The Saga of Becoming Fruitful

Archive for the ‘Who's Taking Care of You?’ Category

My First “Reproductive” Acupuncture Experience

So today was my first (ever!) acupuncture session.

I did not go to those clinics which called and/or advertised themselves as having expertise on ‘reproductive’ acupuncture. Instead, I chose to go to one of the earliest acupuncture clinic in town because of 2 reasons - 1) they are in-network with my insurance, 2) the acupuncturist/s are real Chinese … so maybe they are the “genuine” articles.

(That’s not meant to be reverse discrimination … it’s just my way of crooked logic. Maybe I should go to those “reproductive acupuncture” experts… I’ll try the “real Chinese” guys first and see what happens…)

My acupuncturist recommends herbs but I refused them since their interaction with fertility medicines are not known. She said that my ovaries and uterus may be “cold” so she recommended that I do not eat nor drink anything cold.

Anyhow, I got needles on my inner ankles, knees, elbows, wrists …..

… and my stomach (one on each side of the belly button).

And I had a warmer directed on my belly area, too. Remember… my ovaries and uterus are suspected to be “cold”.

Anyway, it wasn’t bad at all. I did not feel most of the needles while some I felt antbite-like sensation when the needles were tapped in. I was soooo relaxed that I think I dozed off during the 30 minutes that the needles were in.

And I could still drive after the session, contrary to what I read in the internet (Cleveland Clinic).

…..

And once again, those 1-800 folks from my insurance told the acupuncture clinic that I still need to have a co-pay (despite meeting my Out-of-Pocket Maximum already) …

GRRRRR…

The office girl at the acupuncture clinic was the only person on the office that day, so she was kind enough to hold off charging me…

My plan is to call the insurance next time I go there and get them to talk to the office girl. I hate having to go through another “They told me (office girl)” vs “They told me (me)” cycle again…

…..

Hey… for those of you who are doing acupuncture for enhanced reproductive health, where are the acupuncture points where they put in the needles?

Update on “Free” Chiropractic Services

The post on the Geriatric Pregnancy caused a bit of a stir, huh?

Here’s a quick update on the insurance coverage issue I mentioned in previous posts - that my “copay counts towards my Out-of-Pocket (OOP) Maximum”.

I finally pinned down United Health Care on not paying (even) any copay for my chiropractic treatments since I have met my OOP for the year. So now, I don’t have to pay anything…zero….zilch…nada… woo hoo!!! Well, at least for the rest of year 2008 since I have 20 sessions allowed. 18 more to go…

UHC is “wise” though… they want the chiropractic service provider to re-file and re-assess the case (moi!) after every 7 sessions. I guess to make sure that I’m not just there for the massage… which I am there for mainly

Anyhow, it took a total of 2 calls from me and 2 calls from the service provider to establish this - the last call being at the chiropractor’s office where both the office person and I had to speak to the insurance’s 1-800 folks. For some reason, those 1-800 folks somehow end up reading the family OOP… every time … instead of my individual OOP. I’m not sure if those were honest mistakes or if they are trying to avoid paying.

Well, you just have to “know your rights”…

Woman - Are You a Geriatric Case???

I went to see the Chiropractor - only the 2nd in the last 12 months of my 40 year-life. It was my first time to see her and she is good! She massaged my back, eased my very knotted shoulders and adjusted a lot of my bones! Crack and pop! Whoa, I feel much better!

Guess what? After NOT trying for 11 years, she had an unplanned pregnancy early this year but miscarried. She is 35 years old, 3 months pregnant again and still cracking bones.

I asked her until when she will be able to do that (as I like her already even if it is just our first appointment and I don’t want to be passed on to the other practitioners). She said she does not know yet and will just have to wait and see…

Anyway, her doctor called her a case of “geriatric pregnancy”. Hu-wat??? Say it again… GERIATRIC PREGNANCY. If she, a 35-year old woman , is considered a geriatric pregnancy case, that means I, 40-years old, fall in that same category also (I am not pregnant though, I just wish though…)

Wow, I never thought of my case being “geriatric”. Somehow, I reserve that term to the really, really old people - all wrinkled, gray hair, slow-moving and stooping. Yes, we all go that way in the future…but meanwhile, I just never thought of myself in that way at this time.

Hmmm… the Reproductive Endocrinologists do call our cases “Advanced Maternal Age” - are they just being nice??? Or does the terminology change once they turn us over to the OB/GYNEs???

…..

When she learned that I was trying to get pregnant too, she mentioned that she had a couple of friends who had difficulty conceiving and were able to get pregnant after going through acupuncture. She specifically mentioned one who was getting periods 2x a year only and got pregnant!

I’m not easily affected by such statements but hmmm…. I’m just wondering if acupuncture is the new “just relax and you’ll get pregnant” or “if you adopt, you’ll get pregnant” statements?

…..

Now, I mentioned in my previous post that the insurance’s 1-800 number said that since I have met my Out-of -Pocket max expense for the year, that I do not have to have co-pay. Well, the Chiropractor office asked me for a co-pay since their system showed that I still need to have co-pay. I’m disappointed but I’d like to go back and continue my “therapy”, so I paid the co-pay.

I called the insurance 1-800 number again and they did confirm my original understanding. I called the Chiropractor’s office and they said they will look into it. I told them that I would like to have that settled before my next appointment because I do not want to keep paying if I do not need to (even if they will refund it).

After I confirm that my insurance does take over 100% and no copay after meeting my Out-Of-Pocket, Acupuncture is next!!!

…..

Ohhhh… all the blogging ideas coming to me when I am laying on my tummy and getting my back massaged!

Thoughts After IVF Orientation

DH and I went to the IVF Orientation last Wednesday.

What I liked about it are:
1. They described (albeit briefly) the 4 drug protocols they use for the IVF Stimulation and had timeline schematics that described how each one differed. The timeline differences was clarified for visual-me.
2. That was the perfect opportunity that DH had to get the big IVF picture aside from the information that I have been sharing with him. He did say that the info are pieced together well and he understands the IVF process better now.

What I did not like was that our clinic does not offer CGH yet. Since they do offer PGS and test of 9 chromosomes only, I assume that they ask their provider labs to do FISH. We talked briefly to the embryologist and he said that CGH was “interesting, but it is still very new”. I guess they are more conservative in adopting newer technologies.  DrB did actually mention a couple of times that there is a tendency of “let’s not change this since it is apparently working anyway”.

Since we do want to do the egg CGH, this may mean out-of-state IVF treatment. I can think of 2 challenges for going that route. I am sure there are more but these are what we could potentially be facing sooner:
1. Finding a local physician who is willing and able to collaborate with the out-of-state physician. I could go back to DrH but I am not comfortable with it right now. (She’s nice but I do not know how she will react to our potential plans. I will probably have to think about this more later, if we do proceed out-of-state.) Meanwhile, I have scheduled to go see 2 OB/GYNEs to check them out.

For those of you who are doing/planning out-of-state, what has been your selection experience for a local physician?

2. DH’s paid-time off are already spoken for for almost the rest of the year - 5 days in New York this month (woo hoo vacation!!!) and 3 days forced vacation due to facility shutdown. He seems to get the idea that he cannot do unpaid-time off… He has the assignment to check out if and how FMLA can be used.

For those of you who are doing/planning out-of-state, how does FMLA, if at all, figure into the treatment schedule planning?

CD1: Phone Consult on Infertility Treatment Pathforwards

Ms Flo arrived yesterday with a lot of aches on my lower back and the back of my legs.

So on Thurday morning, I called in to the clinic as instructed and actually get to talk to a live person! Woo hoo! J used to be the one calling me up on updates - I have met her face to face already, so that’s good. This is a cleaned up and shortened version of what transpired (or at least this is my recollection):

Arpee: I’m having a weak flow but that it may be CD1 already since I was passing clots. Remember that the last 2 periods that I had were similarly weak and clot-passing, and that is why I think this is my real flow and this is CD1.

J: Alright. So what cycle are we doing next?

Arpee: I don’t know. (intentionally remained silent.)

J: I don’t have your chart with me right now, but are you looking to maybe another clomid cycle or injectables cycle? (Gets chart, I think) Oh yeah, you are in injectables now. So you’re looking into whether another cycle of IUI or move to IVF.

Arpee: Yes and I was hoping we could have a talk with DrH so that we can discuss it. Can we have a phone consult with her?

J: Unfortunately, she doesn’t do phone consults. What we could do is to schedule you a consult with her on the 28th. Or we could schedule you in for a baseline ultrasound … I would need to squeeze you in tomorrow since DrH is out on the weekend… and then you can talk to her after that.

Arpee: Wow, the 28th…that’s a long time from now.

J: Well, you can come in tomorrow but I would hate for you to pay for the ultrasound if you didn’t need to if you are not proceeding yet to an assisted cycle.

Arpee: Yeah, me too. I just want to know if she has a recommendation on next steps.

J: How about I write her a note and I’ll get back to you within the day?

Arpee: That would be great. Can ask her also what she thinks could be learned and further improved based on our previous cycle?

J: Alright, will call back later.

So I went off with my day, mostly in front of the computer… until I got a call back from the clinic later in the afternoon. This time I got K who is currently the one giving me updates - I’ve met her face-to-face as well (but she is also the one who should have called me regarding my recent beta-hCG results)

K: Hi. I talked to DrH and she said that she recommends IVF.

Arpee: Did she elaborate on why she recommends IVF to be the next step?

K: No, but I think it is because of your age and the past cycles. Would you like to talk to the IVF Nurse? I can transfer you to A so that she can let you know what to expect.

Arpee: Sure, why not. (Transfers me to the IVF nurse and I will write another post on that.)

Meanwhile, I just realized that although I did not get a phone consult directly with DrH, I did get an indrect phone consult through the nurses as the middleman. It wasn’t the best way to do it since they cannot sufficiently answer the questions I asked such as:
- What could be learned and further improved based on our previous cycle?
- Why is IVF being recommended as the next step for my case.

Although I understand the generic answer of “because of your age”, I thought I needed more convincing on why another IUI is not a good idea. I am thinking that a even just a phone consult with DrH would have been more spot-on. (Thinking now…. DrS in Boise, ID (whom I mentioned somewhere in this blog as being not aggressive enough and not keen on explaining things) earns a point for having a phone consults.)

What was your experience with the clinic and your RE (or FS) after a failed cycle? Did you get a call from your RE (or FS) directly? Did the clinic initiate the call regarding next steps? Did they seem to be on top of your case when you have a conversation?

For those of you who will kindly share their experiences, can you please add if your clinic is a big or a small. (I know, “big” and “small” are subjective. For this post though, let’s just say, if it is a single practice (not a partnership), let’s call it small.)

July 2008 Cycle (7/7-8/7): 31 days
June 2008 cycle (6/2 - 7/6): 34 days

My Doctor…

I recently got a forum message regarding my RE, Dr H. The forum poster #1 was not happy with her and went to another doctor instead. I responded that overall, I was happy with her. Later, another poster #2 added her 2 cents not on Dr H but another Dr in the same center. I’ve culled some excerpts here but if you are interested in the whole context and everything, you can read it at SoulCysters.

Poster #1:

Arpee~ That’s interesting that you like Dr H. She was my RE for over a year and I had a different experience than you, unfortunately. I ended up doing 6 cycles of IUI, 5 on clomid with one BFP (ended in m/c). Even though I only ever got pg with a trigger, she constantly pushed for OPKs (though my records clearly showed a history of high LH and unreliable OPK results). We went in knowing we had relatively severe male factor and yet she did not change her normal protocol for us AT ALL. My m/c was horrifying at that office. DH and I went in to see the h/b at 7wk having had an earlier bleeding scare (so we were relatively ready to hear m/c). She just sighed and said, “Looks like you’ll have to try again with another embryo.” And her staff just walked out like rats on a sinking ship. She told me it would be like a heavy AF and to call after it was over and we’ll do another cycle of clomid. Needless to say, she was totally wrong. When we were told the numbers from DH’s post-wash count, we were never told the total motile. After I got the records, the counts were below 5 million for the last 3 cycles. These are well below the 10 mil threshold most clinics use for IUI. We could have just saved the money for the IVF that we now have to do. They never called when they said they would (which is scary early in pg when you’re waiting for beta and progesterone numbers) and you may have to explain your situation multiple times depending on who answers the phone. Needless to say, I’m over at Dr Y’s office and they are 10 billion times more compassionate and informative. I got (correct) statistics for our situation. I really hope you have a much better experience than I did!

My response:

Hey NerdyGirl,
…when I was looking for an RE, I searched the internet for reviews and got 1+ and 0-. Also, I wanted a woman RE and at that point, it was her and the new lady doctor at the same clinic. So I opted for the “older” one.

Just like I mentioned earlier, I like it that she is a straight shooter. Perhaps because I am so myself. They’ve been good at calling my stats to me, so that aspect is not a problem, either.

Your post and some recent experiences though gave me some things to think about:
1. When she saw that my cysts have shrunk already, she said that we were ready for the next Clomid cycle. Wrong…we were ready for our next Follistim cycle. (I realized doctors don’t typically review the charts before they see you.) (My blog details it more.)

2. She told me to use my leftover Follistim (from my 1st cycle) for my 2nd cycle without warning me about the 28-30 days allowed time in the refrigerator once the vial has been used. Good thing I called them today to ask about it. I should have not even used it for the 2nd cycle. The “good news” is that the med seems to be still working (at least until the 3rd Follistim day monitor) even if they have “expired”. Will see tomorrow if that “good news” continued up to the 6th Follistim day - although I use a new vial tonight that my husband will be picking up from her clinic later today.

3. She made a “deal” with me when we cancelled our 1st cycle (due to OHSS symptoms starting to show) that she will shoulder 600IU of my meds. Now that I am following up, her staff got back to me that what she said was that she was going to shoulder half of my meds - 300 IU. $300 worth - not too big of a deal. But that may be an indication that they do not track what they are promising their patients too well.

So you did 5 clomid and 6IUI cycles with her? Anyway, if things do not really work out with her, I may consider going to a male RE. Being of advanced maternal age and 2 miscarriages, it is possible I will be needing a perinatologist. So I like it the idea that they will be the one who will continue to care for you until you give birth - instead of being passed on to a next doctor, the perinatologist.

Thanks for the info! And I wish you health as you and your DH prepare for your next IVF cycle!

Poster #2:

I have to chime in on that center vs Dr. Y issue. I posted this some of this story on the other Austin OB thread, but I think it has relevance on this thread too.

I went to that clinic in February 2005 from a referral from my old GYN at Women Partners in Health (she’s since moved out of state, so no reason to state her name). I saw Dr. V, and neither DH or I were very impressed with him. My GYN had been seeing me for several years, and we had been trying to get pregnant. She ordered an u/s to “check” for PCOS, and I just happened to have the one cycle that I ovulated in about 3 years during that u/s. So, they ruled out PCOS because I was ovulating. She did the standard fertility workup, and found that my progesterone was low and my estrogen was high. So, I had a hormonal imbalance and she sent me to TFC.

Dr. V met with us, and told me that based on my records from WPinH that I had a hormonal imbalance based on me being overweight. That’s it. Nothing else. He didn’t do any tests, didn’t look at other factors like my overall family medical history, my appearance, etc. He said that I needed to go on BCP to regulate my hormones, I needed to lose 40 pounds, and then, and only then, would he start me on Clomid.

I started seeing a new Family Practitioner in April 2005, and she diagnosed me with PCOS right off the bat from medical history and my appearance (where I carry my weight, hair growth/loss, hormone profile from the GYN tests, etc). Her blood tests and putting me on Met confirmed the diagnosis.

I started seeing Dr. Y in November 2005 on my old FP’s recommendation, and at his office we finally saw the string of pearls cysts on my ovaries during an u/s. I talked to him about starting Clomid, and we elected to wait until after the beginning of the year (DH’s benefits started covering infertility then) and for me to try to lose 5% of my weight. I had an appointment on Feb 28, 2006 to talk to him about starting Clomid, and I got my BFP for DD#1 on Feb 24 from Avandamet alone.

The moral of the story is that I went for 3 long years not being properly diagnosed, and I feel Dr. V at TFC was part of that. I don’t know if I would have had a different experience if I had seen a different doctor at TFC, but if nothing else, the attitude I got at TFC and Dr. V regarding my weight put me off of them entirely. My FP who diagnosed me thought that putting me on BCP when I was TRYING to get pregnant and needing infertility treatment was the dumbest thing she had heard of. She was also not happy that a fertility clinic/reproductive endo office missed the PCOS diagnosis when I exhibit pretty much all the clinical symptoms.

In the interest of “balanced” views here, I am adding excerpts from other forum regarding Dr H and the center she has her practice on:

We used Texas Fertility (Dr H) and really liked them. They are really good about making you feel at home & comfortable asking questions. I was sad when we got ‘promoted’ to a regular ob since everything went so good. Dr V (one of the physicians) was on one of the local news channels recently and is very well known. They also have a class (free) once a month that is super informative. Their statistics were very good when we checked although right this minute I can’t recall where we looked but I think it might have been through the Tx center for Disease Control? Anyway, hope this helps and just fyi….we are 18+ weeks w/ twins!!!
- MedHelp

I am currently going there. We had our 2nd IUI today. About half my class from last year was concieved through them. (IUI’s, IVF and donor eggs) Everyone has been really nice and personable. There office staff is great. They try to squeeze you in when they can and are always patient. I am seeing Dr. S but have also seen Dr V and Dr H for ultrasounds.
- Mothering.com (This one has more related posts, so just go there if you are interest in more.)

I think we all have to take these varying inputs like these with a grain of salt. This is where “different strokes for different folks” is very applicable. None is right or wrong. It’s just that there are some things you are looking for and some doctors you just can’t work with. To each her own, just like the many churches one sees around, they cater to different people.

That is why it is so important and proactive to research and do the rounds when looking for an RE (or any health care specialist for that matter). I would really, really, really think twice in setting up a first meeting if my research had shown consistent negative feedback on a particular doctor or center.

In my case, my research on Dr H’s practice’s SART stats vs other centers makes me feel more comfortable with theirs. So from a numbers standpoint, I like them. I know it is more than the numbers…but so far, my actual experience has been well.

I’m pretty happy right now with Dr H. I have no compelling reason for me to transfer to another RE at this point.

How about you? Have you switched REs in the past and what was your breaking point?