I was nervous but excited to start IVF. This was our chance to make a baby! I stared at the needles, willing myself to see them as a golden ticket to motherhood rather than a necessary evil. The nurse pulled out her sample syringes and models. She demonstrated how to draw up the medication from the vial and then how to inject the needle like a dart into my belly or leg. I could do this. What was a little poke in the belly?
She then moved onto shot number two which would stimulate my ovaries. This shot came as a dial-up pen that I would use twice daily. I simply had to attach the needle, dial to the correct dose, and then stab myself again in the belly or leg. The nurse recommended using my belly as much as possible. Since the abdomen has more subcutaneous fat it causes less bruising and is a little less painful. She told me that pinching my skin a little would help prevent bruising, and applying an ice-cube to numb it might help minimize the sting.
The final shot was the big one…progesterone. Unlike the others which used a short needle, this shot had to be injected in the bottom twice daily with a 2 1/2 inch long needle! Yikes! My other option was a creamy gel that I could squeeze into my vagina twice daily. I opted for the creamy gunk! I could put up with panty-liners for a few weeks.
After I was given my prescriptions, I headed to the pharmacy. Thankfully, since my husband was an employee at the hospital we got a huge break on the medications. What should have cost us several thousand dollars only cost several hundred. This was a relief considering we would soon be paying our large upfront deposit for the cycle.
This med center was pay as you go for infertility treatments. They didn’t have the lump packages like some medical centers and private clinics. In those packages you get a break for paying for several cycles up front. If you get pregnant on the first cycle, then you lose a pretty chunk of change. But, if you aren’t pregnant, then it’s a good thing that you bought the discounted insurance package because you can get right back to it. For many plans if you aren’t pregnant after 5 cycles, then you get your money back! What a deal! One of the problems with this scenario, however, is that getting pregnant and carrying a baby to term or delivery are two very different things. Pregnancy rates don’t equal baby in your arm rates.
So, I was okay that our center just did the traditional pay as you go. They of course required a chunk up-front. We looked through our finances and decided that we would just have to make it work. What other option did we have? Ten to 15 thousand dollars was a huge chunk of change to us, but I had gotten a bonus at work, and we had been saving diligently since we had started residency. We told ourselves that it would be worth every penny even if it cost us our savings. Besides, if it didn’t work the first time, we would most likely have frozen embryos left over that we could use in a subsequent cycle. Frozen cycles only cost about $1500. What a bargain!
I rushed home to put the medications in the fridge. My period eventually came after what seemed like forever; how ironic that I was now hoping for my period to arrive. I was ready to start the shots. I pulled out my medication and opened the box of follistem, assuming that the injection pen would be included. It was not. As I examined the medication box I noted that it clearly said, “Pen not included.” The pharmacy was now closed. The IVF clinic was closed. This was the day based on my cycle that I had to start the medication! What was I going to do?
I quickly looked for the physician on-call number. I paged the physician and waited…and waited… and waited. I paged the number again. After 2 hours I received a return call from a resident. Yes, I had just been a resident one year prior, but I wasn’t in the mood to talk with someone who wasn’t an infertility expert. I was paying too much money and had too much on the line to speak with a novice.
Unfortunately, a novice is exactly what I got. It must have been her first day on the infertility rotation because she had no clue about the medications. I calmly explained that I could not give myself the shot without the pen. She explained that the pen should have been with the medication. Back and forth we went. I asked how I could get the pen. She then simply said I should use a syringe to draw up the medication. But, I calmly explained that the follistem vials were only to be used with the pen.
She then tried to educate me on how to draw up medication. I had to stop her there. I tersely informed her that I was a physician and knew how to draw up medication, and I knew what the pen looked like. I was not confused about how to do it, and NO, I did not have the pen in my possession! Since she didn’t have a clue how to get me a pen, her advice was to call the clinic in the morning to sort things out. By now I was more than frustrated and irritated. I couldn’t wait until the morning. I needed a correct answer right now…not just a guess at what should be done. For $15,000 I felt entitled to concierge care not a first year intern’s best guess. I asked her to page the attending on-call. When she balked at the idea (because most attendings don’t want to be bothered on a Friday evening) I told her that I wasn’t suggesting this…I was demanding it. I’m usually pretty laid back, but in that moment, the combination of infertility, an empty bank account, and a box of needles and meds that I could do nothing with pushed me over the edge.
She wasn’t pleased with my authoritative attitude, but she agreed to touch base with them. Oh, the poor resident! It is so hard learning on the job. I am sure that she had her strengths, but she just wasn’t yet familiar with the infertility process. I didn’t want to be too hard on her. Goodness, I had my own moments of weakness as a resident.
After another hour, the now timid resident told me that the IVF clinic should have given me the pen at my education session. The pharmacy didn’t carry them. I would have to push back the medications by a day and get the pen in the morning at the clinic before work. The mix up was a result of the usual training nurse being on vacation the day that I had been trained on the medications. The fill in nurse thought that the usual nurse had given me the pen. Clearly not!
Now I had to run to the opposite side of town to pick up the pen before I headed to work in the morning. Since I hadn’t pushed back my own schedule of patients, I would now have an incredibly unhappy waiting room full of patients. I rushed to the hospital bathroom stall, hiked up my skirt and stabbed myself with the pen. What a way to start my first cycle of IVF.
From The Mom in Me, MD