CD3 testing (FSH, LH, and E2) & birth control

[chocolatepie]

I talked to my insurance company fertility nurse (yay for not making me wait all week to hear back!) and she confirmed they had to have the CD3 tests but figured it was already done and they'd just send them over. So I told her that evidently, they missed them and instead are manipulating my cycle to do them.

She said that that could be a problem; the tests are intended to be done unmedicated so if you've been on birth control, it could give a false number - which could result in insurance denial. She urged me to check with the clinic to make sure we don't screw something up. 

I neglected to ask her how long you should be off birth control and googling isn't telling me much (already left msg for coordinator). I am probably too trusting, esp with things I don't understand, and assume the coordinator knows her stuff and the time period she is giving me will not give a wrong reading (she has me stopping BCP Thurs and testing Tues, so 4 full days in between).

Those of you that have walked this road and understand these tests better, do you have any insight on how long you should be off birth control before a CD3 testing? Will the coordinator be super annoyed with me for questioning her on it?

[G22]

I'm sorry, I dont know the answer because the only time I'm on BCP is prior to a IF treatment. So my testing has always been done way before I'm back on BCP. But the coordinator definitely shouldn't get frustrated for you asking. Most of your confusion has come from the office to begin with!

[Jalapeñomel]

If you get your period, that’s CD1. So if you stop BCP and get your period the next day, you’d do it the fourth day you stopped.

So assuming that happens on Thursday, period Friday, CD3 should be on Sunday.

[seeyalater52]

First of all, they should not be annoyed at you for asking and if they are I feel like that is a red flag!

I didn’t want to say anything in the other thread about this because I’m not an expert by any stretch, but I have heard real baseline CD3 tests should be done he cycle following a rest cycle off BCP. It’s a little different if it was just an insurance rule hoop to jump through, or if you had them done previously and had a sense of your ranges from that so accuracy isn’t super important. If you haven’t had them before I’d ask some questions because these numbers will help determine your protocol and stim dosing.

[seeyalater52]

For more context on the insurance, it’s common for insurers to have stricter criteria for patients >40 of what hormone ranges they will approve for IVF. Once you “fail out” of the range they will not only deny you, but even if your levels change later sometimes they can sometimes use the previous denial to deny you again. I have no idea what your insurance’s medical necessity criteria is obviously (you may be able to request a copy from your clinic or the insurer or even find it on google with “infertility medical necessity criteria [plan name]”) but if it’s on the strict side I would be concerned about how this route could impact your bloodwork and ability to use your coverage.

[chocolatepie]

Jan 8, 2019 8:00:24 GMT -5 seeyalater52 said:

For more context on the insurance, it’s common for insurers to have stricter criteria for patients >40 of what hormone ranges they will approve for IVF. Once you “fail out” of the range they will not only deny you, but even if your levels change later sometimes they can sometimes use the previous denial to deny you again. I have no idea what your insurance’s medical necessity criteria is obviously (you may be able to request a copy from your clinic or the insurer or even find it on google with “infertility medical necessity criteria [plan name]”) but if it’s on the strict side I would be concerned about how this route could impact your bloodwork and ability to use your coverage.

Thanks for these thoughts.

My coordinator called back first thing this morning and said that she was confident 4 days before labs would allow for an accurate reading but to stop taking the DHEA now. Thankfully, she was extremely kind and not at all annoyed. Just reassured me it would be no problem.

Insurance company approved me to move forward based on the medical records they have to-date and diagnosis. Nurse said that if the numbers came in high or low, insurance would first kick it back and tell them I need to retest the following month because they would assume there was other medication in the system manipulating the results OR there is something like pcos in play and would want further testing to rule that out. With that info, I feel better with rolling the dice and putting trust in the coordinator who hasn't let me down yet.

Incidentally, insurance DID say they won't approve a FET unless there is a medical reason why we aren't doing a fresh first. She said there is not enough medical documentation proving frozen is better than fresh so we have to start with that. So, coordinator is getting with the doctor today to redo my whole schedule in prep for a fresh transfer instead. 

And now I have a whole new thing to stay up at night googling 

(I googled the criteria - very helpful and my mind is swimming lol! Thanks for the tip!)

[seeyalater52]

chocolatepie, I'm glad you're feeling better about things! And also glad you're having some more positive interactions with your clinic. They owe it to you to make sure you have a good experience, especially since they were partially responsible for the rocky start!

My insurance also won't approve a retrieval without a fresh transfer unless you're doing PGS for a specific genetic reason, although if you are planning on fresh hyper-stimulate during the cycle obviously they can cancel it for a medical reason. It seems that is very common.

Best of luck with everything! Lots of us on the board have done fresh transfers so if you have questions please don't hesitate to ask!

[chocolatepie]

Jan 8, 2019 14:58:32 GMT -5 seeyalater52 said:

chocolatepie , I'm glad you're feeling better about things! And also glad you're having some more positive interactions with your clinic. They owe it to you to make sure you have a good experience, especially since they were partially responsible for the rocky start!

My insurance also won't approve a retrieval without a fresh transfer unless you're doing PGS for a specific genetic reason, although if you are planning on fresh hyper-stimulate during the cycle obviously they can cancel it for a medical reason. It seems that is very common.

Best of luck with everything! Lots of us on the board have done fresh transfers so if you have questions please don't hesitate to ask!

Good to hear that's standard insurance procedure! 

I feel like I've been obnoxious in my questions lately so I'm gonna shut up for awhile but may post closer to the scheduled date for fresh transfer experiences