Specialists…and the time we almost burned a pharmacy to the ground.

[Picking up from the last post] …Again with no answers, some more trauma, and nothing to lose, we made an appointment to see one of their doctors.

This appointment was terrible! The doctor we met with was oddly abrasive and had no patience to answer any of our questions (a lawyer and a teacher…we had questions!).  His suggestion to us was something like this: “Do NOT try IUI, it will never work.  Just start IVF as soon as possible. Don’t worry about the cost. You’re a lawyer you can afford it. And you’re obviously not from Upstate NY, you seem like a Westchester type of guy.  Pay for what your wife needs.”  Our favorite part of the whole meeting was the very beginning though when he said: “Sorry guys, I didn’t get a chance to look at either one of your medical records prior to the appointment because the PDF was scanned upside down on my computer screen so I couldn’t read it.”  bookAdditionally, Melanie would like to note that he said she was healthy, and upon asking her weight (remember, he was unable to read the upside down records), told her, “Well, you carry it well.”  Yup.  Thanks for that.  Awesome.  Now, the financial pressure and snap judgment about who we are was offensive, to say the least.  But the medical record thing was ridiculous. We were looking at this guy and thinking, “if he doesn’t know that he can just print the records out, and turn them right-side up and read them or if he doesn’t know how to rotate a PDF document on his screen, how is he ever going to help us?”  We agreed to do nothing with the CNY facility and later in the week asked for them to transfer our medical records to Boston IVF, who luckily also has a satellite office in Albany, NY.  It took a real FIGHT just to get them to transfer our records.  What a joke some of these places can be!

By the time we had the miscarriage, restarted trying to get pregnant with Clomid and failed, had the bad appointment with CNY, and then got our medical records transferred to Boston IVF, it was March of 2017.  It had been more than 2 years since we first started trying for this elusive baby. stork-e1519606708408.png

We had our first meeting with the doctor at Boston IVF in April of 2017 (we think).  And right from the start we could tell she was wonderful.  Our initial interview was fantastic and very informative.  It had been a year since we last went through the basic fertility tests, so they asked that we re-do them.  So I had to go to a new masturbatorium (this one outfitted with a 60 inch flat-screen and a Roku of porn, pretty cool, I’d say) and Melanie went through her whole range of testing.  The results were in again……”UNEXPLAINED INFERTILITY.”  But we already knew this, so at this point the question we had for the doctor was, how do we come up with a medical plan that makes sense scientifically when we don’t have any data telling us what is wrong? And we both loved her response, because it was so freakin’ honest.  She said: “Look, this field is developing, it doesn’t have all the answers, I have two procedures that I can do for you guys, IUI or IVF.  After that, the medical field has nothing else to help you, and no other technology to measure what is wrong.”  So knowing that we still knew nothing, we were (at least) equipped with an honest answer and a doctor we personally loved.  So we just told her to tell us what she recommended and we would do it so long as we could afford it.

Her first recommendation was to do three rounds of IUI (covered in full by insurance), because, maybe whatever our un-observable problem was would be fixed by inserting the sperm higher in the uterus. So we did it.  Twice.  Coupled with Clomid 3 times.  2 & 3 aren’t the same number…and there are two stories here.  I’ll tell you about the Clomid first.  

Remember when our original OBGYN said he could prescribe up to 150mg?  Well, our RE (Reproductive Endocrinologist…or specialist, really), told us the same thing….however, being an RE, she could presecribe up to 250mg.  Let’s start with 100, though, since it worked the time we got pregnant.  I responded well to the Clomid.  The follicles looked good, the IUI was unsuccessful.  Second round: 100mg, because I’d responded so well the last round.  Unsuccessful.  Third & final round.  It’s only prudent here to mention, we had a consult with her after the 2nd round and she said most of my results were borderline, low, or just above average…I was constantly riding the wave with my blood levels, so IUI most likely wouldn’t be successful, but we could try a 3rd time and she would up the dosage.  Sure, why not.  I had already grown accustomed to sweating all day and night, so let’s increase the side effects (please read as, I would suffer any side effects if it meant carrying a pregnancy and delivering our baby).  150mg.  The prescription would be called in the next day (a Friday) and I was to start it Saturday night between 7 & 9 pm (everything is timed in Infertility Land).

We’re going to split this story up…1 Saturday afternoon.  150mg of Clomid.  2 perspectives:

This is where the infertility s**t (and rage) gets REAL

Melanie:  I got a call from CVS on my phone while I was driving, and because I don’t answer the phone while driving (mostly because my mother raised me well…thanks, Mom), I let it go to voicemail.  Plus, CVS automated messages aren’t worth answering.  Yeah, yeah, my prescription is ready for pickup.  So Mike and I are out and about and swing by our local CVS to pick up the Clomid.  We go to the drive-through window and buzz the pharmacist.  I tell her my name and date of birth, she leaves, and then she comes back to the window.  What happened next felt like an out of body experience. rx The pharmacist, whose name I know but am choosing not to type on the Internet…let’s just call her H…told us that she couldn’t distribute the medicine because it was a higher dosage than the last time.  We say, we know this, the 150 is the correct dosage.
She tells us, “While yes, that’s what the prescription is for, I tried calling the office to confirm it yesterday at 6pm.”  I (calmly, while death-gripping the steering wheel) tell her, the office closed at 4.  And it was sent over yesterday morning.  I then ask, “What were you hoping to achieve at 6pm?”  What I later thought of, was,
If this was such a concern, why didn’t you leave a message with their call answering service????  I then tell her, what anyone suffering through infertility, following a miscarriage, wants to tell a stranger in a small town.  “I’m infertile and the other doses haven’t worked.  I need this medicine and I need to take it tonight to try and have a baby.”  To which she tells us, “I don’t feel comfortable giving you this much.”  Mike, my hero, then leans across me and yells, “Listen.  My wife is a teacher.  I am a lawyer.  We are well-educated and in need of medicine to try and conceive a child.  Are you telling me you can’t or won’t give us this medicine?”  And she says, “I’m telling you, I’m making a professional decision not to give you this much Clomid.”  At some point I yelled at her, I’m not going to sell the extra Clomid on the streets! I need this amount to try and have a baby.  But no, she would not budge.  She was overriding a specialist, after NOT calling during business hours and NOT leaving a message for the on-call service after hours!!

OH NO YOU DIDN’T.  You’re overriding our specialist????  Who, once again, can prescribe up to 250mg….you’re making that decision, when we have a time-sensitive dosage to take?!?!?  

I drive away from the drive-through, park, and sob.  Why does even this have to be so damn hard?  As I google my dr’s office so I can call the answering service, Mike gets out of the car.  I get through to the answering service, leave my name and number, and am told I’ll receive a call within an hour.  I call my parents’ house phone at this point to tell my mom what’s happening, and my dad answers…my mom was out, what was going on?  He assured me everything would work out, not to get too upset, and that he was glad Mike was with me.  SO. WAS. I.  The pharmacist, however, probably was not.  Here’s where Mike can take over:

Mike: My memory of this incident is still clouded with rage…but here’s my recall of how this went down:  We pulled up to the drive-through window of the CVS, and I was reading an article on my phone about the college football playoff potential matchup.  As usual, I was not paying any attention to what was happening. Then at some point I hear the tone in Melanie’s voice change form pleasant to sad, and even though reading about potential CFP playoff scenarios is important, I put my phone down and listened into what was happening.  This is when I hear something like “I’m not able to dispense this amount of dosage to you Mrs. Carroll, because it’s above our normal dosage guidelines, and this dosage level can lead to severe side effects.”  At that point, I unbuckled my seat belt and leaned over Melanie and said, “are you not dispensing the medication because of CVS rules or in your professional discretion?” To which she responded, “it’s my professional opinion that this dosage is not appropriate because of the potential side effects, and because I haven’t had a second confirmation from your specialist, I can’t dispense.”  street sideTo which I said “Look, my wife and I are educated people, she is a teacher and I am a lawyer, we had a meeting with our specialist where she explained the risks associated with this dosage, and we understand the situation, and we’re not going to go be Clomid drug dealers on the streets of Saugerties.    To which she said something along the lines of “I understand sir, but I am not going to dispense this dosage amount.” To which I said “Do you consider yourself a doctor?  Because you’re not a doctor!  You’re pharmacist! And it sounds to me like you’re practicing medicine without a license!”  **Note: when we got home, we looked it up, and had she not dispensed our time-sensitive medication, we could have filed a suit against her under the ADA…know your rights and advocate for yourself, people!!** Then I got out of the car and stormed into CVS and starting screaming at another person who greeted me at the pharmacist front desk and told me “I had upset the entire staff and should calm down.”  To which I said “You have upset my wife who has been trying to get pregnant for over two years, and you are insulting our intelligence, and you cannot override the prescription of a reproductive specialist who has prescribed time sensitive medication because your staff wants to pretend to be doctors.”  rmThen all of my years of education climaxed into creating a super-douche bag who “requested to know his due process rights” and wanted to speak with the “regional manager”
and “to please provide me with the NYS Dept of Health complaint form for pharmacy disputes.”  Literally making all of that up on the fly in pure rage. In the middle of my tirade, the medicine was dispensed to me.  Not because of anything I did, but because the pharmacist finally got a hold of the nurse on-call after hours at our RE and they confirmed the medication was correct. Crisis averted! And screaming at people really made me feel pretty good about the whole thing. Now back to Melanie.

Meanwhile, a nurse practitioner called me back, told me she’d already called CVS and approved the dosage.  She said, “The pharmacist, H, or however you say her name, seems less than nice.” To which I said, “You’re telling me!”  She told me it was ok, get the medicine…and maybe consider a different pharmacy moving forward. Once again….You’re.Telling.Me.  This, I think, is what Mike looked like as he left CVS that day, Clomid in hand:

fire

Part B of this story is that our schedule seemed to be on track, I was going for monitoring, thought I had a couple more days, and was told (shockingly), my body was moving faster than expected and I could trigger, and plan on a 10:30 IUI in 2 days time.  Um, that couldn’t work.  Why?  Oh, 11 months prior, I bought tickets for Hamilton for me and Mike, and it was the only thing that I was looking forward to.  No, really.  The only thing.  Since the doctor was pretty sure the 3rd IUI wouldn’t work, we triggered and had the green light for timed intercourse, rather than a mid-morning appointment that wouldn’t get us to the matinee show on time.  I hemmed and hawed over so many things during our battle against infertility (because really, a journey most people head out on willingly…and we are constantly fighting against this invisible beast), but I knew if we missed Hamilton for another failed IUI, it could destroy the joy and spirit within me.  I know this seems dramatic.  I KNOW it does.  But Mike and I felt confident with our decision, and we loved our day in the city to see Hamilton together.  In a way, I think it’s what we needed.  It reminded us of life beyond (and really, amidst) infertility.  For those of you who think this was stupid, you’re probably (not) thinking of this line from the show: awesome.jpg


After our third failed test we met with our doctor again, and she was able to shed some light on what we were experiencing.  She was able to observe through our 3 Clomid cycles that Melanie’s AMH levels were just below or JUST at/above average on each of her cycles, and as the doctor explained, this meant that she believed Melanie had a “low ovarian reserve,” and that as a result, it was unlikely that we would ever get pregnant on our own.  She said that the one time we did get pregnant was more of a fluke than an indicator of a future possibility.  She recommended that we move onto IVF.  At this point, we felt a bit relieved, in the sense that we finally had an idea WTF was happening!  We said to ourselves: “OK, so Melanie’s eggs need a boost, and maybe the IVF stimming process is what we need!”  So we thought we’d consider IVF, if we could do pick the right time to do it, and we could figure out how much it would cost.   

angry cat
First we looked into cost: At our facility $12,500 for IVF medicine and procedure. $1,000 for freezing, $2,500 for a frozen transfer.  Now for two people who are trying to get out from under their student loans, save some money, and want to move sometime in the next year or two, we felt like, SHIT! But at the same time, we couldn’t let that dictate our chances of trying to have a family.  So we checked our insurance plans to see if there was any chance of coverage. We found out no chance to cover the surgical procedures ($6,500) but a slight chance that the medication would be covered ($6,000), because as our nurse told us, “More often than not,  your insurance will cover the IVF injections.”   Now this seemed crazy to us, but we decided, we’d cross our fingers and hope this was the case.  Also, we have this amazing health insurance plan through Melanie’s school, where they pay our entire deductible and we only owe for co-pays after the deductible has been used up, until reaching out of pocket max (Melanie is $40 away from her max…and it’s February.)  So we agreed to pay $6,500 for the procedure and hoped the medicine was covered.  And to our pleasant surprise, IT WAS!  So while we paid a good amount of money, it’s not as bad as it could be.   After we crossed this financial hurdle, it was around November of 2017.  We decided we’d wait until after the holidays (Melanie’s favorite time of year…our anniversary, her birthday, Christmas, saying one hell of a good bye to the sh** storm that was 2017, etc.) were over to start IVF.  Mike’s usually not very busy in February and Melanie could do IVF around her February break time, so we decided we’d start the stimming process at the end of Jan/beginning of February.  

So that is where we find ourselves now.  Waiting, once again, for results.  Hoping for positive news on Tuesday.  And although Melanie has said she won’t POAS (pee on a stick) before then, if the Beta level is good (please let it be good), she’ll definitely POAS to see those two pink lines again.waiting still


Thanks for reading this far, if you are, still, in fact reading.  Mike told me today he didn’t realize people could leave comments on the blog, so if the spirit moves you, please don’t hesitate to reach out with a reaction or a question.  If you’re going through infertility, I hope it helps knowing that there are good and bad times for everyone on this rollercoaster ride.  That, and feel free to drop a line to talk about what you’re going through, too!  And if you’re on the other side of infertility, I leave you with the origin story of The Infertile Turtle, as told by Mike:

We were telling our friends about all of the stupid shit people say to couples who don’t have children/are struggling with infertility, and I mentioned to Melanie that she should carry around a small turtle hand puppet, and when someone says something stupid you should take out the hand puppet and say “the infertile turtle says you’re an idiot.”  We all had a good drunken laugh about it…but it has become a nice way to vent and a cathartic experience.  [Plus, some day our child(ren) will know how much we wanted this.]

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Retrieval & Fert Report

Yesterday morning Mike and I needed to be at our RE’s office by 8:30.  We arrived at 8:22, so for anyone who knows us (or just Mike), this was a big deal!  We were early!  I felt pretty good.  On the drive up, we listened to the Beach Boys: Endless Summer, which was the first cassette I ever bought…and I sang most (all) of the songs to Mike as he drove.  After arriving, we signed in and sat in the waiting room for less than a minute before a nurse, Grace, called us back to the IVF Suite.  It sounds very fancy, doesn’t it?  

The IVF Suite was in a totally different part of the building than we’d been to before.  A nurse showed us to our space, area 4, and I was handed a Rubbermaid box with a gown, booties, blue hair cover, and a blanket.  I emptied my bladder, which I had (nervously) tried to empty at least 4 times before we left the house.  Then we completed the intake paperwork before my IV.  

Getting my IV was, in all honesty, the hardest part of yesterday.  Jennifer, the nurse who was doing my intake was struggling to find a vein on my left hand/forearm.  I told her that the phlebotomist has a hard time finding a vein on my left arm, but my right arm is usually pretty good.  She explained that the anesthesia team prefers the IV on my left side, if possible.  After Jennifer tried 3 times, she called another nurse over to help.  Kristin, nurse #2, said that the vein felt good, “it’s a pipe” was the actual quote…whatever that means.  But Kristin couldn’t get the IV in, either.  So she called in the nurse anesthetist, Rachel, who tried the left hand, and she, too, failed.  So she switched sides and after some poking and moving around, success!  She apologized in advance for the bruises I’d probably have when all was said and done.  No worries, I told her.  No need to apologize.  Do whatever it takes to get the IV, put me in twilight, and retrieve those eggs!

Then Mike had to leave to give his sample.  So he kissed me goodbye and I waited alone in area 4.  Our RE came in about 10 or 15 minutes later to talk with me…asked how I was doing, how’s Mike, are we ready, excited, etc?  She said I looked good and she was excited for me.  As she exited my area, two nurses swooped right in, started my anesthesia, and escorted me to the operating room.  It was quick!  It was a well oiled machine.  I had no doubts about the care I was receiving.  

Jessica and Michelle, two nurses with whom I talk a bunch about scheduling and updates, were in the OR with me.  Jessica helped me scooch onto the table and as I was getting in place, Rachel said, “Take two deep breaths and think about your favorite vacation.”  Next thing I knew, I was waking up back in area 4.  

This is the funny part of yesterday’s story:  I woke up and asked where Mike was, to which a nurse told me he’d be in to see me soon.  I fell back asleep (for 30 seconds? 4 minutes? An hour?) and when I woke up, I head a nurse saying to someone else (in passing) “Oh, it was bad.”  So, in my drugged state, I decided that my retrieval had been bad and Mike was somewhere else finding out first.  And I started to cry a little.  Then I saw Kristin and asked her if she knew where Mike was…she said she’d go get him and asked if I was ok, to which I said, “I just miss him”.  ❤

The nurses thought this was pretty sweet and Grace came in to check on me and offered me a mini can of ginger ale.  I had a couple of sips, fell asleep again (I think) and then Mike came in area 4.  (Reunited & it feels so good!)  In reality, he found me crying and explaining that I missed him…then I told him my fear about “it was bad” and he assured me no one had said anything yet.  Then the doctor came in and handed us a small card that said “14 eggs retrieved”.  FOURTEEN.  14

When we met with our RE for our initial IVf consultation, she told us she hopes, on average, to retrieve 10 eggs.  And on Friday, Michelle told me the ultrasound made it look like 6 or 7 mature follicles/eggs.  But, Dr. Elguero retrieved 14 eggs and we were so excited.  It was well beyond what we expected, and even more than we hoped for, I think.  We have been beaten down by infertility and years of negative pregnancy tests, and a miscarriage following our one (and only) positive test.   So imagine our surprise to hear better than expected results!

After we talked with our doctor a bit (Mike remembers more of this than I do), we were told we’d hear the Fert (Fertilization) Report midday today.  Then I finished my mini ginger ale, emptied my bladder one last time, got my IV removed, and was allowed to change and go home.  As I shuffled out the door holding Mike’s hand (there’s an exit right from the IVF Suite!), the nurses waved and smiled and someone said, “Now you won’t have to miss him because you’ll be together all day!”  It was so cute.  We made some calls, Mike drove home, got us some lunch, and then there was much napping on the couch with the heating pad.  

Midday came early today!  Michelle called at 9am this morning to check in on me…and to tell us that 9 of our eggs fertilized!  NINE!  nine  A second day of great news!  We are ahead of the curve we expected to be following, or that we hoped and aspired to be somewhere near!  Mike and I talked a bunch today and we both expected/prepped ourselves for low numbers without sharing that concern with the other.  Results have been borderline-to-low with all testing and moreover, Dr. Elguero suspected there might be an egg quantity and/or quality issue.  Now we’re (cautiously) hopeful that my eggs are good, they just needed some help!  Michelle scheduled our 5 day transfer for Friday, and my acupuncture will immediately follow the transfer.  

So now we’re back in limbo, back in the waiting abyss.  But, at least we’re in limbo with some positivity, The Office on Netflix, IMG_4999.JPGa heating pad, Gatorade, and unexpected joy in our hearts.  Right now, we could field a baseball team with our 9 embryos.  Statistically, half will make it to Friday…we would be lucky and blessed to have 4 or 5 embryos when all is said and done.  And until our transfer on Friday, we’ll continue to hope and pray that our little embryos strengthen and grow!  Little embryos…let’s grow!

Weekend Update

Friday I had my earliest appointment yet: 6:45 am.  It was really quick, unlike waiting for the phone call from my nurse about what was next.  The call came around 2pm (not bad, but time was ticking backward at one point, I think) and Michelle (the IVF coordinating nurse) told me the doctor liked what she saw and that I was ready to trigger.  To which I replied, “Really?  Are you sure?”

I felt like I could have stimmed indefinitely.  Yes, there were mild side effects, but I was so involved!  And now, after the trigger, I go back to being a spectator of sorts.  I mean, I’m obviously involved, but, I’m also along for the ride.  Speaking of being along for the ride, after going over the trigger shot, Michelle told me to be at the doctor’s office at 8:30 Sunday morning and make sure that Mike brings his license, because he’ll need to prove he can drive me home afterward.

I triggered Friday night.  It may have been the most painless of all the shots I administered the last 2 weeks.  And tonight, there were no shots.  Mike took me to dinner to celebrate that we got to this point.  We toasted (I had seltzer and Mike had a Sloop Juice Bomb) to luck ahead and to our future baby(ies).  Mike shared a picture on Facebook from dinner and said that we were out to celebrate our IV FU to infertility.  (A la Argo‘s famous, “Ar-go-f**k-yourself.)  It was perfect.

Fingers and toes (but not ovaries) crossed that we have good,quality eggs, later-this-week embryos, and someday-babies that are retrieved tomorrow.  It’s only a day away.

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