The Cost of Infertility

Sometimes, I wonder if pharmaceutical companies are in cahoots.

Actually, I assume they totally are.

After talking to my RE about next steps, I was prescribed Follistim in a low dose as well as Ovidrel. I remember the first time I paid for Ovidrel and it wasn't covered by our insurance. It was about $175 cash price. 

I thought that was expensive.

Then I was introduced to Follistim.

I received a phone call from the specialty cash pharmacy on my way to my doctor's appointment. I asked about my options and when I would need to ship the meds by. Well, since I would need the medication on Monday, and I was talking to them on Friday, they would have to ship on Friday for Saturday delivery since you have to keep the stuff refrigerated.

Then I asked the amount. 

I kindly asked if I could call them back after I had been to my doctor's appointment.

After going to the doctor, they instructed me to also give my insurance provider's pharmacy a call. For us, it's Caremark/CVS. Now, I must say that they are great and also not so great. They are great if the medication is something generic and general. 

I'm thrilled to say that the Metformin 90-day supply (that I take for PCOS) is $0.36! Yeah, ridiculously cheap. Even the Letrozole, because it's an off-label use is just $0.22. Like, I felt bad swiping a card to pay that little amount. 

Now fertility meds on the other hand, not so great. Like flipping expensive...like I imagine how depressing it would be to be going through infertility and then have the barrier of how expensive it is keep you from moving forward. And through Caremark, with some unknown amount of coverage was still more than twice the cost from the cash pharmacy!

I ended up ordering Ovidrel from our insurance pharmacy (since cost was the same as the cash pharmacy) and Follistim through the cash pharmacy.

Out of curiosity, I checked another online pharmacy that carries Follistim...that was another $100 more than Caremark!

My heart goes out to all the people who are going through infertility and doing IVF and have a PLETHORA more medications compared to what I had to order. I can't even imagine paying for all of that out of pocket.

It's pretty ridiculous. Why is it SO expensive to get help to have a baby? And yet it's so simple to terminate a pregnancy? I don't want to get into a political debate about it all, but it just feels like women who need assistance conceiving are penalized over something they can't control. And that premium? 

Cahoots. 

Tired of Failing

My cycle started last Wednesday.

And I took it harder than I expected.

My RE's office told me that I could take an HPT on Monday 2/8, but me, being ever the pragmatist, waited. I knew I should wait a few extra days, instead of "wasting" an HPT on a negative result. I think I need to get some of those cheap tests off Amazon.

According to my period tracking app, Glow, it said that my period was due on Wednesday 2/10. That morning, I had no signs of it starting. I don't generally experience very many PMS symptoms (I know, I'm lucky), and there were no physical signs. Throughout the day, there was some light spotting, and of course I tried to tell myself that it was implantation spotting...anything but my period starting.

By that evening, it started. And I was mad. I was sad. I was disappointed. I was frustrated.

I keep going back to thinking about how pregnancy is totally not an accident...it truly is a miracle. I know there are women out who blink and get pregnant, but for the rest of us, we pray, we plead, we beg...

So instead of calling my RE's office to report a positive HPT on Thursday, I got to call them to report a new cycle. We talked about getting a little more aggressive in treatment since I had just completed two cycles of Letrozole. One without a trigger shot and one with. They brought me in for a baseline ultrasound that next day and taught me how to inject myself with Follistim.

My doctor prescribed two days of Follistim alongside of taking Letrozole. I go in for a follow up sonogram on Wednesday to see if we can trigger and do an IUI.

I think the hardest part of this journey is that every month you feel like you're putting all your eggs in one basket (no pun with "eggs" intended) and hold on to hope that this will be it.

One the one hand, you don't want to lose hope. On the other, it's exhausting and frustrating and disappointing when you don't get your desired result. I know that I have to remain confident in the path that we are taking and to NOT compare my journey with anyone else. I will just get upset if I think about all the "OOPS" babies that have been conceived and may be terminated. Knowing what a freakin' miracle conception is, I don't take it for granted for one second.

Starting Again

I never expected that we'd have to wait so long to get started trying again after the miscarriage. Now, having experienced one, I know so much more and have so much more empathy for all the women who have had one or multiple miscarriages.

Any miscarriage is heartbreaking.

I think it's because you have that glimmer of hope. If you had a positive pregnancy test, there's a special kind of exhilaration you experience when you've been trying for years for this one thing to finally happen.

And then it's all taken away.

In addition to the emotional toll that it takes, there's also a physical toll.

I experienced our miscarriage in September 2015.

My RE then told me to wait until my next two regular cycles.

My first cycle post-miscarriage was the heaviest, longest period I've ever experienced. It felt like a mini-miscarriage minus the cramps.

My second cycle post-miscarriage was still on the heavier than normal side (for me), but a lot more normal than that first cycle post-miscarriage.

So that brought us to November, at which point, my RE had us come in for the remainder of the testing that we never had done when we first met with her because I had a positive pregnancy test...all kinds of crazy.

I had a hysterosalpingogram (HSG) and a hysteroscopy.

The hysterosalpingogram is where they set you up underneath an x-ray machine, inject dye to see if your fallopian tubes are clear. For me, the experience was mostly painless - there was some pressure from injecting the dye, but my doctor talked me through it as she completed the procedure. I felt some cramping, but nothing major, and nothing in comparison to the miscarriage. I have heard from other women, however, who have said that when they had the HSG done, it was a very painful experience. I think it really depends on you, your doctor, and your pain threshold.

As far as the hysteroscopy, you're lying down on a exam table, and the doctor will insert a scope with a small/tiny camera to check out your insides. It takes all of about 2-3 minutes and it's similar pressure and I'd say less painful than the HSG. My doctor did find evidence of a polyp on the back wall of my uterus as well as the site of where implantation had occurred. They call it "products of conception."

Because of the polyp, my RE recommended to have it removed as she suspected that it could have contributed to the cause of the miscarriage. We'll never fully know, but for me, it makes me feel a little better knowing there was some kind of "reason" for it happening.

In December, at the start of my next cycle, I had the surgery. It was a hysteroscopic polypectomy, which is a fancy way of saying that the polyp was removed with a hysteroscope. Thankfully that meant that no incisions were made on me. I was put under general anesthesia for the first time ever, and while I was a little apprehensive about it, it was the best sleep that I can remember.

For me, the surgery was easy. I had surgery on Friday, napped most of Friday afternoon, and felt pretty back to normal by Saturday afternoon. I had to take a week off of exercise/activity until my post-op appointment, but otherwise, everything was back to normal.

So that brings us back to now. At my post-op appointment, my RE told me that the surgery was a success and that she removed the polyp and "products of conception". She asked me what we wanted to do and if we were ready to try again. I said that we were ready. I went in for a baseline ultrasound right before Christmas and started Letrozole. I had a Day 11 ultrasound and it looked like I had already ovulated. They drew blood for a progesterone test, and later that day confirmed that ovulation had occurred. At that point we just had to wait to see what the two week wait might present.

Two days before I expected my period, and on the day that the RE's nurse had told me I could take a HPT, my cycle started.

Sometimes I just want to tell my body to stop being so rude.

So I called my RE's office to let them know that my cycle started again, and I went back in for a baseline ultrasound this past Monday on Day 4. I started Letrozole on Day 4, and I'll go in for a follow up ultrasound on Day 8 - a few days earlier than typical with the hope that we don't miss the ovulation window...because the plan is to trigger ovulation with Ovidrel.

It was weird that I ovulated so early last cycle, but after asking in my support groups, it sounds like other ladies who also took Letrozole experienced some early ovulation as well.

So we'll see what happens this cycle.

What no one tells you about a miscarriage

This fall was one of, if not THE, hardest seasons of my life that I have ever gone through. I felt like I was weathering a storm that no one could really protect me from. Between the physical and the emotional, it all now feels like a numb blur.

And it's kind of weird because miscarriages are such a deeply personal experience. You don't really know what it's like until you're in the thick of it. I'll admit that I didn't understand "what the big deal" was until it happened to us. I figured that it was "better" than being further along. But there's something special that happens when you find out that you are pregnant. You're instantly a parent. There's something that clicks in your brain and refocuses your priorities.

Here are some of the things I wish someone could have told me about going through miscarriage.

It doesn't matter how far along you are, the emotional pain is just as real and as strong. I remember going in for our second follow up ultrasound and seeing the look on the ultrasound technician's face. I got a pit in my stomach and I knew it wasn't looking good. I tried to hold it together and not break down in that moment, but a sudden sadness washed over me. We were 7 weeks along.

Your first period after a miscarriage can feel like another miscarriage. Because every woman's body is different, there's no way to know what your first period post-miscarriage will be like. My doctor wanted me to wait until my second cycle start before revisiting our situation. Well, let me tell you, and warn you what it was like for me. It was kind of like the miscarriage events without the cramps. I've never had a period that heavy in my life. And it was also full of clots. Big ones. Soaking through pads in minutes. It went on for about seven days. My thoughts were - "How do I even have any blood left to shed?!"

No one really understands what it's like unless they've been through it. We didn't tell anyone except our immediate family that we were expecting. Because we were so excited, we had told them the day we found out. Telling them the sad news was one of the hardest pieces of news to deliver. When I subtly shared online that we had gone through miscarriage on October 15 (pregnancy & infant loss day), there were some people who came out of the woodwork. However, for most people, they get this speechless look on their face and they don't know what to say. It's understandable. I didn't want anyone to feel sorry for me. I just wanted someone to just be there.

There's no "right" way to mourn. Grief is a strange beast. It creeps up on you when you least expect it. It lingers when you think it's passed. I felt like I (for lack of better words) "got over it" fairly quickly. It was an intense September when everything happened, and then as we slipped into October, I felt myself emerging from the fog. I felt guilty for not being more sad. I felt guilty for being still sad. I was confused and overwhelmed. There were times when I'd just be in my car and start crying. It's okay to feel all the feelings and now understand what the heck is going on with yourself. Feel it. Seek help from a counselor. Talk it out.

Certain milestones can trigger emotions. When we were at my parents' for Thanksgiving, my great aunt asked me how we were doing. Apparently, no one had shared the news with her. I remember that I had written down the weeks on a calendar of how far along I would be, in the event that it would impact travel. Well, at Thanksgiving I would have been 20 weeks. I'm guessing we would have found out the gender and I would be about halfway and showing. Her innocent question brought back those emotions. By Christmas, we would have been 24 weeks, and by Spring there'd be a bundle of joy. We'll see how it is in April when our due date comes and goes.

If you've gone through miscarriage(s), what are some of the things you've learned that you wish you knew?

Where are we now

After the miscarriage happened, I had to take a step back and just allow myself to feel all the feelings. Once the physical part of the process had passed, a lot of my grief and frustration felt like it passed as well. I think I was most sad, and felt the most feelings, between finding out and going through the miscarriage.

It was kind of weird. I guess grieving is such a personal process, that there is no "right" way of doing it.

But I'll be honest, I felt a little guilty that I wasn't more sad. Is that weird? Once it had all passed, it was therapeutic (albeit the worst physical thing I've gone through so far in life). I felt guilty that I "got over it" so quickly. Perhaps it was because it was only at 5 weeks. We didn't know the gender or pick a name....

I had to wait until my next cycle started before doing anything else. I also had to go into my doctor's office for a blood draw to check my hCG levels. I did that bi-weekly until I got down to zero. However, the last blood draw I had, the level was still only at 1.3... the hCG just lingered in my system. It went from like 1400, to 300, to 4, to 1.3....

Also, what I wish I could have known before the start of my first cycle post-miscarriage, is that your period can be SUPER HEAVY. Like SUPER HEAVY. I know this probably doesn't happen to everyone, but just know that it's a possibility. Honestly, it was kind of like the flow I experienced in my miscarriage, but drawn out over 7 days. And clots. LOTS of clots. (Sorry for the TMI) But I would have wanted to know.

My doctor's office told me to wait until my next cycle before coming in again.

All the waiting. So much waiting. But I guess that's just what is required in this journey. Waiting.