Thursday to Sunday. I hope it's not on Saturday, but I also hope it's not on Friday because I have a major meeting on Friday morning. It can't be rescheduled because it includes 30+ people so I would have to just call in sick. I don't like doing it, but it is what it is.


As for acupuncture, I was able to finally talk to the acupuncturist after playing multiple rounds of phone tag. She gave me a lot of information and what I gathered from it is that I don't think it's for me. She suggested a once/week regimen and said most people do it for 3 - 6 months before they even start IVF. She doesn't have Sunday or evening appointments (until after a transfer, weird rule) so that would mean I'd have to take off time from work to get it done, which includes 20 min driving in each direction to her office, and the hour of the session. She also doesn't accept my insurance.


When I asked the monitoring doctor about her recommendation about acupuncture, she chose her words carefully and basically said that a lot of patients find it relaxing and because they are more relaxed they see higher success rates.  She made sure to clarify that it's not medically necessary but if it makes me feel better they support it 100%. 


The acupuncturist mentioned that it's helpful for balancing hormones, helping the ovaries reduce in size after a retrieval, etc. All the things she's mentioned aren't issues for me. We've had beautiful, strong embryos. The problem is that they didn't stick the past two times. Realistically speaking, in the "real world," people don't try two months in a row and then decide something is wrong if they're still not pregnant. IVF raises the rates but it's not a guarantee of anything.


I can get on board with adding a relaxation routine to my life, but I don't think it has to be acupuncture.  There's massage, yoga, exercise, meditation, and probably other things I'm not thinking of. I've never had a massage before but I did a little research and there's a great place right near me with evening and weekend appointments. Beside that I've read that massage can help lower blood pressure, reduce stress, and relieve muscle tension. To me that sounds like a lot of the same benefits that acupuncture boasts.


As soon as I find out when the egg retrieval is schedule for, I will plan to get a massage the day before. If I like it, I'll schedule one for the day before or day of the FET transfer, assuming we have something to transfer.

Day 6

A few quick updates:


IVF:  We're moving along!  Today's monitoring included bloodwork and ultrasound. Meds upped again and I'm scheduled for another appointment on Friday.


Eyes: In other news, I also had my eye appointment and apparently I have dry eyes. I got some eye drops and the symptoms were better almost immediately. She suggested to take them every few hours for a week so I'll give it a try.


Acupuncture: I'm looking into more information. I've heard from some people that acupuncture helped them relax throughout the cycling process which led to successful transfers and pregnancies. I know acupuncture isn't a miracle, and if it was required as part of the transfer process it would be part of my treatment plan. I'm not a stressed person and I have a pretty positive attitude. Even so, it's a stressful process so acupuncture can't hurt, right? It costs $140 for the first session and $90 for each session after that. It's not covered by insurance. So is it worth it for "can't hurt?" I'm not sure.


Home décor: We're having a hard time tracking down a contractor to do our basement.  We have two we're vetting but so far we haven't been able to nail down a date. It's the first phase of major house decorating so it's annoying that it's being held up. New update on that soon.


Looking ahead: Pesach prep is going to be right around a potential FET. We usually have guests stay over and I don't know if it's a good idea this year. Best case it will be right at the beginning of a preg; worst case... we'll be grieving another negative beta. I don't know the answer but I'll explore more in a future post.

Day 4

Snow again! 

Second time I've had to go in for bloodwork where the roads were covered in white. Luckily it's President's Day so schools were closed which meant less traffic. I was prepared to Uber it if I felt uncomfortable driving but thankfully the roads weren't too bad and I was able to get to and from the clinic without traffic issues.


I went in for day 4 monitoring. I made sure to drink lots and lots of water last night and this morning. As soon as I woke up I chugged a bottle of water and that unsettled my stomach a little. Note to self: don't chug cold water at 6:30 AM.  It seems to have done the trick, though, because the bloodwork part was easy and quick. Things are so much simpler when the veins cooperate.


Ultrasound was next and things look ok. Cyst that they saw at the baseline appointment seems to have gone away, so yay for that. I got the call from my nurse already with results (have I mentioned I love my new nurse?) and they're upping the meds, as expected.


Other than the aforementioned nausea I'm not feeling many noticeable symptoms. I am getting a headache every so often which is unusual for me. Probably related, my eyes have been bothering me also. It seems like they are puffy and stuff gets trapped in them but when I look in there there's nothing. I work a lot with Excel spreadsheets so it's possible they're strained. I also find myself squinting when it's really bright in a room or outside, something that never used to bother me. It's almost as though my Rx is no longer right for me, like it's too strong, even though I've been wearing glasses since elementary school.  Is it related to the IVF treatment? Who knows.  I made an appointment with the eye doc to check it out.

Stims

Today is the first night of stims. I'm starting with Menopur and Gonal-F. I've done this before and I know what to expect, but this time starting seems more overwhelming. Starting shots means the end of the "break." It means bloating and mood swings and nausea. At the end of the two weeks, if I'm lucky, there's an egg retrieval which means recovery and anxiety and pain.


I'm excited and scared. There are two possible outcomes each on very opposite sides of the spectrum. Success means pregnancy which signifies the start of our family and the culmination of a long time trying. Lack of success means another failed cycle. I've been there and knowing the devastating heartache and what it's like makes me almost not want to try again. It almost makes me not want to want it as bad. Rejection, failure, disappointment... everything negative. But if you don't try, you don't get the highs of the possible success. It's worth a try.


It's been exactly eight weeks since we go the news that the second cycle failed and we got the negative beta. Eight weeks minus two days since we got the results of the PGD and found out that none of the six embryos from the second egg retrieval were transferable. We had eight weeks to recover.  It started with grieving over the loss of potential, the loss of the cycle, the money wasted. Once the new year started, we were hopeful again. We were ready to try again and with the insurance drama keeping me busy I didn't really think much of the specifics of this new cycle. 


After the go-ahead from the baseline appointment earlier this week, we are ready to start shots tonight and it makes it real. This is happening again and after all the time we waited it's happening now.  Two weeks of stims, followed by two weeks of recovery waiting for my period, followed by two weeks of PIO before a potential FET, assuming there's something to transfer from this cycle. 


I've never wanted something so much that's beyond my control. I just want to know that it can work. I believe everything is up to Hashem but I also believe that I have the ability to do my part. When I wanted a better job, I quit my old one and found a new one.  When I wanted a degree, I worked hard in school and earned it.  When we were looking for a house, I did the legwork and found the house we bought. It's so clear that this is completely beyond my control because the clinic is doing everything they can - we just need Hashem to take over and let nature do its thing.  We have a strong support system with so many people rooting for us to succeed.  I don't want another failure. I want to share good news. Hoping and having high expectations are part of the package. It's the hope that gets crushed at the failure, but it's also the hope that fuels the ability to do this more than once. So I keep hoping and work on a positive attitude as we start this fresh cycle.


I really hope it works this time and we have a successful transfer, an uncomplicated pregnancy, and a healthy baby.  As I prepare for candle lighting tonight, I wonder if this time next year we might have an extra little candle. 

House decor

I recently went to see a show on broadway and was so impressed by the set design. I was a little lost in the plot until I wikipedia'd it at intermission, but the costumes and stage props were fabulous. Not only was it elaborate and interesting, but it was specifically designed with space in mind. A wall would move and a door would open and there would be a set for an act in an office. Obviously this was specifically designed for short set up time between acts. What impressed me most was that everything on set was there for a reason. Whether it was a hook for the actor to hang his coat or a framed degree hanging in the corner to symbolize his education... whether it was decorative to show that it's a "real home" or necessary for the performance itself, everything on set had a purpose.

It reminded me of all the things in my house I don't use.  Clearly there's a difference between a house where people live and a set. I'm not going to throw out my shovel just because winter is over, that's a normal thing to store. But I know for a fact that there's a closet door in my basement taken off from the second bedroom by the previous owner that's just sitting in the basement taking space. There are boxes full of things... papers and notebooks and paper goods and who knows what else. I've gone through the basement a year ago and got rid of a lot of things, like a rug we were no longer using and could be enjoyed by someone else instead of taking up space in my basement. There's a broken lamp and old cleaning supplies.  Just stuff.

It's also not just the basement. Even though I take care to prune often, my closet has so many things that I don't wear. In fact, we've taken over the closets in the other rooms because there's no space in our closet. It's not only because our current closet is small, it is. But it's also because we're cramming it with clothes that we're just not using. I would say that at least a third of my closet is dedicated to "at home clothing" which I would never wear outdoors but don't want to get rid of for whatever reason. I also have a section of "future clothing" which are at least a size or two smaller than my current size.

There are drawers full of stuff.  What stuff? Other than old clothing, I've found scarves, laptops parts, old cell phones, papers, yarn, chatchkees (like things from health fairs that are useful but also useless at the same time). Nothing significant enough that I can't or shouldn't get rid of.

We decided to start the basement project: we're knocking down a wall separating two rooms to make one large room, and then adding built-in bookshelves. This is the first part in a multi-level overhaul job to make our house less cluttered and more functional.  Here are the phases as I see:

Phase 1. construction. Knock wall, build bookcase.
Phase 2. relocation. Relocate all books from over the house to
basement bookcase wall. Move futon up to guest room. Move couches from living room to basement.
Phase 3. purge. Sell old bookcases, donate clothes, clean out drawers and declutter in general.
Phase 4. upgrade. Buy new furniture for living room.
Phase 5. redesign. Move bedroom furniture to guest room. Master bedroom overhaul including new furniture, possible addition of bathroom and/or closets.

As for timeline, I see phases 1-4 happening within the next three months with phase 5 happening within the next 5 years. Bedroom remodeling deserves its own post in the future.

Baseline: IVF #3

We were financially cleared to get started and had the baseline appointment today. There was a question of whether I'd be able to get to the clinic this morning because the forecast was predicting 6 - 9" of snow on the ground this morning. Thankfully, it ended up being a lot less at under an inch and I got the clinic without any incidents.


I'm always unsure how to act around people in the elevator. Obviously we're going to the same floor, it's the only office open this early in the morning. There's always a hushed tone in the waiting room, also.  Even couples who come in together whisper to each other. I'm not sure why, but that's the vibe.


We ended up getting our answer late last night about the self-pay rate being ruled in our favor. We were so happy with the news. I, especially, needed a win. I felt like it was my fault for not reading the fine print more carefully on my new insurance. I wanted this to go our way so that we could regain some faith in the systems our clinic has. We're happy with how it worked out.


I went in for weighing first and BMI was ok, then ultrasound came next. She said everything was "quiet" as it should be, but measured a tiny cyst, which I was told was nothing to worry about so I won't. I wish it wasn't there but if they said not to worry, I won't but I have a feeling it's not the last we've heard of it. 


Bloodwork came after that. I used to find the bloodwork part so easy but that was before my veins decided to declare mutiny. I have one vein that works and all the others are hiding. So if the cooperative vein is having a bad day, drawing blood gets complicated. I try to stay hydrated when going in for these appointments but for some reason today it wasn't cooperating. She got the needle in but nothing was coming out. The person I had was really good so I trusted her with it. Instead of taking out the needle entirely she took it out a little and readjusted. It took about three other readjustments but finally the vein cooperated.


My nurse called with the results and dosage in the afternoon.  Here we go. 


Happy Rosh Chodesh Adar I - may it be a month of happiness and success.

Uphill

Last year I was on my husband's insurance. We used up the majority of the fertility treatment benefits and were nearing the lifetime maximum so we decided that I would switch over to the insurance offered by my employer. Before switching, we were debating whether it was necessary to keep me on his insurance as a secondary insurance. I verified with the clinic that, should there be no coverage by insurance (I like planning for worst case scenario), we would still receive the self-pay rate offered by my husband's insurance. Per the supervisor, we were approved as long as one of us was on that insurance, and since he was staying on his own, we decided I would switch without keeping his as secondary since there was no point.  I submitted the insurance information as soon as I got it (mid-December) even though I knew they couldn't do anything until it became active on 1/1 but so that they can verify it as soon as possible and to avoid any last minute scramble.

January 1 comes around and the wait begins.  We were told it takes 4-6 weeks to verify insurance. Once insurance is verified, it's an additional 2-3 weeks for preauthorization. We could have technically started a cycle the second week of January but we waited for insurance to kick in. We were verified January 20 and submitted for authorization. Response came back on February 3 that authorization was denied. The reason? We don't have "documented infertility for a minimum of 2 years." We requested a peer-to-peer review and the doctor had the appointment on Friday, however insurance is not changing their mind. As frustrating as it is, I feel responsible for not checking the fine print more carefully before switching. Even though we didn't really have another option since we had reached nearly the lifetime maximum on the previous insurance.


Meanwhile... I saw that it was taking a while to get the answer back from insurance and didn't want to miss another cycle start date so I confirmed with the clinic that the previous self-pay rate was still active.  I received the worst email in response:

"So I spoke with my supervisor again this morning just to confirm the rate. She did not realize that you were not on the actual plan, that it is just your husband's plan. If this is the case, we cannot extend the rate to you. You, as the patient, actually have to be on the plan, even if it is only as secondary insurance, to receive the rate."

I was just completely floored.  I had ASKED. I VERIFIED! We purposely had multiple conversations about this!  Then I took the information YOU gave me and made decisions based on it!  These decisions affect me until January 2017!  You're going back on it because someone didn't realize something??  I was livid. I couldn't see straight. I couldn't type a response without tearing up. It took me several deep breaths to collect myself and start the week-long discussion with the clinic about how we shouldn't be penalized for their lack of communication skills.  I kept the emails professional and to the point, knowing they file everything. They kept calling it a "miscommunication" to which I replied that while for them it's being referred to as a misunderstanding, for me it means that I made a decision based on information I received from their office that will make a difference of thousands of dollars, possibly multiple times. They promised me an answer by Thursday. I got no answer by Thursday and nothing on Friday. I escalated the issue twice until I got to the management team, who told me to expect "worst case scenario" and that they hope to get me an answer by Monday. 


Good business sense and customer service dictate that if your office makes an error then you should rule in favor of the customer in order to keep the customer happy. Even if it means making a few less bucks now, you'll keep the customer coming back and make more money in the long run. I don't think that happens in the IVF world because they know you need them and will pay whatever they require. I'm curious how they will respond to this. 


As it stands right now we have no insurance coverage and no cushion in terms of self-pay. We also don't qualify for any of the financial programs they offer because we're just shy of the eligibility requirements. I definitely plan to fight for the insurance benefits but it's not going to get resolved overnight and in the meantime, I have a baseline appointment scheduled for Tuesday which I plan to keep regardless of the answer we get tomorrow.