Remember kids, you can't spell "Are you kidding me?" without an RE. You could spell "Unimaginably Complicated Fuckpuzzler" without Managed Care, but why would you?
In the background, the reproductive wheels have been continuing to turn. As you might recall, we met with an RE who agreed that we should have Steve's sperm tested via FISH to figure out how many assassin sperm we are dealing with on any given sexy day. Do 80% of the little suckers have dynamite strapped to their tails, or is it more like 60%? Once the RE waved his hand over my research article and murmured Vade in Pace, I was able to start the laborious process of trying to get the test covered through my insurance company. For a while Nurse RE and I played badminton with my primary care clinic until I realized that it was a sperm test, uh-huh, and although I sometimes feel like I have the balls in this family (heh heh, love you baby) I, in point of fact, do not. So we slammed on the brakes á la Starsky and Hutch and began courting Steve's primary care physician, bearing in mind of course that the RE referral is mine and no one in his health care system has ever heard of any of this. No genetic lab reports on him or me or any of the pregnancies, naturally. And, equally of course, his internist was not up on the latest in genetic testing for the freaky. So there were many many many calls and many many many requests for medical record transfers. Something that kept mystifying me is the actual genetic report on Steve never showed up. I kept asking for records from my old OB and then my new OB and then the perinatalogists and they would send along what they had but it was never what we needed. Yesterday I finally learned that the cytogenetics lab that performed the actual test guards those results like the Secret Harbor Defense plans. And you have to admire their zeal, really, since your chromosomal make-up should be private. Very private. Stay out of my genes private. Nevertheless, it was frustrating, since without the actual report the Andrology Lab could not confirm that they have the specific probes required, thus adding yet another scene to the scheduling drama.
I finally got the proper requests faxed to the proper people and was very pleased to get a phone call from Steve's managed care elf, Debbie, saying that she had gotten the referral written and approved and we were good to go. I am a trifle skeptical about whether my insurance company will pony up after all, but the odds are greatly improved by an honest-to-god certified pre-authorization. In triplicate. So I called the Andrology Lab, who had finally gotten the right report, and scheduled delivery of Steve's, er, product, for next Wednesday. It had to be in before 9 am because they, in turn, FedEx the goodness to Utah (of course, Utah) for probing. Not a problem, and I even remembered to borrow a sterile specimen container from my primary care clinic while they were gouging me yesterday.
I considered the whole thing a job well done until this morning. This morning I got a call from Cindy over in Andrology. She talked to the head of the Utah lab and it turns out they are switching to St. Barnabas in New Jersey for future PGD testing. You want to have PGD (if any) and FISH done by the same place. Fine. However, they haven't quite finished their contract negotiations with St. Barnabas, so they will have to let me know in two weeks about things like timing and pricing. OK? So, rather than getting the results of Steve's sperm test by, oh, say, the end of next week, we may or may not have anything by the end of May. By which time my hard-won referral will have turned into dust.
I guess it doesn't really matter, for a few reasons. One, I can always get the referral extended if we have to. Two, I have an appointment on Monday with my OB to talk about checking into any uterine scarring I might have from all of those D&Cs. I expect that it will be a few weeks anyway until we have something definitive about that. Three, I had already decided that I am (probably) willing to try again without interventions at least one more time. The FISH results will have no impact upon that, just upon future IVF, so there is no great hurry.
I am human, though, man am I human, and it snarks me off to think about the hours I have put into getting this test set up, only to be derailed by inter-lab contract negotiations.
It reminds me of a story my mother’s gentleman friend tells. He met a very old lady who had driven from Charlottesville to DC to consult with him. She was complaining about the drive and he, thinking he was being charming and sympathetic, started to tell her that he has a long commute every day himself. He lives 60 miles away from the office and…
She cut him off.
“I don’t care where you live,” she said in a rich, Virginian drawl. “I don’t care anything about you. I am telling you that I have just driven over two hours to get he-ah and you had better make damn sure you are worth it.”