WWYD -lying to medical insurance.

[Sleepswithbutterflies]

Well. Not exactly lying, more exaggerating. Please stick with me, it's quite involved.

So we have ds conceived easily and naturally but have been TTC dc2 for 2 years, our issue is extreme male factor (hardly any sperm usual shape).

We've had two failed rounds of icsi Ivf where we got to transfer but have never had any embryos survive to blastocyst. However both times they gave us about a 35% chance of success.

Both failed and at my follow up appointment the consultant advised me to have a laparoscopy to see if the c section I had with ds has caused endometriosis. I did have some problems following my c section (retained product, sorry tmi) and the consultant said that scar tissue may be stopping embryos from implanting. I personally think that the embryos have just stopped developing since none of the ones we didn't transfer did brilliantly but he's the expert I guess.

Anyway a laparoscopy costs £4k privately. The only symptom I have of endo is extremely painful ovulation which I have been to the gp for previously even when we weren't TTC. It is much much worse since having ds and sometimes makes me cry with pain and lasts for several days. Other months not so bad but definitely painful every month. The gp basically said that the nhs would just give me progesterone treatment to stop me ovulating and hence stop the pain but that is no good when TTC. The nhs won't help me with anything fertility wise because we already have one child. Fair enough.

We have private medical insurance which we've paid for a long time but they won't pay out understandably for fertility issues or I think for problems caused by childbirth, which possibly mine is. I have to be honest and say I probably wouldn't go for a laparoscopy if we weren't TTC and I wasn't worried about scar tissue affecting implantation, we will never get pregnant naturally because dh's sperm is so poor.

The private consultant has advised me to tell the gp that Im suffering painful periods, bleeding between periods, painful sex and pain on ovulation. It just doesn't sit well with me and I'm a crap liar. The only bit that's true is the painfuld ovulation. He said to ask the gp to refer back to him and as long as the insurance don't get wind of fertility issues it'll be ok. I've spoken to the insurance and told them that we've had fertility treatment for male factor infertility and they said that was ok, it wouldn't affect this claim. But it still feels wrong.

Otoh god I want a baby and we've already spent £10k on treatment and don't really want to spend another £4k on something that may or may not help. The sensible thing would just be to except I've got one child and live with it but it's so hard. I'm only 31. I don't want to feel sad about this for the rest of my life.

WWYD?

Actually it just sounds like cons is telling you what you need to say to be referred for the lap.

If its for endo then there are other reasons than fertility to have it removed like the pain. He just knows the gp will likely fob off if you dont have every symptom in the book.

Eg i went in for thyroid issues useless gp 'no youre too thin'. What about my 7st sister 'oh she cant have thyroid issues'. So now 3 years later now on thyroxine.

Gps do not know about fertility they are not specialists in it.

In general they diagnose by probability and i suspect number of symptoms. No symptoms you probably dont have endo. 1/5 symptoms they would probably still say that, it doesnt mean you dont have it though.

I have pcos i have about 1/5 symptoms

I wouldnt be surprised if i had endo despite no symptoms due to immature eggs at collection but i have never had a lap or hyscos , nor has OH had a scan for a varicocele. If id had the tube scan maybe i wouldnt have had the hydro scare.

Wouldnt it be easier if the cons could just say he suspects endo from her symptoms why does gp have to be involved?

He already asks, has done for ages. Says he's lonely and I don't play like another child would.

What about when he's grown up? He's got no cousins. What about if he doesn't meet someone? Have a family of his own? Gets divorced? He will be all by himself and I can't stand it.

There are a couple of other things that make me suspect possible endo but they are only mild. I wouldn't have linked them except for when I looked into it a little further myself.

Gp has to refer me back through gynaecology rather than fertility.

Op, our medical insurance didn't cover us for fertility treatment but it did cover us for fertility testing and investigations which may include this procedure

Are you completely sure that they won't pay out for problems caused by childbirth? Mine will not cover the actual childbirth part, but health problems resulting from pregnancy are covered. My boss's wife had to have a CS for her first child as she was breach, and the subsequent CSs were covered by medical insurnance, as they were required due to previous medical intervention.

I would go to the GP with your extremely painful periods, and ask for a referral for private medical. Most GPs are happy to get you off their books. Then be honest with the insurance company, as it does appear that your CS caused some damage which is causing you extreme pain most months. That is a fact, irrespective of the fact you are trying to have children at the moment. Yes you might not be so worried about getting it sorted if you had had all your children, but it does not stop it being a health problem that started after you started paying your premiums.

Aside from the insurance/ NHS angle, no it is not normal to be in pain from ovulation each month, especially so severely. I empathise hugely as I had this problem, and an ultrasound scan found a cyst on my ovary. The NHS specialist I saw told me that as I am young and unmarried (!) he recommended I went on the pill to stop the ovulation happening at all, which has worked. He did say if I were 'newly married' and TTC they would look at other options, so there probably will be treatment options for you.

I'm not sure.
The policy says it won't cover stuff related to childbirth. I don't know whether that means it won't pay for elective sections or won't pay for anything at all.
I will have to check.

The ovulation pain is about a million times worse since having ds. If I hadn't already had my appendix out I would think it was appendicitis. It causes cystitis type symptoms too. Lovely. Not sure if that is symptomatic of endo or not.

The lap doesn't sound much fun so in all honesty if we didn't want more children id either go back on the pill to stop the ovulation pain or id just keep taking painkiller every month.
However I don't think the pain can be normal. I know some women get ovulation pain and as I said I always had it but not like this. Never lasting several days.

This is a bit off topic but I think if it's literally just a laparoscopy to have a look, your consultant is on the very expensive side, charging 4k. A Google search suggests it should be about half of that sum at reputable places like Spire and Bupa. The reason I thought it was a bit steep is that I had a Gynae laparotomy done privately (a much bigger operation which involves several nights in hospital) and I was charged 4k for that!

Actually I would go to the GP and ask to be referred for the ovulation pain. If it is as severe as you say then you shouldn't suffer it stoically. I'd treat it as a completely different issue to the IVF because while it may be related, it may not.

An interesting question is why you think you should endure pain every month that you don't have to? I think as women we expect to put up with a certain amount of pain/discomfort/inconvenience because it's just something you have to with women's health. Well I say bollocks to that. You deserve to have a painful problem treated because it's not normal and you don't have to put up with it.

I wouldn't exaggerate or lie about symptoms you don't have but it sounds like you do have cause to ask for a referral and there's nothing bad or immoral or fraudulent about that.

Do it, you'll be fine.

Also they would do a lap for endo diagnosis and confirmation. I've had this done twice (once for endo dx and once for ovarian cyst removal in which consultant also looked to see how endo was). Both of these things were covered by my private insurance. Although not directly related to fertility, I was having miscarriages which endo may cause in addition to other symptoms. Insurance didn't question this.

My friend did this via her private health insurance. She'd always had painful periods and investigations for endometriosis.

She used her private medical care for more investigations, whilst at the same time starting investigations separately as to why she couldn't conceive.

I think if you can legitimately say that you're experiencing pain every month and that you'd like further tests, then do it. That's not lying.

Op i'm so sorry you are going through this.. I have been in a very similar situation so will give you my experience incase this helps.
We also had icsi for male factor, there was nothing apparently wrong with me but after 2 failed implantations I felt I needed to get checked out just incase. My consultant suggested a hysteroscopy though rather than lap. I had private medical cover through work. They were very specific in the policy that they would not cover fertility treatment but would cover 'investigations' into infertility. So basically as long as i couldnt actually get pregnant through the procedure they would cover it. Is there any chance your policy wording might be the same? It was a bit of a faff getting all the paperwork right etc but they authorised it in the end.
The results turned out to be normal and thankfully our third icsi cycle worked and I now have a little boy. Apparently the main difference in cycles was my lining quality was much better 3rd time but the clinic and I went into it prepared to do a freeze-all if the lining hadn't been looking so great on scans.
I hope you can find a way to get the procedure but also remember you have confirmed male factor plus you have been pregnant before so it is very likely not going to be your issue so in the end the lap might not be needed and it might just be a numbers game unfortunately. If you/I were lucky enough to be trying naturally you certainly wouldn't rush into a lap on the third month of not catching but I totally understand the need to check every avenue when each try costs so much financially and emotionally.
I am just about to get onto the whole rollercoaster again to try for a sibling so i do understand exactly how you feel.

Yes I think that's the best thing to do. Go and state I have monthly pain and wish to be referred for further investigation.
Which is the truth.

Right my policy states it won't pay for routine pregnancy and childbirth or fertility investigations.

So if I just go and state the truth re ovulation pain and that I want a referral to have it investigated then I think that falls in line with my policy. So it won't be fraud? At no point will I lie or make up any symptoms. I will just tell the truth.

What about when he's grown up? He's got no cousins. What about if he doesn't meet someone? Have a family of his own? Gets divorced? He will be all by himself and I can't stand it.

As a parent of an only child, frankly that doesn't make very nice reading.

This is no doubt something you don't want to hear, but I think you need to see things from a more objective standpoint. You are ignoring the wonderful child that you have right now and all of the wonderful opportunities you have to enjoy parenthood every day with your dc and instead you are concentrating on some mythical fairytale future where you will have two children that love each other and will support each other through thick and thin for all their days. What are you going to do if :-

• One of your children is mildly disabled so you can't parent them 'equally'

• One of your children is profoundly disabled and needs specialist care for life, would you expect the sibling to sacrifice their own future career to do that?

• Your children hate each other and fight all waking hours.

• One child dies so you are left with an "only" child

• Any other non-rosy future for 2 siblings

There are so many possibilities of how a future with two children could be, I think you need to be much more realistic in your expectations.

There is a profound saying that I can't recall at the moment but the gist of it is stop focusing on things you cannot have and open your eyes and notice the wonderful things you already have in your life right now and be grateful.

Yes all of that is true.
He might not get on with a sibling. The sibling might be disabled.

However if he never has a sibling we will never know. He won't even have the opportunity to get on with them.

I am a happy only one but I'm still aware that once my parents aren't around anymore, I'm on my own.

Having two or more children is no guarantee a person won't be 'all alone'.

It is very sad you are wasting your life not enjoying it because of this.

These toxic relatives need to be told to shut their gobs.

I know a lot of people who are only children and childfree, too. Are they just saddos who are all alone?

They don't appear to be, and lead very full, happy lives with many friends.

What a shame you see your life this way, it's so precious. I had a child that died. I am glad I never wasted time when she was alive, wanting to be something else.

'The trouble is, you think you have time.'

I think your need for a second child is completely souring your experience of family life. You come across as way too focused on a second child, to the detriment of your current child. If you cannot find any pleasure in your life then I think you've got bigger problems than insurance fraud. :(

I used to work for medical insurance co and I have to warn you that if the consultant works in the infertility field the insurer will know about it, even if the referral is for a gynae problem. You would be taking a chance. Someone else said up post £4k sounds pricey - it is so check out local private hospitals for their flat rate / all inclusive prices.

If there is truly no joy in your life even with your little one, please seek out some counselling or other support. You sound so fragile and vulnerable. I'm not sure from your post how old your little one is but could there be a possibility of some residual PND ?

Also get your DH to kick your MIL in to touch - that's was extremely cruel thing to say to you. You are a family - it might not be the size you wish for, but you are a family and don't let anyone tell you otherwise. If they do - ask them to pay for the treatment!

OP, read up on the various symptoms of endometriosis online and check if you have any others. Go to your GP and tell them about your symptoms and that your gynaecologist is suspecting endometriosis. You can't use contraceptives as TTC. You have tried painkillers and ovulation pain still severe. Those are good grounds for referral to gynae, and the truth. If your GP is reluctant mention your private medical insurance as sometimes local hospital pathways prevent referrals unless certain strict criteria met. If GP says no seek a second GP opinion. Best of luck.

OP, also read this, based on NICE guidelines:

cks.nice.org.uk/endometriosis

Suggests you would warrant gynae referral.