title? do you want EVERYTHING now?

This post is going to have to be much shorter than I would like, because I barel have time to breathe today, let alone idle away time in front of my computer with a glass of OJ before I've even gotten into the shower. Yesterday we had our injectibles lesson followed by a pre-injectibles/IUI consult with Dr. Quixotic and then a bunch of speedbumps in the pharmacy. And I need quite a bit of advice (or assvice, whatever) from my friends inside the computer, so please be sure to take notes as we go along.

Injectibles lesson: cool. I'm going to be using the Gonal-F pen, and my HCG trigger shot will be from a pre-filled Ovidrel syringe, sub-Q. Yay! No butt-shot! Ezra was quite relieved.

Consult: Not bad, but also not exactly as expected. There was a fellow sitting in for most of the appointment, and she piped up with a few questions about us and our treatment. I found it somewhat disruptive, but on balance I do think it was good (for the greater good, I mean) to have the fellow there. She has to learn somehow, right? But that wasn't really my issue.

First issue: they're starting me at a dose of 37.5. 37.5! Is that even....medication? Are my ovaries going to just ignore the stuff, or, worse, cackle contemptuously? But Dr. Quixotic felt strongly about this, especially given my (young) age and his fear of hyperstimulation, so we're going to go along with it. My first monitoring will be the morning after my third or fourth dose, so we can change the dosing fairly early on if necessary.

Second issue: Dr. Quixotic is not sold on the idea that we need to do an IUI with this cycle. Ezra's semen analysis came back normal, and Dr. Q has a general philosophy of treating the problems you know about first, before moving on to anticipatory treatments for problems that may or may not be there. I don't ovulate, therefore we have no reasaon to think there will be any problems with fertilization once I do ovulate, so with the (small) risks of adverse reactions to the insemination, why add this to the mess? We (well, I) pressed him a bit on the issue, so he did add "IUI" to the treatment plan on my chart, telling us we could always change our minds later. (There's a chance we won't have an IUI anyway, since on this first cycle we don't want to go through the trouble involved in having it done on Shabbat.)

Third: Dr. Q is recommending I not have an HSG done this cycle. He said that given my age and medical history (no abdominal surgery or anything likely to have caused scarring and severe - or even moderate - menstrual pain) there was only about a 5% chance I had any sort of tubal blockage. Remember what I just wrote about his treatment philosophy? So, yeah, he doesn't want to dive into this right away. He said we could do one next cycle, whether I'm undergoing treratment or taking the month off (which he will require if my ovaries go into overdrive). Ezra seems to lean toward this option as well, but mainly because I've been under a lot of stress, and the next few weeks will be adding a lot more. I'm really torn - I'd like to just get it out of the way, and I'm going to be right pissed if I do ovulate this cycle and we discover later that I'm blocked in both tubes or something. On the other hand, it would be nice to have one fewer thing to worry about next week.

Fourth and final: we need to decide abou converting to an IVF cycle if I end up producing too many large follicles. Apparently this is the sort of decision we'll have only a few hours to make, as the treatment plan will need to change as of that day, but if we opt to convert to IVF we'll have about two days before retrieval to back out of the decision. I think this is something we also need to discuss with Rabbi Spock, but any advice from others who considered such a decision would be welcome.

OK, that was Dr. Q. After the appointment, we went on a hunt for Nurse Kid Gloves and/or Nurse Space Cadet so that we could have my prescriptions called in at the pharmacy downstairs. it was only then that I learned (from Nurse Spacey) that Dr. Q was also prescibing a progesterone cream for post-ovulatory support. Hmmm, would have been nice for someone to have told me that before, but I'll deal. Nurse Spacey assured me that I could get an HSG appointment with about a week's notice, so we'll make that decision Monday and schedule for either Friday or the following Monday. Then we headed downstairs to the pharmacy...

...where, after much waiting, we learned that our insurance company was requiring payments for the medications that were higher than the pharmacy's cash price. Ezra got on the phone with our insurance company, and after about half an a hour of phone trees finally spoke to a person who pretty much refused to budge on the issue (even though we're pretty damn sure this is supposed to be covered, both in his insurance plan and by law in our state) and told him to speak to HR tomorrow. So, no meds. But, we did learn something else quite valuable. The Friendly Pharmacist showed us the price lists for our medications, and it was at this point that we learned that Nurse Space Cadet (true to her name) had called in a scrip for twenty 75-unit vials of Gonal-F. Twenty! and: Vials! No and no, lady! I'm using the pen - I don't know how to mess with these vials, nor do I want to learn. And 1500 units total? At my starting dose? Are you high? I'll come back for a refill if I need it, rather than taking that much stuff home all at once.

So, Ezra and I each have our tasks for the day. He will contact HR and his insurance company again and see if he can get the prescription coverage sorted out. I will contact Nurse Space Cadet and get the prescription itself sorted out. Oh, and also schedule my day-25-ish appointment, at which point apparently we apparently will treat my uterus as if it contains Schroedinger's cat.

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UPDATE: Apparently meds are not covered under our insurance. I was under the impression that they were, but Ezra just verified this with both the company and his HR department. I actually have the opportunity to switch to an insurance plan through my work as of July 1; I need to make that decision within the next two weeks. We're going to research plans this weekend, but the truth is that I think there some major drawbacks to the switch. Maybe there's a future post in there.

In other news, Nurse Glovely is handling all of Dr. Q's patients today, and she's straightened out the pen/vial situation. So now all we have to do to get the right meds is pop over to the pharmacy and put a hefty charge on a credit card.