Another meltdown at table 6, please (post by Jessi)

When you first meet with the Reproductive Endocrinologist to learn more about IVF and how it works, a good doctor will make sure you know what to expect during the process.  My doctor covered all of the usual bases:

1. It’s expensive.  No doubt!  The IVF cycle alone is $9,100.  That doesn’t include medication, legal fees, and all of the other related health care expenses for the myriad of specialists you have to see in order to just begin the process.
2. It’s emotional.  The phrase I remember hearing was “PMS on steroids.”  In addition to the mood swings, irritability, and discomfort associated with hormone treatments, there’s also the “waiting for the other shoe to drop” phenomenon because the potential for failure exists at every step in the IVF process.  What if I don’t respond to the stimulation drugs?  What if there are no eggs in my follicles when they go to retrieve them?  What if the eggs don’t fertilize?  What if they fertilize but they’re not viable?  What if they die in the dish before they make it to transfer day? What if, what if, what if?  Each little step is a tiny victory that just leads to another step with its own unique set of what ifs.  Emotional. Roller. Coaster.
3. It’s all-consuming.  Over the last two weeks:  I’ve had 5 or 6 ultrasounds on 5 or 6 different days;  I have track marks on my arm from the frequent blood draws;  I know all of the parking garage attendants and how long it takes each of them to open the gate;  I have daily correspondence with Nurse Mo or her back up, Nicole; and I’m constantly reminded about the looming nightly injections by the temporary drug store set up on our kitchen counter. 
4. It’s a gamble.  While FAHC’s success rates are better than the national average for women of our age, there’s still a 60% chance of failure.  But, as a hopeless optimistic, I find this one easier to dismiss.  If we were older I’d be more concerned but in terms of success rates, you can’t get any better than what we’ve got.

So yeah, we were and are prepared to effectively handle all of these issues.  Bet you can’t guess what our biggest challenge has been so far???  Like hysterically-crying-my-eyes-out-wishing-I’d-never-started-IVF-in-the-first-place kind of breakdown?  

The fertility pharmacy and Fed Ex.  Let’s start with the pharmacy, shall we?

I’m sure you’ve read Maggie’s post about her love of the fertility pharmacy.  My first experience with them was not as bad mostly due to the fact that I have to self-pay because my insurance doesn’t cover any fertility medications.  

Random note:  Freedom Pharmacy’s hold music has a lame voiceover that says “we respect that you have a choice in pharmacies and we are happy you chose us”  yadda yadda yadda, it makes me want to scream.  We don’t have a choice, you’re our only choice as this is Vermont and not a single pharmacy stocks this stuff.  

My first stimulation was in October.  A couple days before the egg retrieval I needed to take a “trigger” drug.  This is usually HCG (which I had on hand) but due to my hormone levels, the docs decided it would be best to use Lupron.  Now, let me just preface this by saying that the stimulation prep is a cumulative, day-to-day process.  There’s no skipping or stopping meds for a day or two.  And because a patient’s hormone levels can change daily, the meds oftentimes need to be adjusted at a moment’s notice.  As a fertility pharmacy, Freedom is well aware of the nature and circumstances to which their drugs are used and, in response, provides no-hassle overnight shipping.  

Mo calls in a script of Lupron on the morning of 10/29.  I call 20 minutes later to place the order and explain that it’s my trigger so I’ll need overnight delivery.  “No problem,” says the nurse.  “It should be there by 5:00pm tomorrow, 10/30.”  

On my way home from work on 10/30 (which also happened to be Maggie’s birthday and the night of the World Series), I called Benny to have him check for the package.  “Nope, no package” he says.  Ok, I think to myself.  I’ll just call Freedom and see what’s up.  After the regular formalities of confirming my identity and the script I’m looking for, the nurse puts me on hold.  While I’m on hold, I immediately assume the worst and can feel the emotions start to well up inside of me.  Something’s not right.  

Eventually, the nurse comes back (and by this time I’m quietly weeping and half convincing myself I’m just overreacting) and she starts out by apologizing on behalf of the pharmacy.  She explains the order was processed but the package never left the facility.  It’s still at Freedom waiting to be picked up.  

And that’s when the hormonal gates of hell opened up!  

I don’t remember much of what I said next because I was crying hysterically and driving (yeah, I know) but I’m pretty sure I dropped the F-bomb.  I had come all this way, 7 days to be exact, endured dozens of injections, appointments and was almost to the finish line with stimulation and my drug hadn’t even left Massachusetts?  The next few hours were also a blur of phone calls with the FAHC docs, supervisors at Freedom, emails exchanges between Nurse Mo, Maggie and me.  With each passing minute, I was getting closer and closer to the specific time (11:15pm) I had to take the Lupron or all bets were off.  

Freedom was going to make good on their promise and get me the drug I needed to trigger that night. While that was a relief of sorts, they were still 4.5 hours away which means it needed to be en route by 6:30ish in order to make the 11:15 deadline.  Still not trusting Freedom to come through, we worked out another plan for Benny and me to drive to Maggie’s house at 9:30 on her birthday (Happy Birthday Maggie, we’re here for drugs!) and pick up her leftover Lupron.  Meanwhile, an unlucky courier got the worst assignment of his life.  He now had to leave Boston on the night of the World Series and spend the entire evening in the car to deliver the Lupron which should’ve arrived at our house hours earlier.  Sure, I could’ve called Freedom and said that we’d worked out a plan and there wasn’t any need to rush the courier to Vermont, but I didn’t.  Sorry, Mr Courier Guy – it was nothing against you, but maybe you’d consider being a courier for a pharmacy that doesn’t just leave trigger drug orders on the shelf overnight.    Also, you were late.  Good thing I had a backup plan because had I not, I would’ve missed the deadline and, consequently, had to start all over on meds. 

The second round of stimulation has been much longer.  This is actually a good thing and I can tell Dr Davenport is pleased.  My hormone levels have been lower than last time and so for the last few days, they’ve increased my dosage to get them back up.  I only had so much of my meds on hand, and the Pharmacy was closed over the weekend, so Nurse Nicole helped me source what I needed to get through the weekend locally.  On Monday, I called to place another order of meds to get me through to Egg Retrieval.  Again, I needed this shipped overnight.  “No problem,” says the nurse.  Yeah, I’ve heard that before.  A few hours later I received an email from Freedom with a tracking number for my shipment.  What a huge relief.  There must be a note in my patient file that says “don’t ever mess this woman’s order up again.  She will freeeak out!”  

When I got home yesterday my package wasn’t there.  Checked on the status of my shipment with Fed Ex and saw that it was in Williston, VT at 6am and loaded on a truck for delivery at 9:39am.  How precise.  I thought I better call Freedom, just in case.  They advised me that the package was sent via Fed Ex Ground which means they do deliveries up to 8pm.  It was 6pm.  Ok. Fine.

Here’s what happened next:

• 6:10 – Called Fed Ex to confirm that it was actually on the truck like the tracking number indicated.  Woman confirmed it was on the truck and she couldn’t give out any additional information about the truck’s whereabouts or when I could expect to receive it other than by or before 8pm. OK BYE!
• 6:10 – 7:30 – Make dinner, eat dinner, chat with Benny, check driveway for headlights every 2-3 minutes.  Pretend to hold it together on the outside even though I was screaming on the inside.  Obsessively check tracking status to see if it changed.
• 7:30 – Call Fed Ex again to explain my concerns.  “Here’s my tracking number.  This package has medication in it that needs to be taken tonight and I’m worried about it not arriving in time.”  Dude on other end reassures me they’ll deliver it.  OK BYE!
• 7:30 – 8:10 – Sit and fester.  Fidget.  Continue to stare down the driveway.  Pretend to watch the Olympics.  Pace the floor.  Obsessively check tracking status to see if it changed.
• 8:10 – Call Fed Ex again.  Explain that I don’t think it’s coming tonight and ask how I can get it because it’s an emergency.  A different dude puts me on hold while he supposedly checks in with Williston terminal.  Says he’s confirmed it’s still on the truck. OK BYE!
• 8:11 – Email Mo: “So this might just all fall apart at the last minute because even though my tracking email from Freedom says my package is out for delivery, Fed Ex hasn't delivered it yet. They can't do anything to track its whereabouts until tomorrow.  I'm freaking out!”
• 8:11 – 9:00 – Obsessively check tracking status to see if it changed.  Continue to lose my shit.  Decide the best plan of action is to head into Williston and hold a Fed Ex driver hostage until I get my meds.
• 9:00 – Decide that Benny will stay at home in case this mythical creature they call a Fed Ex delivery guy shows up.  Put on the brand new Muck boots Benny got me for Valentine’s day and head into Williston.
• 9:15 – Check tracking status on my phone while driving.  Delivery status updated from “In Transit” to “Delivery Delayed due to Weather”.  What weather?  It was 40 minutes away on a truck in Williston this morning.  

And that’s when the hormonal gates of hell opened up!  

• 9:15 – Full-blown hysterics begin.  Call Fed Ex crying.  They apologize and ask me for my tracking number for the one-thousandth time.  I explain that I need the package tonight and I’m on my way to the hub in Williston to pick it up.  Customer Service lady explains that no one is there and I cannot access my package because the office closes at 4:30.  “Say what now!?!  If you closed at 4:30 then why wasn’t my tracking status updated until 9:15?”  Proceed to cry, scream and beg them to do whatever was possible to get my drugs. 
• 9:20 - Customer Service person #4 transfers me to Jacqueline, in Customer Advocacy.  Jacqueline wants to know what the drugs are for, when my procedure is and what time I’m supposed to take my meds tonight.  She sympathizes with me but gives me no reassurance that I can actually pick up my shipment.  She then puts me on hold. 
• 9:20 – 9:40 – Still in hysterics considering the worst case scenario.  How did I end up in the same predicament I was in October on a tight deadline for meds?  If I miss tonight’s dose, the last 12 days would’ve been for nothing.  I’ll have to stop all treatment, wait for my period to come and go again and then fork over another $4,000 for meds to start all over.  But the worst part of everything going through my head was that I knew I wouldn’t be able to go through this again.  I’m so close to producing 6 eggs (holy crap, I just thought of myself as a chicken) and I just don’t have it in me to start over again.  This could be the end of the road for us, I thought.  Maybe this is all happening for a reason.  Why is the universe so against me right now?  Damn you rural Vermont. 
• 9:40 – Jacqueline comes back on the line with a name and cell phone number of Matt, the only guy left standing in the Fed Ex Ground warehouse.  She said call him when I get there and he will give me my shipment.  “I love you Jacqueline.”
• Five minutes later I arrive at the warehouse.  It was surreal.  That area of Williston is bustling throughout the day with big trucks and all kinds of traffic and noise.  But at 9:45 on a Tuesday night, it was barren.  No street lights, no traffic, just a dark, empty parking lot with a lone trucker finishing up his paperwork for the overnight run.  I walked in looking like a mess with snot stains on my sleeves and puffy, bloodshot eyes and then I saw it, my package of hope.  He asked for my ID, I signed for the package and drove straight to my parent’s house to shoot up.

Fortunately for Fed Ex, everything worked out and we are still on track for egg retrieval this Friday.  Mo was wonderfully helpful and supportive throughout the evening and was so pissed off she also filed a complaint with Fed Ex. Ain't nobody gonna mess around and jeopardize her patient's shot at motherhood.  Thanks, Mama Bear Mo.

 Look out world, nothing is holding us back now!