No Laparoscopy for This Lady

So insurance will NOT cover the laparoscopy to look for endometriosis. Shit. Not that I was in any way looking forward to going through a laparoscopy (especially since I have to fly to Boston 2 days later), but it would have been nice to have that information and something to treat if something was there.

Well….my Friday’s now open….anyone wanna catch a movie?

We are repeating the Beta 3 integrin biopsy (super gross) at the end of this cycle/end of the month so we will see if it is again negative or if it’s positive (it can change month to month). I am also taking delestrogen – injectable estrogen – every other night to see if this stronger medicine can take care of the “out of phase” issue with my endometrial lining (build up the quality not just the quantity). So that’s two things we’re hoping to fix with this trial/test cycle.

If that Beta 3 integrin’s negative again they want to treat me as if I have endometriosis: Lupron for 3 months or Birth Control pills with Letrozole/Femara (don’t know how long that would be) to hopefully shrink whatever might be there (might be there because we don’t know if I even have endometriosis because I can’t get an exploratory laparoscopy – Eat a D insurance company) and get the environment more suitable (Beta 3 positive) for implantation and occupation.

Now here’s the pickle: we don’t have that kind of time. My hubbo’s contract is up in a few months and our bells & whistles insurance is tied to that. I.e. our fertility coverage goes away end of May/June-ish – he’s in touch with his HR person to get a firm answer on what timeline we’re looking at.

So….we may have to say Fuck It to all this stuff (remember: “ignore all this info and proceed” was one of the options Dr. Hail Mary gave us) and move forward with an honest-to-goodness-low-probability-of-success-but-giving-it-a-shot-anyway IVF starting next month.

Timeline for now: some bloodwork & ultrasounds on 15th, 20th & 25th to see how body’s responding to delestrogen/progesterone trial cycle, Beta 3 integrin biopsy on 30th or 31st…..then we wait the 10ish days for that test to come back.

AND! We really need to make a decision on when to move forward with the adoption process – we’re not getting any younger and that’s a (probably….potentially) LONG process. The first step is 10-12 weeks of paperwork/interviews to get past the home visit stage….which is the point at which potential birth mothers can start seeing your profile. The woman we met with felt we were great candidates, in part because we have very few limitations on the child we’re looking for – we just need to fill out the application and get going. 

But you know – who wants to drop a few thousand on the start of an adoption process only to find out their IVF worked (Hail Mary!!!). It’s only a few more months of waiting…but I’m feeling antsy about making things happen/wanting to be proactive.

It’s alot. It’s all alot. For the first time I wonder if I’m cracking a bit under the pressure. I’m mostly okay but there are a few more “rain cloud” moments within the day where I’m thinking too much and wondering when the tide will turn. I still have all the faith that we’ll end up with our family – it’s just feeling like it’s taking an awfully long time to get there.

Clearly I need to go that Liam Neeson movie and hope for some throat punching….Friday? Anyone? Chicago? My treat!

 

 

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.

Diagnosis: Numerous Implantation Hurdles

So more tests have rolled in and unfortunately they’ve presented some issues. Luckily we were able to get in with Dr. Hail Mary this morning to get an explanation of what those test results mean and what we should do about them.

While we’re still waiting on the results of the receptivity biopsy, the Beta-3 Integrin biopsy has come back negative…and this is one that you’d rather hear “positive” as a result. Beta-3 integrin helps with implantation….without it, things are…..”tougher” – not impossible, but “tougher.”  Also, they also found out that my endometrial lining is out of phase – meaning, it doesn’t mature at the proper time (this could be causing the negative Beta integrin) which also makes implantation difficult. The negative beta integrin can also be secondary to inflammation – meaning, there could be some endometriosis in there.  (These issues are on top of the elevated Protein C we found out about that can also get in the way of implantation – I’ll take blood thinners for that).

By the way – I am completely asymptomatic for endometriosis, but the doctor roughly 1/3 of all women with endometriosis do not have any symptoms.

He gave us 5 options for how to proceed:

1. Repeat test/trial cycle with a different hormone protocol i.e. injectable estrogen to build up lining and injectable progesterone to mature the lining – see if they can build as hospitable apartment in there.

2. Ignore the results.

3. 3 months of Lupron to shut down system, shrink any endometriosis (if there’s any) that might be causing negative Beta-3 and then try to get pregnant after that.

4. Laparoscopy/hysteroscopy – go in, look for endometriosis, get rid of it if it’s there.

5. Use a gestational carrier.

We found 2 not so logical, 3 not really an option due to our insurance ending in May/June (at least insurance that has fertility coverage, so we need to get this show on the road) and 5 just made us giggle.

So, we’re going to combo-platter 1 and 4: test/trail cycle at the same time as laparoscopy.

If they get in there with the laparoscopy and there’s no endometriosis then we’ll continue the testing/trial cycle by repeating the endometrial biopsy to see if the injectable estrogen/progesterone did the trick re: maturing the endometrium during the necessary window of time for implantation. If they find endometriosis then we’ll end the trial cycle – the doctor figures that would be the cause of the negative Beta3, therefore no need to repeat that biopsy (which was a real joy to do the first time…..cough cough…hey look over there!).

I mean, it’s enough that I gotta stress about making at least one friggin good embryo – now I gotta worry about even being able to build a house that’ll accept a resident!

The laparoscopy is scheduled for next Friday, March 14, so we’ll see what we see then. In the meantime, I start injectable estrogen tonight.

Ah the joys of what we do.