I just got the call from my nurse - my doctor requested that I take the trigger tonight at midnight (guess I'm not going to sleep at 10pm like most nights). She then said that he wants my husband back on Tuesday for his sample, and I should show up a hour later for the IUI.
One problem - we had planned a timed intercourse cycle due to insurance reasons. They'll cover the cost of medication for a timed intercourse cycle, but not an IUI cycle. And they have generously covered the medications that have worked so beautifully. I've got a 20 mm follicle on my left ovary, and an 18 mm follicle on my right ovary, and my E2 levels indicate I've got two beautifully mature eggs in there, and my uterine lining is at 7.5 on CD11. It all looks "textbook perfect," in the words of the nurse.
So... she said we should just go ahead with the IUI! Oh my goodness! I just finished writing the whole post about keeping hope in check - stoking the fire slowly to keep it burning through several cycles if needed - and this was like throwing gasoline right on the fire.
I'm going to call tomorrow with my nurse and make sure it won't somehow mean I have to pay full cost for all the medication that I've already used for this cycle retroactively. If that's the case, we'll keep with timed intercourse as the plan. Otherwise, I think we're going to grasp this opportunity and do the IUI on Tuesday!
The fact that it's even a consideration is rather infuriating to me. The insurance company won't have to pay for my IUI, they won't pay for the sperm preparation. They won't pay a penny more than they would pay for a TI cycle. So why exactly won't the insurance cover the same medication for an IUI cycle than a TI cycle? When it's like an IUI is what will make the difference between hope and no hope, why does the insurance company draw that line in the sand?
The only answer I can come up with is religion. Certain religions oppose ART (Artificial Reproductive Therapy), or specifically any form of conception that is not through sex. I understand it, I can respect it - if you don't want to use medical techniques to overcome physical obstacles to conception, that's completely your choice. That's fine! But by deciding that the insurance company will only cover medicine if the method of conception is sex is unfair. That can help plenty of people, sure. But what about those it can't help? I understand also not covering the IUI procedure - I do! That's fine. I don't like it, but it's acceptable. But by removing otherwise covered benefits simply because I am choosing to add a procedure that will more than double my chances of success is cruel and unfair.
That's my political rant of the day. I wish all infertility treatments were covered as needed. Not only is it a cruel medical condition, there would be fewer twin and higher order multiple pregnancies if insurance carriers covered treatment because people would take fewer risks. It would be easier to decide to cancel a cycle where you over responded and risk higher order multiple pregnancies if you knew you wouldn't be losing thousands of dollars on the cycle.
You'd think, "Well, the insurance company doesn't want to pay for that either!" Understandable! But what isn't considered is the additional costs to the insurance company from those higher order multiple pregnancies that occur as the result of women taking higher risks because they couldn't afford multiple cycles. Women who went ahead with IUIs with 4 mature follicles, women who implanted 2-3 embryos during IVF because they couldn't afford another cycle. Those women end up pregnant with twins or triplets or even quads (or, very rarely, even more). Sometimes they then have to make the incredibly difficult choice of selective reduction (where you have to choose whether or not to eliminate one or more of the fetuses to increase the chance of survival for the rest of them and lower the risks to the health of the mother).
Stay with me - you're still wondering why the insurance company should consider paying for such expensive elective treatments. They're a company who wants to make money - what is their motivation in covering that at all?
We'll start with their financial benefits (and hit on the misnomer of "elective" later) from covering these procedures.
How much does a typical IUI procedure cost out of pocket? Usually under $3000, sometimes as low as $1000 depending on the medication. If they don't cover the IUI itself and just the medication, under $2500 usually. If it's simply a Clomid or Femara IUI with trigger, and they aren't paying for the IUI, perhaps only $400-500.
How much does a typical IVF cycle count? Probably around $15,000. Perhaps as much as $20,000 with medications.
What are the most common risks from twins and especially higher order multiples? Miscarriage, pregnancy complications, early labor, premature delivery. One day in the hospital for even one of those issues would easily cost more than the cost of one cycle of IUI, and likely IVF. If even one baby ends up spending time in the NICU, it is not unusual to rack up an insurance bill of over $100,000.
So what is the insurance company's motivation to cover fertility treatments? So women will take LESS risks because of the high costs of each cycle. Less risks will likely mean less risky pregnancies, which will result in exponentially fewer costs of care for the Mom and baby (or babies).
Okay, I'll stop ranting... all that to say, I think we might get to do an IUI this cycle! We'll pay the $650 for it if we do, but I will gladly pay that to double our chances. I'm just going to make sure we don't have to pay retroactively for the medication we were already prescribed (and already took) for this cycle, because the Follistim would put us back easily the cost of another cycle (or two!) so it wouldn't be worth it.
Keep your fingers crossed for me. I'm in uncharted territory, and not sure how this will all work out. Either way, I'm hoping beyond hope that this is our cycle, that it's finally our turn!
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