Test Results Equal Shitty News

There’s alot happening all of a sudden – I’m going to break it up into a few posts:

Monday my husband and I sat down with Dr. Hail Mary thinking we were there to ask some last minute questions and then charge into IVF4: The Final Frontier. I had repeated the endometrial receptivity/Beta 3 integrin biopsy on March 31 and those results were already in.

Good news: the Beta 3 integrin was now positive. Bad news: my lining was still out of phase “despite aggressive treatment.” Dr. Hail Mary explained that this meant the cells weren’t getting the message from the progesterone and estrogen and therefore the lining was not receptive to implantation.

Think of it this way: my lining is Quantity over Quality.

Basically: there’s enough lining but implantation is highly improbable in that environment.

He said, “In this business we pay so much attention to egg quality that sometimes we disregard the environment we’ll be putting that embryo into.”

He figures this is the most likely reason I miscarried and have had 3 unsuccessful IUIs and 3 failed IVFs.

Y’all: my eco-system is off.

He doesn’t know why my lining is out of phase. He said it shouldn’t be an age issue and there’s every likelihood that it’s always been this way – meaning I may have had trouble whenever we’d tried to conceive. He’s not sure of that by the way, but it’s a possibility.

Oh and our fertility insurance runs out May 31 (it’s attached to my husband’s contract which ends May 31) so basically we have 8 weeks of coverage left.

It’s always somethin’ am I right?

The doctor recommends more testing cycles to see if he can figure out a) what may be causing the out-of-phase lining and more importantly b) if he can fix it. There’s some trial-and-error involved here since he doesn’t know why his usual methods didn’t fix things.

Given our waining insurance situation he suggested we proceed with our final IVF cycle (insurance covers 4), go through stims, see if there’s anyone to freeze, freeze them, THEN do at least one (if not more) cycle of testing to try to make my lining receptive and then hopefully move forward with a FET (Frozen Embryo Transfer) or perhaps use a gestational carrier (insert the giggles of two midwestern lower middle class people in their 40s with no retirement plan).

Basically we’re looking at a rough estimate of 4ish months (2 months for IVF, 1ish months for testing, 1 cycle for FET) before I can do that transfer….so end of July or August.

He was….not hopeful….pretty matter of fact….and honest in his confusion over why my body doesn’t seem to be playing ball. My husband asked if there’s the possibility that he might not be able to fix this phase issue to which the doctor said, “that is a real possibility.”

It’s not just my age anymore, there’s actual stuff keeping me from getting pregnant.

This pill is far more bitter and harder to swallow than I’d anticipated.

It feels like my already low chances of getting pregnant at 43 just dropped. Alot.

The doctor estimated that a woman with my ovarian reserve has approximately a 10% chance of GETTING pregnant. STAYING pregnant is another matter…..that number is significantly lower.

We’ve been talking alot and mulling over what to do….and I think we know what’s ahead of us.

More on that tomorrow.

 

Insurance: To Cover or Not To Cover

So Friday I had the following email exchange with my RE’s office regarding our upcoming laparoscopy to look for endometriosis:

RE’s office:    

I just wanted to give you a heads up that as of right now, (Insurance Co) is denying your surgery. A negative Beta  Integrin  test  is not justification for laparoscopy.  [We will] review your history to  determine if there  are other signs/symptoms to support a laparoscopy. I will keep you posted on Monday after we are able to review your chart.

Me:                  

Out of curiosity, with so many women asymptomatic (as I am), how does the surgery usually get justified? Or is this often a problem?

RE’s office:    

It is a problem …. Beta Integrin testing (that’s the gross biopsy I had a few weeks ago and will likely repeat) is not recommended/approved by ASRM. That’s why insurance does not cover the test and you had to pay for it out of pocket.  It is a controversial subject in the field. It is kind of one of those theories that has  not been 100% proven or backed by the RE community and studies.

Me:                

Oh I get that – but what about ladies who don’t have symptoms (a 1/3 of women with endo don’t have symptoms) but it becomes necessary to check to see if endometriosis is present….that it’s the culprit for fertility problems? Do you have to go through this every time?

RE’s office:  

If patients are asymptomatic there is usually no need to check for endo.  The only reason we typically do a diagnostic laparoscopy is because someone has symptoms and we have a hunch that those symptoms are due to endo so we go in a look to confirm if our theory is correct.

So…..hopefully they’ll be able to make the case, because it would be nice to know what’s going on in there…and if there’s something going on in there, do something to fix it. We will not do the lap if it’s out-of-pocket. It would be thousands and thousands (and thousands) of dollars, and since it’s only to “look and see” we’d rather save those thousands and thousands (and thousands) of dollars to put into our adoption fund if IVF4 doesn’t pay off. (Speaking of, we had a great meeting with an adoption agency a week ago – I really need o write about that soon).

I have a pre-op phone consult tomorrow to discuss the surgery….hopefully I’ll know soon if I’m actually going to have it.