I've often referred to my ovaries as inconsiderate, inconsistent, sadistic little bitches, who have felt under appreciated for many years and now enjoying their moments of revenge. My follicular phase follows our google calendar and my LH surge seems to be correlated with the most inconvenient time for coitus. However, I have to give an nod of appreciation to the girls, (although it's probably the influence of the Femara and HCG trigger, but at least they're playing along) as my recent cycles have allowed me to schedule my monitoring appointments on a Saturday. I can bank my excuses for needing to leave work and use them when we're doing IVF.
I initially had little sympathy when my RE told us at our initial consultation that he works 6 days a week. I admit I developed some sub-specialty resentment while caring for a morbidly obese woman who was impregnated via IVF. My first objection was to the fact that someone in such an unhealthy state should not be exposed to the dangers of pregnancy (she had premature rupture of membranes at 28 weeks and later developed a blood clot in her leg) but on a personal note, I was woken up many times during the night to help the nurses locate the baby's heartbeat with an ultrasound so she could continue to be monitored. Every time I left the call room, I thought about how soundly her RE must have been sleeping at that moment.
Well, I have a newly found appreciation for RE's schedules, as well as for many other aspects of their difficult jobs. In particular, both providers at my RE's office work their own schedules on Saturday. The office of Co-worker's RE was open 7 days a week, but each provider alternated working on the weekend. She found it was interesting that the two had such conflicting approaches and styles, and she ended up preferring her RE's partner and awkwardly hoped her cycles would coordinate with his weekends. I was relieved that my RE didn't say anything to the effect of 'I'm sorry this IUI didn't work'. Especially, as he was probably thinking, 'yeah, I'm not surprised to see you back here.'
After getting the green light from my quiet ovaries to proceed with this IUI cycle, I started thinking about the logistics for the next one. If my trigger and procedure dates followed the same time as my last one, the mid cycle monitoring would need to be done around Memorial Day weekend. I'm sure the office will be closed for their rare long weekend, but I also have to travel to the east coast that weekend. Last year when I flew back on Memorial Day, I was bumped of my flight and didn't return until a day later. I would be hesitant to proceed with a cycle that compromised the time frame in any way. There was another consideration; Husband has a hockey tournament that weekend. Although I know running around for three days probably won't have too much of an effect on his count, but it just doesn't seem ideal. The more practical consideration was how he would be able to adhere to the wank schedule in order to reset in time for IUI day. I've heard stories from others who succeeded on cycles that felt less than optimal, but I don't know if I want to take that risk. Husband and I began to consider if we should skip the IUI cycle in May.
I had a voice mail from my RE's office at 10 AM on a Monday morning. It's never a good thing when you get an unexpected call from your RE's office. I figured my appointment would need to be rescheduled. Ugh, I would have to come up with an excuse to leave the office after all. It turns out the phone call was from the insurance person. Although, my last authorisation letter indicated a time frame from 1 March - 15 June, that apparently was only for one IUI. I need to get an authorisation each cycle, she informed me in a rather lecturing tone.
"Do you want to proceed with this cycle?" she asked
I realise that it was a valid question, and she is just doing her job. I worked in a medical office obtaining surgical authorisations one summer, it's a shitty job.However, my initial response to her inquiry was, No, I've only been waiting to do this since last year, so by all means, I won't proceed if it will inconvenience you...
Maybe I am being a bit harsh as I don't like feeling that I'm being reprimanded in any way, but seriously it was only cycle day 4. I called late Friday morning to report AF's arrival, we were only half a day behind in this process at that time. She acknowledged my intention to continue with this cycle and reported that she already placed a request to my insurance. "Oh, and just so you know," she continued "You won't be able to do a treatment next month, as your account shows a balance. I know you paid your co-pay, but we need payment from your insurance company."
I thanked her for her efforts and hung up the phone as quickly as I could. I wanted to scream. As my blog title notes, I've been discovering that the fertility process is not mine to command. I've accepted the limitations from my inconsistent ovaries, divided uterus and male factor infertility. I was not prepared to discover that our procreation potential is not also dependent on someone sitting at a desk signing a permission slip for me to proceed with a procedure that is one of my covered benefits, but also for someone in the claims department to actually process the payment. (For the record, I do know that I am fortunate to have some insurance coverage, but it can also be restrictive) I understand that it all comes down to the money -everyone needs to get paid. She could have presented us with the option of clearing the balance and receiving a credit once the insurance payment came though.
I felt that it wasn't worth arguing, as we had already accepted that this cycle would conflict with the holiday schedule (I've grown accustomed to these types of delays). However, it started to resonate that this process is not supposed to be this complicated, even after acknowledging that we won't reproduce by simply having sex. There's a tempting thought to say, fuck it and give up. Fortunately, I'm just too stubborn. Case in point; I asked my RE if I could use Femara next month, even if we won't be doing an IUI, just so I can keep my cycle on the same calendar schedule. Given that there are so many elements beyond my control, I want to command any aspect that will work to my advantage. "Well, let's wait and see if you actually get pregnant this cycle" he responded to my inquiry. I laughed a little inside my head and felt an accompanying sense of pity oh, how sweet!, you think this could actually work...