Previously on Selfmade Motherhood Blog...I was extolling the virtues of the US healthcare system and how it is changing lives for the better. I'm just playin'! American healthcare may be better for some people under the ACA, but it's still a total clusterfuck controlled by the insurance companies and Big Pharma. ANYWAYZ....For the first time since moving to New York 12 years ago (okay, okay...technically I'm a Jersey girl now...but for the first time since 2004) I have health insurance in the US. I make that distinction because previous to 2004, I lived in Japan for two years and was covered under the NHS there (before that, I lived in LA and worked at a company that provided my health insurance), and from 2011-2013, I lived in HK and was covered under the NHS there. Don't get too excited though. I have the cheapest plan I could find (not that I could afford, because I can barely afford this one, but the cheapest one I could find) and it's a Bronze level plan with a $3000 deductible and something like $6300 out of pocket yearly cap. So on top of the almost $300 per month premium, every single doctor's visit or procedure or test or whatever is going towards my $3000 deductible, but coming directly out of my pocket (which might not even be so bad if that wasn't taking away from my buy-some-more-frozen-sperm money). Having insurance does have a few advantages (and several very big disadvantages), but we'll get into that as we move on.
So...I went onto my insurance company website to find an RE in my area. There are exactly two RE practices (lots of doctors, but only two practices). So I called and made a new patient appointment with RMANJ (Reproductive Medicine Associates of New Jersey) as they have an office in West Orange and I live in East Orange. Beforehand, through the patient portal online, I had sent them all of my pertinent medical records and my fertility charting highlights in pdf form from my FertilityFriend.com account. I went in on February 17th, their last available appointment, 2pm (because when you charge this much for your services, you can afford to go home at 4pm every day and not work on weekends). It was inconvenient having to miss work, but I managed to get the work baby out and activitied in the morning & the parent who'd worked from home that day took over to feed her lunch and put her down for nap so that I could go.
Moving on....I arrived at almost exactly 2pm and filled out all the new patient paperwork before heading back to talk to Dr. M. in her office. The low-down: The RE & and nurse team seem nice (they pair each RE with a nurse so that you'll always know who to ask for when you call...since the nurse's pretty much do all of patient relations). Dr. M. knows I'm not interested in IVF, but gave me their stats etc. anyway. She went over my medical history and explained all of the preliminary diagnostic tests (which I already knew about). She seemed concerned about my age and that I might have a low follicle count (because that's the thing that they are all programmed to be concerned about, I suppose). She explained all the options as far as natural cycle vs. medicated Clomid cycle vs. medicated injectables cycle (p.s. they use an hcg trigger shot even on natural cycle IUI....I'm not ruling that completely out). Then we went into the exam room where an intake nurse took my vitals....Let me digress for just a second. I'm not a small person. I'm actually at my all-time heaviest weight right now (Hush! I'm working on it. Baby steps...baby steps...), but I take pretty good care of myself. I don't eat meat (haven't since I was about 15), have never been a smoker, rarely if ever consume alcohol, and my work is relatively low stress and makes me happy. So, it's always interesting watching the intake nurse's face while she's trying to reconcile my size, my melanin, and my low-to-normal blood pressure. Coming back to the actual story: Transvaginal ultrasound: FUN! Okay, not really. But it wasn't too uncomfortable once the probe (read: specially outfitted dildo-like device) was in place. Apparently my uterus is lovely and my ovaries are equally lovely. Dr. M. seemed surprised by the antral follicle count (7-8 follicles on each side), but was careful to stress that "they might not all be of good quality because of [my] age." (These IVF people...they really just can't help themselves, can they?) She did notice a fibroid off in a corner somewhere (not on an ovary or obstructing anything) , but said it didn't appear to be bothering anything. That was it!
Then I got dressed and peed in a cup, and talked to a nurse about when to call in to schedule my Day 3 labs (where they check all your ovulation & pregnancy hormones and do and AMH test to check your ovarian reserve - how many eggs you actually have left to work with) and when to schedule the HSG (where they inject dye into your uterus to see if your fallopian tubes are open). At that time, the way my nurse, R., explained how & when all this testing got done, I was under the impression that I'd be able to schedule the HSG on a weekend (it has to be done between cycle days 6-10) since they only do that test at another facility that's about 30 miles away and I didn't want to miss work if it could be avoided. That turned out not to be the case. The bloodwork can be done at my local office, and the lab is open from 6am 7 days a week, so I could do bloodwork any day and never even be late for work. The HSG, done 30 miles away, can only be done Monday to Friday, and only between 8am - 12pm. I didn't find that out until about a week later when I went in for my Day 3 labs though. (more on that later) The RE's office is actually located just across the street from the fancy dine-in movie theatre that has become one of my local favorites for mainstream blockbusters, so instead of going straight home, I decided to walk over and watch Deadpool again. So the day wasn't a total loss.
They gave me a bunch of info in two folders: One about required tests and cycles and options. The other about the financial side of it all. I looked through the financial packet when I got home and nearly lost all hope while looking up the cost of pre-cycle services. The HSG alone was listed at $1075. FSH/LH/Progesterone were $75 each. Plus anothe set of annual screenings that wasn't even listed (thyroid, AMH, STI's, CBC, blood type, etc.). I was nearly paralyzed with fear that anything could possible be wrong with me because, as per my crap insurance and its super high deductible, I was already looking to be out of pocket for all of this up to $3000, and then the insurance would still only pay 50% of the cost after that. I just felt like my insurance was completely useless and the premium was just more money out the window every month that could have been going towards the purchase of spermcicles and shipping. Grrrrr....I hate American healthcare so much.
*sigh....So, after my weird, not-pregnant-but-feeling-pregnant cycle, I had a super weird cycle (flow was different, ovulated earlier than usual, and had only 9 day LP). I called the RE's office on cd1 of my next cycle to schedule the Day 3 labs and the rest of the annual bloodwork screening. I wanted to schedule the HSG, but that's when I found out that the hours were ridiculous and I couldn't take another day off work in such a short span of time. I resigned myself to do the HSG in the following cycle and maybe just go ahead with another home insem if all the bloodwork came back normal. The next day, I talked on the phone with their financial consultant to go over what is and isn't covered by my crap insurance. I told her how concerned I was about the cost of all the prelim testing and she said (you're gonna love this!), the prices they list in the financial packet are out-of-pocket prices WITHOUT AN INSURANCE COMPANY DISCOUNT. What????? Yeah, so apparently if you have insurance, even if your insurance doesn't cover something, the price you get is a discounted price vs. if you're paying out of pocket with no insurance. So the HSG that was listed at $1075 was actually going to be more like $258. This was such a weight off my shoulders! (
UPDATE: It took nearly a month to see the actual financials on that, but the insurance discounted price on the HSG did, in fact, turn out to be $268 or something, AND the insurance covered the whole thing and I don't have to pay a dime out of pocket. I think it's because it's all diagnostic and not actual treatment at this point.) But then I was immediately pissed off that insurance companies are completely dominating what the standard of care is for people, since the financial aspect is what keeps a lot of people from seeking treatment in the first place (i.e. why I never saw an RE until five years into my ttc journey because I was uninsured all that time). Anyways....I went in the day after that for the bloodwork. It took two nurses and three tries to find a vein (and the bruise on one of the failed attempts lingered for over a week!). But it was over pretty quickly, and I called an Uber to take me to work and went on with my day. I thought I'd have to wait at least 24 hours to hear anything back, but Nurse R. rang me that afternoon (just as I was trying to hustle my work baby down the block to catch the bus with her by one hand an umbrella in the other, and a sack full of toddler detritus and library books over one shoulder), so admittedly, my attention was a bit divided. She said that my Day 3 labs were all good and within normal range. My FSH was a little high, but just on the higher side of normal...so still within the normal range. The rest of the bloodwork was sent out to another lab, so I should hear back about that in about a week, she said. (I literally never heard a single word or received any phone calls or correspondence about the rest of the bloodwork until I called three or more weeks later to schedule my HSG for the following cycle, btw. Guess I'm fairly healthy and not interested in IVF, so I'm not really at the top of their priority list.)
That was basically all the news there was until my current cycle. Without the financial millstone around my neck (the insurance is stealing all of my spermcicle money, but at least it gives me a discount on diagnostic labs and stuff...), I scheduled the HSG. Unfortunately, I had to take the whole first half of the day off from work to go out there, but it was on a Friday & my work baby mama was planning to work from home anyway; so she ended up taking the whole day off work and the two of them had a fun morning out. My Uber driver was a bit of an idiot...and drove completely in the wrong direction. Twice. My appointment was at 10am and they ask that you arrive 30 minutes early. I got there at 9:55am and had to wait in line to sign in, so I didn't even check in until after 10am. Grrrrr....They were really tight on the schedule though, and as soon as I was signed in, they brought me back to the ultrasound waiting room, and as soon as I arrived there, a nurse gave me a cup to pee in. Right after I handed that off, I was taken to the HSG room.
I undressed from the waist down, and lay down on the exam table with a drape over my lower half. The team came in (different facility, different doctor team), and the doc explained the procedure. They put my legs up on these weird knee stirrups, but they were a bit limited on horizontal movement, and I felt like my legs/hips weren't open enough to get the speculum in comfortably (UNDERSTATEMENT). It didn't help that he used some kind of elephant-sized speculum and it was mad painful just getting it in, let alone adjusted. I was in a lot of pain, so he got a narrower one that felt more like normal going in. Still uncomfortable while he was adjusting it for a better view of my cervix though (the man did not have a gentle touch or comforting bedside manner in the least). More discomfort while he cleared away mucous.
Next was a "pinch" (again, understatement) as he injected two shots of lidocaine into my cervix (not through the os, but into the actual muscle of the cervix) to numb it because they have to "pinch the cervix open in order to insert the metal catheter that they use to inject the dye. Then came the actual dye injection: OH MY GOD IT HURT SO MUCH!!!!! One of the nurses was talking me through it, coaching me on how to breathe through the pressure and pain. It couldn't have lasted for more than a minute, but WHOA! There was "spill out" from my right tube right away (meaning the dye went through the fallopian tube and spilled out into the pocket near the ovary. Then, eventually, spill-out on the left side, too. The doc proclaimed me ALL CLEAR! While he was cleaning me up and waiting for the bleeding to stop (from the lidocaine injection sites on my cervix), I asked if I could take a photo of the image(s) on the screens. He said that once he was done "down there", he'd scroll through the images, explain each one to me, and find the best image for me to photograph with my phone. See?
 |
(click to enlarge)
You can see my pelvis, the speculum
in place, & the catheter that injected
the dye. The middle is my uterus, the
roundish sacks on either side are the
spaces around my ovaries to where
the dye spilled out. |
Then, they all left the room and I got dressed (they gave me two cheapie sanitary pads, but I'd brought my own good ones from home - Yay internet research!). I sat in the waiting area for five minutes and then I was free to go! Done and DONE!
Here's my amateur theory: The two times that I've had a transvaginal ultrasound and seen my ovaries, I've had more follicles on the left than on the right (or the left ones seems to mature faster). The very few times I've ever had any kind of ovulation pain, it's been on the left side as well. I think there may have been some kind of slight blockage on the lefthand tube and the HSG helped to clear it out (which is why it was so painful for me). Hopefully, this helped set the stage for this cycle's successful home IUI attempt and cleared the way for a pregnancy to happen. (fingers crossed!)
Here's the overview: RE's (I'm assuming in general, but at the very least at the one practice that I've visited so far) are really all about IVF and they use all the scare tactics they can to encourage women to take on more aggressive treatments and push for IVF because that's what they do best and how they get paid best. And when they can literally find nothing wrong with you (as in my case, all bloodwork normal and no fallopian blockages), they use the one thing they can't test for to scare you with: Your "advanced age" and your "possibly poor egg quality". There are tests to see how many eggs you have, but there is absolutely now way to know the quality of your eggs, so they go by the woman's age as the only determining factor. And since I'm not keen on IVF and would prefer to do my insems on my own at home if there is no reason to believe that I can't get pregnant, I'm of no interest to them. This was confirmed by RE Nurse R. when we spoke about my HSG results. She wanted to talk about next steps and I said (as I have from the beginning) that if there were no problems found besides my "advanced age", I'd prefer to continue trying home insems. When I asked about the possibility of progesterone support for after my IUI, she said that Dr. M. told her to tell me to get it from my regular OB/GYN....of course, they know that I just moved to Jersey and I don't have one, so if I don't agree to moniter my cycle with the RE's office and submit to any and all of their testing prerequisites, then I'm on my own. As of yet, I've not formulated any plan that will get me progesterone suppositories in time for this cycle's insem, so I'll likely just use the progesterone cream that I still have in the cabinet until I test and go from there...
Stay tuned...
I took the vial out of the Tardis and placed it in the finger of a sterile exam glove (to protect it from any water getting in), then placed that into a luke warm water bath (97.6 F) for a little under ten minutes. 
