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It was a dull Thursday around lunchtime when private eye "Foxtrot"… - Elizabeth Unexplained
Lots of data but no answers
greyautumnrain
greyautumnrain
It was a dull Thursday around lunchtime when private eye "Foxtrot" D. walked into the office with his Dame on his arm. They were there to talk to the Doc about the botched job the Lexington gang had carried out.

The Doc was pretty clear, and everyone agreed on a couple of things. There weren't enough eggs in the basket, and "Five" never stood a chance. It was clear they were going to need more firepower next time, the Doc figured twice as much. That was OK with the Dame, especially once the Doc explained that the endo was probably the reason for the lack of action last time.

Then the Doc dropped the bombshell. It says here they did ICSI* on all of them. Foxtrot was not impressed. They were supposed to call if they did that, and they never did. They talked it over then, Foxtrot, Doc and the Dame. Doc figured maybe they had to do ICSI. The Lexinton gang was supposed to do things the old fashioned way and use microdrop. Maybe it was just a simple case of rescue ICSI, maybe they ran the numbers and figured it was the only way to go. The red-headed Dame muttered that they were still supposed to call. The Doc was also a bit curious as to why there was no note saying who made the call to do ICSI. Doc was also a bit suspicious about that egg that wasn't an egg. The way the Doc figured it, someone in the Lexington gang had goofed on that one, and the didn't figure it out until they went to do the rescue ICSI. Foxtrot wanted facts, not theories. Find out when they did it and why.

So they made their plans, Doc, Foxtrot and the Dame. Next time twice as much juice from the start, and transfer up to three this time. The Doc figured maybe they should plan to just do ICSI from the start this time, but Foxtrot wanted the facts from the Lexington gang first, so they left it at that.

It wasn't too long after leaving that the Dame's phone rang. Doc had heard from the Lexington gang. Their story was that they never did ICSI, that it was a simple clerical error. The head of the Lexingtion gang said they'd done microdrop, just like they were supposed to. Doc said that maybe the Dame and Foxtrot should consider doing ICSI from the start next time anyway. The Dame said she'd talk to Foxtrot.

When the Dame finally got a hold of Foxtrot he smelled a rat. The Lexington gang get fooled by this bogus egg, and now they say one thing in their records and another thing to the Doc. That struck Foxtrot as sloppy, and sloppy doesn't cut it with Foxtrot. Foxtrot D. is on the case, and you can be sure that if the Lexington gang doesn't deliver the goods this time he'll be looking to find someone who can.

*Intra-cytoplasmic Sperm Injection
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Comments
chenoameg From: chenoameg Date: January 11th, 2007 10:30 pm (UTC) (Link)
Wait, where did the Jedi go?
enugent From: enugent Date: January 11th, 2007 11:11 pm (UTC) (Link)
Remember the cardinal rule, Foxtrot D - follow the money. Was your insurance billed for ICSI?
jaedian From: jaedian Date: January 12th, 2007 02:11 am (UTC) (Link)
That is a good question. I might involve them, since they are footing the bill for this go around, and presumably have a bit more clout than a single patient.
psychohist From: psychohist Date: January 12th, 2007 03:22 pm (UTC) (Link)
Our insurance is through Harvard Pilgrim, an HMO. The actual IVF is subcontracted to a clinic. Dr. Lee said Harvard Pilgrim didn't approve the ICSI, so the clinic wouldn't be able to bill it - this was when we all thought it had actually been done.

It wasn't clear to me whether the other stuff had been billed yet. It was clear that the ICSI hadn't been billed yet. So maybe that's a good sign ... but I'm having trouble coming up with a likely way for the erroneous entries to make their way into the computer.
From: readsalot Date: January 11th, 2007 11:31 pm (UTC) (Link)
I don't remember anything about the egg that wasn't an egg.

firstfrost From: firstfrost Date: January 12th, 2007 01:50 am (UTC) (Link)
Me neither! Is it that five really wasn't sufficient to qualify as an egg? (Less plausible theories involve microdots being mistaken for eggs, which at least fits the genre...)
twe From: twe Date: January 12th, 2007 02:47 am (UTC) (Link)
I think she said in her followup to the post describing the number of eggs they'd gotten than one of the eggs had turned out to be a fragment.
greyautumnrain From: greyautumnrain Date: January 12th, 2007 03:22 pm (UTC) (Link)
Indeed, that was the what the clinic in Lexington said. It was pretty clear, though, that they weren't really sure what it was, just that it wasn't an egg.
jaedian From: jaedian Date: January 12th, 2007 02:09 am (UTC) (Link)
So what is rescue ICSI? Is that saying they tried the microdrop and nothing happened, so they tried to do ICSI afterwards?

I looked around briefly and ICSI is supposed to be for problems with the sperm, correct? Does it make much difference if the sperm counts are high and healthy? Also, I think I would prefer making the sperm do the work, (if it doesn't significantly affect your chances) since then presumably you have selection for a healthy sperm.

What is this about an egg that wasn't an egg?

I am pretty dubious about the lab handling the fertility so far!

greyautumnrain From: greyautumnrain Date: January 12th, 2007 03:28 pm (UTC) (Link)
So what is rescue ICSI? Is that saying they tried the microdrop and nothing happened, so they tried to do ICSI afterwards?

You guessed it, rescue ICSI is when they discover that an egg has not fertilized with the less invasive method and they go back and ICSI it.

ICSI is indeed for sperm issues. The counts have always been in the reasonable range for us, which is one of the reasons we were pretty shocked when they told us they did ICSI.
jaedian From: jaedian Date: January 12th, 2007 02:04 am (UTC) (Link)

Gack!

Well I would be flipping out if they couldn't tell me what actually happened for such an expensive procedure. (yes your insurance pays for this one, but if they botched it, you'll have to pay for any beyond the coverage.)

For such an expensive and involved procedure there shouldn't be any clerical errors, or errors to notify you. I don't know how many samples the lab processes, but I am surprised that they can remember with certainty what they did, several weeks after the fact. They could be trying to cover themselves or not - how can you know - or trust them for the next go around. I hate to think of the other sorts of errors they could be making on such a sensitive procedure.

I only did a small amount of work with human samples for clinical trials, but a mistake like that wouldn't have been tolerated.
greyautumnrain From: greyautumnrain Date: January 12th, 2007 03:41 pm (UTC) (Link)

Re: Gack!

Yeah, psychohist asked me if he was being too picky because he was really bother by this. While he is very picky about a number of things, I didn't feel that he was being excessively so on this issue. At over $8k a shot (without ICSI), I think they should be getting it right. I'm pretty bothered by this, especially since I am facing going in there again to be knocked out while they take a needle to my ovaries. On the other hand, withy my period due next week its a bit late to find another clinic for the next go around.

As for how many procedures they do... on the day I was there I was the last of a large number of procedure. I forget wheter it was 12 retrivals or 16... certainly some number between those two. This was a month ago. Who knows, maybe the doctor does have a photographic memory.
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