June 19 – It’s all out there

It’s out and I can’t take it back.

I sent out my letter requesting infertility coverage. I emailed our HR department, submitted an electronic request and put it out there.

I feel hopeful that it might get added. I feel glad to not keep it secret. But I am terrified that everyone at my work will know. I can’t hide. People might have questions and opinions, suggestions and unwanted “advice.” Some people won’t care. Some will. Others will share their struggle with me. Others will stop hiding too.

What is courage? I am not sure, but I need it now.

Here is a copy of my letter without my employer’s name:

June 17, 2015

Dear Medical Benefits Review Committee,

I would appreciate very much if you will consider infertility treatment coverage for possible inclusion for 2015. This issue is very personal to me.  I was diagnosed with infertility and being very early in my career it is difficult for me to finance the treatment recommended for my diagnosis.

As a newer associate, I rejoiced in that fact that <employer> was well-known for being family-friendly. While adoption information is readily available, I was quite discouraged to learn infertility treatments were not covered by the health insurance. <employer> already offers health insurance plans that cover other aspects of family planning, such as treatment of adult sterilization, infertility corrective surgery and diagnosis, and birth control options including IUDs and diaphragms. Adding infertility treatment coverage to our policy is actually likely to result in reduced costs for <employer> and more successful outcomes for associates diagnosed with infertility.

Imagine sitting in your cubicle working the day away when someone on your team announces excitedly that they are having a baby. The team gushes and asks questions about due date and the baby’s sex. Now imagine that you cannot have children without treatment. There is an empty ache in your heart where the love for your future child waits. You haven’t seen the joy on your child’s face on Christmas morning. You avoid all social media and phone calls on another empty and hopeless Mother’s or Father’s Day. You feel the rush of emotions from knowing that it will take thousands of dollars to even try and grow your family. Maybe you have even been pregnant but miscarried. Maybe your partner is fine and you feel the guilt of being unable to do what you feel you should. Each smile and each question rings in your ears until you have to get up and walk away from your desk just so that you can breathe. This is how painful it can be to be infertile.

As much as this is a personal issue for me, it is advantageous for <employer> to help their associates reach their personal goals so that they will be more productive at work. I have met one other associate here at <employer> who financed his/her own infertility treatments. There are likely others at our large company who quietly struggle with their very private infertility diagnosis, as one in eight couples in the US will not conceive after a year of trying (http://www.resolve.org/about/fast-facts-about-fertility.html).  If we consider that <employer> employs approximately ##,### people that means we can estimate that #,### associates struggle with infertility. It is not just associates with infertility that could benefit from the coverage; for same-sex couples there are only two routes to grow their family: treatments such as IUI or IVF (which are necessary for infertile patients) or fostering/adoption.

In the US, 14 states mandate insurance coverage of infertility treatment. In those states, the rate of high-risk multiples births is lower than those that do not mandate coverage (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002). Massachusetts mandated full infertility coverage, including In Vitro Fertilization (IVF), in 1987, and since then, the cost of infertility services as a percent of the total health premiums went down (Griffin and Panak, Fertility & Sterility, 1998). According to ReproductiveFacts.org, “infertility treatments, including IVF and similar procedures, account for approximately seven hundredths of one percent (0.07%) of U.S. health care costs.” (http://www.reproductivefacts.org/Infographic_Infertility_affects_1_out_of_every_9_women/). For the patients, coverage results in receiving timely and effective treatment of their infertility diagnosis.

When couples are forced to cover the costs of treatment themselves, they make riskier health decisions in order to maximize the probability of conception when financing the high cost of a single fertility treatment. According to the Society for Assisted Reproductive Technology, the average cost of one in vitro fertilization cycle is $12,400.00 (http://www.sart.org/awards/index.aspx?id=3012, “Frequently Asked Questions about Infertility”). The medications for one in vitro fertilization cycle can cost between three and five thousand (http://www.forbes.com/sites/learnvest/2014/02/06/the-cost-of-ivf-4-things-i-learned-while-battling-infertility/, “The Cost of IVF: 4 Things I Learned While Battling Infertility”).  Because of these high costs, couples often choose to transfer more than one embryo.  This decision can result in high-risk pregnancies, post-pregnancy complications and low birth-weight multiples– a cost that their health insurance providers and underwriters bear. A patient diagnosed with infertility can further try to minimize their out-of-pocket expenses by traveling to countries, like India or Thailand, for cheaper infertility treatments with more lax regulations about embryo transfer numbers than in the United States. Any infections or complications will be covered by insurance upon returning to the US. In states that mandate infertility treatment coverage, infertile couples are more likely to have one healthy child as they are not making medical decisions based on cost alone.

Another risk our associates will take to afford treatment is financial risk. Forced to cash out 401ks and IRAs with tax penalties or rack up debt in higher-interest medical loans and credit cards. Even with a health savings account it would take 3 to 4 years to accumulate with the IRS maximum contribution in 2015 at $6,650 for a family. Unfortunately, fertility treatment results are based on age. Time is of the essence. Three to four years of waiting can drastically change the outcome of treatment success.

As a firm that provides advice for long term investment solutions to our clients, how can we not help our associates with this financial burden? And what if the associate cannot raise the funds for infertility treatment without the assistance of insurance coverage? The hope of having a family can slip away. Please don’t let that hope slip away for our associates. Please consider adding infertility treatment coverage to our insurance in 2016.

Please let me know if you would like any additional information on this issue. I am happy to help in your research or to provide my personal testimony.

Thank you for your time and consideration in this matter,

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June 13- Sinking

Today is definitely a bad emotional day. My sister posted some youtube video about always being there for me when my dreams come crashing down. I started to tear up.

I have always been able to overcome hardships in my life. My childhood was not the best. An alcoholic psychotic mother with a prescription pill addiction who loved to start fights for the drama. An alcoholic father who cared a lot but went through so much in the divorce with some serious OCD and anger problems. A little brother with physically handicaps who was angry with the world. A little sister who tries so hard to there for others but her maturity isn’t there. Granted when you practically raise your brother and sister in your teens they turn out the best they can.

I was so close to my dream of having a child. I was pregnant. I had it, I touched it. I couldn’t stop smiling because I could hardly believe it was real. Then it all came crashing down around me. I was miscarrying. I was losing something I spent so much of my life dreaming about. So much of my life wanting. It’s been almost a month since the D&C. My body is still behaving oddly. So signs of a period yet. I’m an emotional wreck.

This seems to be one of the things I can’t pull myself out of. I feel like the harder I struggle the more I sink into the quicksand. There are days when I am feeling ok, happy even and then something tiny catches me off guard and it throws me into a tailspin. Everything gets darker, my mind gets foggy, I get emotional and want to go home and sleep.

I’m trying so hard not to emotionally eat. I have never been great at dealing with emotions constructively. I thought if I could get benefit coverage at work then I would feel better. Sometimes I do, like I am helping even if they don’t approve it. But it only helps some of the time. My heart is so broken, I don’t know how I will recover.

I am dealing not just with the loss of a pregnancy, but the loss of a future. I was so excited to be able to announce the pregnancy to the family as dysfunctional as they are. I even thought I could fly back home for a long weekend around fourth of July when I might be showing a bit. I could not hide from the outside world on Mother’s and Father’s day. Our fourteen year anniversary would have been brought in with the joy of expanding our family. The holidays would have been filled with tiny clothes and diapers.

we were finally going to have our dream. But the glass is shattered. That vision is gone. All I see now is storms and darkness.

I just want to feel better. I want to be strong enough to get over this. I want to be myself again.

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June 9 – Advocacy

Advocacy. What does that really mean? Well to me since my new job does not have insurance coverage for infertility treatments it means writing a fact-based, win-win letter to the HR department at my work and a heart-string tugging letter to the managing and general partners of the firm.

I was lucky enough to get a template from someone in my support group who had done just that. She wrote to her medical benefits review board and was able to get insurance coverage. Amazing.

I took the template and added some more facts to it. Slightly selfishly I added the average cost of an IVF cycle and the cost of medications. I added stats about how little infertility treatments cost in the overall health care costs. I added a story about sitting at your cubicle and getting emotional as your team mates discuss someone’s newly announced pregnancy.

The letter to the managing partner is the one that makes me the most nervous. At my job there is a public forum for him to reply to employee concerns and suggestions. That can be seen by the entire firm. Am I ready to go fully public with our infertility struggles? I think in order to help out others at my job who are struggling in silence I am.

I am only in the rough draft stages (don’t want to rush this one) and will update once I send them out. Wish me luck!!

letter

6/5- HCG finally negative

Well I can finally say this cycle is over. My last blood pregnancy test confirmed that I have dropped into the negative range. I thought I would be feeling better once it was officially over. I guess I still need more time to process.

Our next steps will not be for a while. We have to lose some weight. My hubby is going to see a urologist to see what he can do on his end to improve the count and motility, if anything. I am going to take more supplements.

I think I am going to find a therapist. I have been feeling down and finding the motivation to get going on anything is difficult. Not to mention I put on some weight during this process and have had a hard time doing what I need to in order to lose weight. I have only lost 5 pounds.

I am going to try writing to the corporate HR and see if we can get infertility coverage added for next year. Other than that I see no foreseeable way to pay for another round.

My brother had his baby right after Mother’s Day. She is an adorable little thing. My sock buddy is now pregnant with twins. My friend who was trying IVF to get pregnant lost the only embryo they had and they have no plans to try again. Life is so confusing. I really don’t know the why’s and what-if’s.

I find it unhelpful when people tell me to “give it to God.” I was on the fence about religion a long time ago. Now with this… I have no faith in him/her at all. I don’t understand why this is happening to us at all. The cliché “everything happens for a reason” is the worst too. My mother said it to me. I had to tell her I appreciated her trying to comfort me but that phrase is hollow and hurtful. I lost the only pregnancy I have ever had, for some unknowable reason? I paid 10k to learn “it isn’t in God’s plan/timing.” Well shit, could he give me a schedule before I shell out 15k for our next round? I know people mean well, but thinking about what you are saying first would be great.

Good luck to everyone out there. Will keep you all posted on our next steps. Thank you for your support.