What a Headache!

Dr. B ordered an insane amount of blood work. I have been working hard at getting it completed and as much paid for by insurance as possible. The entire order was sent to an out of network lab (Repro.source) originally. Since some of the testing can be done in network I was able to get two different scripts for the testing. 

All of the following tests will be performed at an in-network lab:

 protein C, Protein S, lupus anticoagulants, antithrombin, Factor X, Factor IX, Factor VII, complete thyroid panel, prolactin, Homocysteine, prothrombin gene analysis, beta 2 glycoprotein, MTHFR, Cardiolipin, Vitamin D, platelet antibodies, DNA double stranded anitbodies, ACE insertion/deletion, Annexin 5, Prothrombin gene (factor II), C3, C4. 

Then there is a script for a karyotype for both me and my husband. 

In addition, there is DNA testing for both of us. These tests include: HLA A, B, C Class I DNA TYP-antibodies and then HLA DR, DQ Class II DNA- antibodies. I'm not sure exactly what all of those abbreviations are for, but I know it has to do with DNA. Aren't I a genius?

For this blood work I had better success today with Quest Diagnostics. I had been try Labcorps but decided they sucked and I should go elsewhere. Today at Quest they seeemd initially overwhelmed and annoyed but then told me that I can return tomorrow afternoon and get all of the tests performed. I'm sure it's going to be a lot of blood, but I will be so happy to have it done and behind me. 

There are a few tests that cannot be performed in network and I therefore have to use a specific company (Repro.source). They sent me two boxes by FedEx and instructed me to take these to my clinic and have them draw the blood and then they would send it. 

Etsy shop lilflower

I brought the boxes with me to my baseline appointment yesterday. When I pulled them out the nurse got a bit upset and wanted to call in the NP to see what to do. I heard them talking about it in the hallway and then the nurse and NP came back. 

The NP came in and was a bit rude about it all. She asked me who ordered these tests and why I was doing them. When I mentioned Dr. Br.averman she appeared even more upset. Things didn't improve much from there. I felt like I was being lectured. She told me that he thinks outside the box and that he does some different things, but that I have to be careful because he will take a lot of my money. She asked if he would be managing my cycle and I said he would. She asked if he would be doing the retrieval and I said he wouldn't. She then said she will need to have written orders from him during my cycle and that her past experiences with him did not include any formal instructions. This is the only way it will be possible. 

She then left the room and the nurse came back in to draw my blood. Once again she seemed annoyed but got it done. The NP popped her head back in the room and seemed to have calmed down a bit but was obviously not happy about the situation. She wrote me a prescription for birth control pills and then said she was going to need the plan to know what to do next. At one point while I was getting my blood drawn I heard Dr. K in the hallway talking to her but I wasn't sure what about. It's pretty rare to hear his voice down in that part of the hallway.

The worst part of this whole thing is that I learned the extra blood work through Repro.source could be covered by my insurance with pre-authorization. I hadn't gotten it prior to getting my blood work done the other day so I had to cancel that set of tests in order to wait for the pre authorization from my insurance company. Then I get to do it all over again. Yay!!

For the past two days I have been upset about it all. I'm frustrated that my clinic appears so upset about an outside opinion. I tried to get their opinion about what I could do differently and I feel like they told me to keep doing the same thing. I can't expect any different results if I keep doing the same thing. I need to make changes and know that I am trying my best and maximizing each cycle to increase success rates. It's almost like the goal of getting me pregnant was forgotten at my clinic and everything was taken personally. I'm not trying to offend them but I don't feel like I am getting what I want from them. I'm willing to pay extra money to feel like we are making positive changes.

A big issue is that I'm too sensitive. I internalize others people's feelings and let it bother me way more than it should. 

One of my friends previously told me she didn't like this NP. She said she didn't feel like the NP includes the patient in discussing the plan or making decisions. I like her because she tends to be more aggressive than the other nurses. I guess I found out that she doesn't like to be told what to do. She really took it personally that I was seeking outside input.

Obviously an option is to not use Dr. B for this cycle and if it doesn't work this time to go to him. That would still involve using my local clinic for monitoring. W and I talked and we still want to move forward with using Dr. B. It is more expensive, but this whole process is so expensive so does it matter that much if it helps? At this point it just feels like a drop in the bucket.

So the questions I could use some input on are: Do I continue with the same NP and hope she turns around on her opinion/attitude?  There are plenty of other nurses at the office but none that know me as well as she does. I think it would be awkward if I suddenly stopped requesting her and then saw her in the office.

Do I send my RE and email telling him the plan for using Dr. B? I was planning to let Dr. B deal with that but from the interaction with the NP I'm wondering how good he is about being in contact with the nurses and doctors. At my clinic it really feel like I only see my RE for retrieval and transfer. There isn't much discussion with him throughout the cycle and I feel like the NP is the one making the decisions.

I also don't know how to put the negativity behind me and move forward. Like I said before I'm really sensitive about other people's reactions to things. I care too much and then worry about it a lot. I just want to move forward and reduce stress as much as possible leading up to this next IVF cycle.

What's Going On

There's not much to report on, but I figured I should give some kind update or another.

Last week was the last week of the school year. Although I work through the summer I have a vastly reduced caseload and rather enjoy it. It's so nice to work shorter days. Today I worked from 9-1:30 and it was pretty amazing. I also realized I only have 1 girl on my caseload for the summer thus far. Help me with the patience to deal with all little boys! I'm going to be supervising a graduate student for a few weeks so that should keep me on the ball and better prepared in general. 

Two weeks ago tonight I got a positive OPK. I have taken a few pregnancy tests and I don't think this cycle was a winner. That's OK. Now I'm just waiting on AF to start my next FET. 

Tonight as we were eating dinner we heard a huge crash and looked outside to see that someone had crashed their truck into the telephone pole right outside our house. Luckily the guy was fine and W was able to call 911. The reason he veered off the road and hit the pole? He was taking a puff on his inhaler on the way to the store to buy cigarettes. 

I've done the initial forms to see about Dr. Braver.man. He is a reproductive immunologist in NYC. Although I have another cycle covered with C.NY I would like his input on what we could do differently. I spent the time filing out his comprehensive history form on Sunday. This morning I saw a number on my phone that I figured was his office. I didn't pick it up because I was running late and it isn't something I'm jumping up and down to do right away. Well, when I listened to my voicemail the message was from Dr. Braver.man himself. He said he read my information and had some ideas. It seemed like the biggest thing he had ideas about was the coasting. I emailed him tonight to see how consulting with my doctor would work. I also found out that a phone consultation is not covered by my insurance but an in office one is. I'm still digesting and trying to figure out if it is worth it. When I looked at his blog they listed a 75% success rate for fresh IVF cycles for women my age. My clinic is 33%. That is such a huge difference I think it is worth investigating. Also, he specializes in recurrent pregnancy loss, which unfortunately, I appear to fall in that category now. 

We attended a wedding this weekend of a friend from graduate school. The wedding was on Cor.nell's campus and was amazing! The bride and groom seemed so happy and in love and everything was beautiful. The food was amazing and everything was really fun. I can't believe how much I ate....

We had our BBQ on Friday and it went really well. It was nice to have all young people there and everyone had a great time. I had way too much wine this weekend between the BBQ and wedding and the cold I had last week has progressed and I'm still feeling crappy. I'm definitely ready to start feeling better. 

So that's the update on what's going on. 

Not Good

Today was my first ultrasound. From the title of this post, I'm sure you can tell it didn't go well. I was shaking like crazy and my pulse was super high. They first drew blood and then we started the ultrasound. W was there, holding my hand watching along with me. 

 I knew what we were looking for. After a few seconds, the technician turned the screen more towards herself. She looked and looked, and didn't find anything. There was a small spot that she said could be a gestational sac, but it was really small. We talked about dates, and then she agreed there should at least be a larger gestational sac as well as a fetal pole. None of those things were present. 

She said she couldn't say for sure what was going on and that we had to wait for my HCG results. If my levels continued to rise I would have to return for another scan. There was still a chance for an ectopic pregnancy as well. 

 We talked about whether I had frozen embryos and agreed that things weren't looking good based on the fact that I was supposed to be 6w1d. 

W's face dropped and as he walked out he looked so sad. I felt awful. We sat in the car and said nothing for a while. It definitely wasn't the way we wanted things to go today. 

We went out for breakfast and talked about everything. I had a call from the clinic while we were there and I listened to the voicemail. On the message she said my HCG levels had dropped and for me to call her back. I was honestly glad we weren't going to be stuck in more beta hell and have to repeat the ultrasound. 

I called back and talked to the NP. She said my HCG levels had dropped to 16.8 and to stop all of my meds. She said I should get a period within 1-2 weeks, but perhaps sooner. I have to go back monday to get my HCG levels checked again. I asked about a RPL (Recurrent Pregnancy Loss) panel, but since this pregnancy is considered chemical, she didn't think insurance would cover the cost. She welcomed me to call the financial advisor to find out. She then said we could treat the next cycle as if I do have RPL issues. We will use Lovenox and probably add IV intralipids. Apparently these help to suppress the immune system. 

We then talked about a FET. I guess I can go ahead the next cycle, but with our vacation (last week of March), I'm not sure how the timing will work out. She said once I get my period and my HCG is negative, I could start estrogen. 

 I can't say I'm extremely surprised. When my initial levels were low and didn't double Dr. Google did not give me promising news. Apparently only about 15% of pregnancies that don't double in a timely fashion turn out OK. Big surprise I fall into the 85%. 

Bring on the hot baths, wine, and sushi.