Hysterosalpingogram -- Yowza, it's expensive.

After doing a brief survey of Google results, I deduced that the HSG would cost around $300-$500 if not covered by insurance. Certainly not cheap, but a drop in the bucket at this point. I called the practice manager at RE's office to find out for sure and she left me this message:

PM: Hi M, got your message. The fee for a Hysterosalpingogram is $355.

Me: (Not bad!)

PM: ...and then, of course, the hospital will send you a bill as well. I don't do the billing for them, but after surveying a few patients I found that the average fee from that facility will be about $900.

Me: (Oh. Bad.)

So, yeah. $1,255. Really hoping that insurance will kick in on this one, but also seriously doubting it, considering they've never covered anything in the past. Also, RE is out of town working at another one of his offices until the beginning of February and won't be able to draft a (another) letter to my insurance company until he gets back. And once they receive it, I assume that it will be a few weeks to get a response. I guess we're on hold until then.

Feeling really frustrated today. Really sick of this whole process.

Hysterosalpingogram

Just got off the phone with the nurse. "M, what are we going to do with you?!" My thoughts exactly. She said that this cycle looked beautiful -- our best yet, and that she had high hopes for us this time. Because everything looked good on paper and I'm surfing the crimson wave yet once again (who doesn't appreciate a good Clueless reference?), she thinks RE would probably be interested in doing a Hysterosalpingogram. Basically, they will inject dye into my fallopian tubes and check for blockages. The nurse that a lot of women get pregnant soon after having an HSG because even if everything looks normal, the dye being pushed through the tubes has a way of clearing everything out.

RE sent a letter to our insurance company in November to check and see if this procedure would be covered. I called today (for the third time) and, conveniently, "The reply letter was mailed out to your doctor today!" Only two months later! Anyway, the letter from the insurance company basically says absolutely nothing and that I can check my benefits online to see if I will be covered or RE can send in a predetermination request (?) to find out more. You know, the insurance company could have told us that back in November. Did it really take two months to give, for all intents and purposes, an automated response?

I have a sneaking suspicion that this will not be covered, as nothing related to fertility has been so far. So, I left a message with the practice manager today to find out what the damage would be out of pocket.

Running out of new and creative ways to say "not pregnant..."

Another disappointment. We were so hopeful this month. My estrogen levels were in line for the first time and I really thought I was having "symptoms." The problem with pregnancy symptoms, you should know, is that they are virtually identical to PMS symptoms. However, I thought that mine were different this time. There were moments were I foolishly allowed myself to believe that I was pregnant. I always try my best to not to get my hopes up, but sometimes a little hope creeps in. Eventually that tiny amount of hope becomes full-on assumption that J and I will be delivering the good news in a matter of days. So, now we wait until we can try again. Really sucks.

The Risk of Miscarriage

After spending the last 6 months or so in the blogosphere, I've come across a lot of women who have experienced the tragedy of miscarriage. My heart bleeds for these women and their husbands. I can't imagine the pain they must feel after this enormous loss.

It also leaves me wondering why so many women with infertility blogs have had miscarriages. Are women that experience infertility more likely to miscarry, or are the miscarriages part of the reason these women blog? Chicken or egg? Do I have a higher risk of miscarriage because I have PCOS?

Mia Wallace

Trigger shot administered smoothly by Nurse J! We realized that we mistakenly used a 22 gauge needle last cycle rather than a 25 gauge -- no wonder it hurt like hell! We won't be making that mistake again. I realize that a 22 gauge needle is hardly something out of Pulp Fiction, but still.

Meh.

Our appointment this morning was decent. I say "decent" because my follicles have grown since Saturday, but in a somewhat frustrating manor. They are at 18.5, 14.5, 14.5, 14, 12, and 12. So, one mature follicle and 5 that may or may not reach maturity. Because of the 18.5 and the risk of it growing too much and becoming a cyst, RE doesn't want me to continue with any more medicine (Follistim) this cycle. We were instructed to wait until tomorrow evening to trigger, hoping that the smaller ones will grow on their own in the meantime (because with my luck, I'm certain that will happen...) (glassy-eyed eye roll).

The good news is that my estrogen is at 597, which is almost five times higher than it has ever been before, presumably because I am no longer taking Femara, a drug that can hinder estrogen levels. However, other than telling the doctor how many mature follicles I have (approx. 200 for the mature follicle, the other 400 making up the combined levels of the 5 growing follicles), I'm really not sure what role estrogen plays in ovulation and/or achieving pregnancy.

I am praying that RE knows what he is doing. However, I am of the opinion that he is too cautious, too conservative. For instance, my largest follicle grew from 16.5 to 18.5 in two days. If we did another day of drug, is there any reason to believe it would grow to a size larger than 25? Very doubtful, right? I realize that I don't have a medical degree and am slowly but surely becoming one of those obnoxious people who presume to know better than their doctors. That said, I'm also a person who has been trying for two years to get pregnant and is becoming frustrated and impatient. Bring on the aggressive treatment, I say!

My Reality

You know, there are so many reality shows about there. Shows about people who can and cannot dance. Who can and cannot sing. Who want to marry a stranger. Who have 18 children (and counting). Who are willing to eat bull testicles. Why not people that are trying to make a baby? Maybe it is too much of a niche market for ABC or NBC, but what about TLC or Lifetime? For now, I'd settle for a decent movie on the subject. Suggestions?

Ultrasound and Bloodwork #2

J and I had an appointment yesterday morning to check my estrogen level and the size of my follicles. This is our first time on a Follistim-only cycle so we're new to the protocol, but it seems like everything went very well! So far, I have 7 follicles on one side and 8 on the other, 4 of note: 12.5, 12.5, 13, and 16.5. My estrogen level was 233, which is almost twice what it was at the end of the last cycle! We are taking this to be good news. RE instructed us to continue with the Follistim injections and come back tomorrow morning for a third ultrasound. If I have enough mature follicles, we will probably trigger in the next day or two. If not, we will simply continue with the shots and return later in the week to check again.

The "danger" of this cycle is that my ovaries may become OVER-stimulated, which is the opposite of what we have had to worry about in the past. The nurse told me that if we end up with five or more follicles of 16+ and an estrogen level of 900-1500, we may be able to continue in the cycle, but they will be very careful to read us all of the fine print before we make that decision. In other words, there will be a much higher risk of multiples. If we reach the point of having even more than that, I believe that they will advise us to cancel, unless we are interested in having our own show on TLC. We all saw how well that worked out for John and Kate.

I'm not too worried. I can almost hear your heads cocking to the side in confusion. But really, because they are monitoring me so closely, I think we should be fine. For the first time in two years, we are actually very optimistic! The nurse agreed that it seems like we have finally found something that my body responds to.

Surprise!

The weirdest thing happened on Saturday -- I started my period! Unprovoked! 6 weeks after the last one! I'm taking this as a sign that my body is working more normally for whatever reason (supplements? yoga? diet?) and that we should be hopeful.

I called my RE's office this morning and, after a massive game of phone tag, found out that there would be a possibility that I would need an ultrasound and bloodwork done during the time that J and I will be out of town for his (first!) marathon. The nurse told me that if we could find a place in Orlando that would be willing to see us and send the results back in record time, we could continue with this cycle. If not, we should scrap it to avoid the possibility of spending $1,000+ and having to cancel mid-cycle.

So, here's the plan. We are going to do a Follistim-only (no Femara) cycle in hopes that I will produce more mature follicles while maintaining a high enough estrogen level. We go in for a baseline ultrasound tomorrow morning at 7am to get things rolling. If we get the "all clear," we will do 4 days of Follistim at 150IU and return on the 5th day for the ultrasound that measures the size of the follicles and the endometrial lining. We will then have ultrasounds approximately every other day from that point on until the follicles are at the ideal size, which they will hopefully reach eventually. If one of our ultrasound dates falls during the time that we are in Orlando, we were approved to go to the Center for Reproductive Medicine (in Orlando) to get that done. We had to figure that out by 3:45pm today in order to be able to begin this cycle and not have to wait until next month, so the past two hours have been a crazy whirlwind of activity around here!

This cycle is a little bit more hardcore than the last, but we are really hoping that it will work! Please send us all of your prayers, finger-crossing, positive thoughts, and general encouragement!

Brief Moment of Self-Pity

A friend of mine is pregnant. She was very thoughtful and told me before the news hit Facebook, as she knows what J and I have been going through. I'm so happy for her, because she recently changed employers (and insurance) and was forced to wait longer than she wanted to start trying to get pregnant. She told me about a year ago that she and her husband would like to start trying but had to wait until August 2009 for her new insurance to kick in. I remember thinking, "Well, J and I have already been trying for nearly eight months. So, by August 2009, my GOD, I'll definitely either be pregnant or have a BABY!" Baby math, as I call it. And yet here I am, December 2009, far from with child.

I realize that it isn't helpful to compare myself to the fertile women around me, but it's hard not to. If you can't wallow in self-pity on your blog, where can you?

J and I spent some time with his family last weekend, which includes our adorable nieces, 5 and 3. They are such sweet little girls and I absolutely adore being with them. They are blonde, blue-eyed little angels that could certainly pass for our children. Being with them makes me realize that much more how eager I am to have a baby with J. Hopefully 2010 will be our year!