6 weeks 6 days - Intake Appointment

Oh man, this is one I'm typing up through some serious queasiness. Even though it's super early, S asked me to pick a hospital and pre-register so I could get on the calendar for prenatal appointments. The hospital choice was a difficult one, more difficult I think because of our location. We live about 5 minutes from Kaiser A. They're a smaller Kaiser but I absolutely love my OB, who is the head of the department there. Unfortunately, they don't really have a rated NICU (it's not even on the state list) and my OB is the only OB I'd want to deliver with there. S wants me very much to deliver and receive care at Kaiser B.

Kaiser B is about 30 min - 1 hour from our house which is a pain in the butt. It's a larger Kaiser with what is considered to be the best labor and delivery unit and a NICU. I had originally planed to go with my awesome OB at Kaiser A but after weighing all the options, it seemed like a better and safer bet to go with Kaiser B, even if it means giving up my beloved OB. The chances of actually delivering with your OB aren't great and I'd be pretty upset if I couldn't have her. S is a Nurse Midwife at Kaiser B and her partner midwife is also supposedly wonderful along with the OBs. If I have any sort of emergency, I can always go to the closer Kaiser A but everything scheduled will take place at Kaiser B.

The next step was actually making the appointment which was mentally harder than it should have been. It felt a lot like tempting fate and I was really hesitant to make those kinds of plans with a pregnancy this new, but I finally went ahead and had my intake appointment today.

This appointment started out with lots of questions answered via tablet. They were mostly basic pregnancy and health questions so it was kind of cool to get them out of the way without wasting my face to face time with the nurse. Once I got to her, we were able to focus entirely on our story and the calendar.  Holy balls was S right about the calendar.

After explaining about our IVF journey and briefly discussing the available prenatal screening options, the nurse opened up "THE CALENDAR" and proceeded to book me for the next 4 months. And she wasn't just booking me to get ahead, there were practically no appointments left for the date ranges I needed! I asked to try and have my appointments with S but she was only available for my July and August appointments. I also needed an OB since I'm not delivering with my wonderful Kaiser A one, so this nurse booked me with the head of this labor and delivery unit. Then, since I'm over 25 and I'm an even chubbier chubster than usual thanks to IVF, the nurse had me take the gestational diabetes screening test.

(Source)

OMG this stuff was disgusting. It tastes like some sort of burning, chemical orange soda and is in no way, shape or form morning sickness friendly. It's now been over 6 hours since I drank it and I still feel sicker to my stomach than normal, and my intestines are making all sorts of angry noises. I somehow managed to choke it down and not vomit, finished up the appointment and then went to have my blood drawn an hour after the drink. I guess the nurse didn't see my previously updated STD panel in my chart that I just did for the clinic so she ordered another full panel along with the glucose and urine test. 10 vials of blood after drinking the Glucola and not being able to drink water or throw up? Not fun. 

My next appointment with Kaiser is in just a week or so to have my physical and first Kaiser ultrasound. Luckily, we won't actually have to wait that long to see our little bean since our next clinic appointment is this weekend.  Two ultrasounds in less than a week? We're going to get spoiled :) This time I just need to remember to ask E to get some video footage for me.

18dp5/6dt - Up, Up and Away!

Yes! I successfully had my labs run at Kaiser this morning and it didn't cost me $300! I'm so glad we were able to get them ordered in time, although it turns out they accidentally got put in as routine instead of STAT. The lab was able to get the HCG back today since they run that on location, but my estrogen and progesterone had to be sent out to their main lab about 30 min away. Considering that they don't do pick up until 12:30 and tomorrow is a Sunday, I think it's unlikely that we'll have those numbers before Monday. I'm not super concerned about it since those hormones are pretty much set by the 4mg Estradiol and 200mg Endometrin I'm taking each day.


 So, at 18dpt or 23dpo my HCG is an impressive 13,024! Going back to betabase.info:

For a singleton pregnancy, we're still on the chart but getting even higher. Only 5.3% of singleton pregnancies reported have an HCG about equal or higher to mine at 23dpo. 

For a twin pregnancy, we're in the high average. 34.6% of twin pregnancies have an HCG about equal or higher. We're actually at the high end of the average group too, another 700 points and and we'd be in the 9.8% of reported twin pregnancies with betas over 13,723 today. That's really only the difference between a morning and afternoon beta.

My doubling time is also still really fast. Usually things have started to slow down just a little bit by 5 weeks but my body clearly didn't get the memo.

At 40 hours, only 14% of reported single pregnancies have a doubling time equal or faster while 52% of reported twin pregnancies have an equal or faster rate.

I know it's entirely pointless to speculate about 1 or 2 at this point, but our ultrasound isn't for another 9 or 10 days and that's a long time to be left wondering. We put in one embryo with the hope that we'd get one baby, the idea that there could potentially be two in there has got us all thrown off. E has always teased me that the only way we'd have three children would be if we had one set of twins. I had thought that option was lost to us, at least without another round of IVF  and assuming we could have any at all, and the idea that the universe might be orchestrating some twins for us after all is wonderful.

17dp5/6dt - OB Labs

As I mentioned in my previous post, once we got our first positive beta we officially completed the protocol for our frozen embryo transfer. This is pretty standard protocol, I knew that our FET fee wouldn't cover our ultrasounds but somehow I got my wires crossed and thought that it would cover all our betas and hormone tests. That was a $450 surprise and both the clinic and I were hoping to avoid more expenses like that if possible.

Since E and I have Kaiser, our insurance should cover all prenatal care - labs, ultrasounds and appointments. However, since our plan is an HMO, they won't cover any outside care that isn't an emergency even when it's prenatal. Darn. The ultrasounds we can't get around because Dr. D has to check up on our little embie himself, but any lab can run blood tests. So, today Dr. D's nurse sent over a lab order and I had the pleasure of figuring out how to translate that order into the Kaiser system.

I think at a regular lab, I'd just hand this slip over. Not so at Kaiser :/

Unfortunately, my first and second choices for getting the labs ordered were unavailable. Both my acupuncturist (and Kaiser nurse midwife) and OB/GYN were out of the office today and wouldn't be back until Monday. My labs needed to be drawn on Saturday so that wouldn't work. My next option was to leave a message for the on call OB, which I did, but didn't feel particularly confident about it since I don't know them. After waiting a couple hours and not hearing back from them, I went for the last resource I could think of, the Kaiser infertility department.

Unlike most departments of Kaiser that prefer you contact them through the general number, the infertility department gives patients a direct line. While I was doing my IUIs with them, I never had to fuss with an automated system or tell the general system receptionist what I was trying to do. There was always a nurse or assistant on the other end of the line and there was one there today when I called almost a year to the day after my first IUI baseline appointment. I explained everything to them, that I had done IUIs there a year ago, moved on to IVF and now that I had a positive beta I was looking everywhere for someone to order tests for me. They were predictably awesome.

Two minutes on hold, during which two other nurses picked up to see if I was a new caller who needed something, and my labs were ordered. Thanks Kaiser Infertility. I should have called you guys straight away, IUI might not have worked for me but you've been awesome from the very beginning.

I hope these lovely dark lines translate into a super high beta tomorrow. I think we're shooting for something around 6,000 but I'm not completely sure. I think doubling times are supposed to slow to 72-96 hours from 48-72 hours between 5 and 6 weeks. 

New RE = More Tests

So after waiting over a month for the urology appointment, the Kaiser system worked a little faster and we were able to get in to see the RE on Black Friday. My overall impression of her was positive, she allowed us to share our story and explain where we are and agreed with most of our assumptions and concerns. For me, she ordered more lab work as well as a saline ultrasound and a hysterosalpingogram. For E, another couple lab tests. Once we begin the procedure for IVF, Kaiser will no longer cover anything so she would like to cover all our bases now.

I will have to go in for my labs on Monday and pick up a course of antibiotics for the hysterosalpingogram since E had to get to work on Friday and we didn't have time. The RE said she very rarely has a case where they can't find any reason at all for male infertility and thinks E might have a microdeletion on his Y chromosome. If he does, the location will play a big part in whether we're able to retrieve viable sperm. And, if we can get viable sperm that produces viable embryos, we will have to have PGD to select for female embryos since any male children will inherit the same deletion.

However, given the information we have thus far, it's likely that we're going to have to use a donor. The RE does agree that I have diminished ovarian reserve and is very concerned that we may have a rapidly closing window to retrieve viable eggs. There was also some confusion over my AFC, during the appointment the RE at the fertility clinic told me 3 and 4 follies for a total of 7. However, the paperwork he faxed over said 3 and 7 for a total of 10, which while it would be AMAZING, doesn't match up with my FSH or my memory. Regardless, the new RE is concerned that in a couple years I will not have any eggs left.

Given that prognosis, we need to think seriously about the IVF vs IUI decision. Kaiser would pay for an IUI, which would be much less invasive and inexpensive. If we were successful, it would probably be at least 2 years before we tried for a second child and by then I might be completely out of eggs. If I did still have high quality eggs left for siblings, we would need to store our donor of choice and do IUI again. If we do IVF now, it will be entirely out of pocket, more invasive and expensive, but will hopefully yield enough embryos that we can freeze some and use them for a second and/maybe third child. It would also mean we would have the same donor for all our children since the embryos would all be made at once.

We've been talking back and forth about it and have just started to casually look at donors online. We won't have DH's results for another month since they have to grow the genetic test in culture, but they probably won't be good. In the meantime, the RE wants me to take DHEA three times a day, keep taking a prenatal and see if I can get my thyroid levels down. While all my tests for the past 10 years have been below or around 1,  my last one was 3. Although it's still technically normal, numbers over 2.5 are associated with much higher rates of miscarriage so I'm going to need to do something about that.

I'm Insured!

When I woke up this morning I had an email from Kaiser waiting for me in my inbox.

The verdict?

I'm insured!

Apparently it is possible for a young, healthy individual with no pre-existing conditions to fork over a crapton of money each month for health care coverage. Honestly I can't believe how expensive it is, I'm going to be paying over four grand a year for the privilege of continuing to never go to the doctor lol.

My choices were the $25 co-payment plan or the $30/$1500 deductible plan. Both Kaiser, since there was no way I could afford the higher deductible plans offered by Anthem or Blue Shield. Those plans have $5000-$15000 deductibles which makes the insurance pretty much useless.

With Kaiser, there's about $100 difference per month between the plans. But, if we want to have a baby in the future it seems to pay to go with the $25 co-payment plan. With the $25 co-payment plan, a pregnancy and delivery is about $500. With the $30/$1500 deductible plan the same pregnancy and delivery would be about $2500. We're only talking about maybe an $800 difference when you factor in the higher monthly cost, but E felt it was worth it for the time being.

Either way, I'm really glad that I was deemed an acceptable candidate and offered insurance. There are so many people in the US who can't get insurance either due to a pre-existing condition or inability to pay the insane premiums. I'm so thankful that E and I are in a position where we can afford(ish) to pay for decent coverage. This way if I'm ever in an accident or we do decide to add some tiny humans to our family, we won't go completely broke paying for medical bills.