The boring part of IVF

Believe it or not there is a boring part of IVF -- the money part.  Over the weekend we received a large envelope from our clinic.  Inside was a number of handouts (conveniently highlighted) detailing our financial obligations and how much dough we'll have to fork over in August.

If you are lucky enough to have insurance coverage for IVF, then this part is rather easy.  Just hand over your insurance card to the staff and you're good to go.  But if you're like me, it isn't that simple.  The numbers are enough to make your head spin and trying to figure out how much you owe, who you owe it to, and when you owe it is a little daunting.

I'm essentially handing over enough money for a brand new car each time I do this, and the thought that by the time I'm done I'll have paid probably over $50,000 to have my children makes me a little dizzy.  But it's been money well spent for sure, and not once have I ever regretted it.

Jumping the gun a little bit....

Finally received the call today from the IVF nurse team at my clinic!  Of course I missed the call and had to call back with my heart thumping around in my chest. You would think by now (and after two previous cycles) I would be past the butterflies of this stage, but nope, here I am, like I was the first time around.

Apparently I am way ahead of myself in scheduling my cycle!  When I told the nurse that I didn't want to be starting meds until September she very kindly told me they weren't dating that far out yet.  In terms of completing my bloodwork and sonogram, I still have time to get that done.  So I am to call back in May to get my official calendar and schedule of events.

Until then I get to chew on everything and hope that somehow Mother Nature decides to cooperate.

Waiting.....and waiting some more

Seems like so much of IVF is just waiting....and then waiting some more.  It's been nearly a week since our meeting with the IVF doctor, and while I've been busy with my regular things and going on vacation to learn how to snowboard, I've been patiently waiting for the call from the IVF nurse to give me my checklist.

I know I'll still have to do more waiting but at least I'll feel like I have something to do, and feel like we're moving forward with the process.  But until then, we wait.

Housekeeping note:  I changed the settings on my blog so that you can now leave comments without needing to register.  All comments are still moderated before they are posted.

Getting the ball rolling....again

Today was the day to get the ball rolling again.  In spite of the fact that this is our third go round, we were still in for a few surprises. 

Our first surprise came right off the bat -- the clinic had moved!  Granted they had only moved to the building next door and up one floor, but this move is actually very good news for us.  In addition to completely remodeling the waiting area, our doctor told us that they brought in an engineer to help them re-design their labs.  From a new air purification system to updated lab equipment to making the lab more closed off (fewer doors to open and close), the clinic is very state of the art.  This in turn has had a positive influence on their success rates -- a statistical jump of nearly 10%!

Our second surprise was equally as pleasant.  I knew I would have to repeat some blood work, mainly to see where my hormone levels were at, but the good news is that they have a new blood test for their IVF patients -- the Ovarian Assessment Report.

According to the handout provided to me by my doctor "the Ovarian Assessment Report provides women with the most accurate assessment of ovulatory egg supply available through the use of a single blood sample.  Ovulatory egg supply is the quantity of eggs a woman has available for collection through controlled ovarian stimulation, commonly referred to as an egg retrieval procedure.  The report provides women with their Egg Retrieval Score which is a unique index score that more accurately estimates the ovulatory egg supply by combining age with multiple ovary-related hormones." The blood for this test is drawn on cycle day 3 (day 1 being the first day of a woman's period).

This means my doctor will get a better picture of how my eggs are doing and how they are aging.  Very useful when it comes to determining the proper protocol for IVF.

In addition to this blood work, I will also have to repeat the Saline Infused Sonogram or Sonohystogram (SHG).  In this test, the doctor fills the uterus with saline and uses ultrasound to check the shape of the uterus.  In addition, she will take a look at my ovaries and see how many potential follicles there are.  For my age group, each ovary should have 9 to 11 potential follicles.  (One of these follicles develops into an egg that will be ovulated.)  This test is done on or after cycle day 10 but before ovulation occurs.  (Ovulation on average occurs on cycle day 14 or 15.)

Our final surprise was the doctor's assessment of my previous IVF cycle.  In a previous post I had mentioned that years ago I had been given the diagnosis of Diminished Ovarian Reserve. This was my opportunity to ask the doctor more about this condition, specifically to how it related my previous IVF cycles, and what it could mean for my future.  Her opinion was that I did not have this condition, but rather possibly a condition call Ovarian Resistance.  Her thinking on why I was given the previous diagnosis was purely based on a number of characteristics that had occurred.  It was purely a clinical dignosis, based on experiences.  Diminished Ovarian Reserve is lumped in with what's called peri-menopause, the decade or so before menopause begins, whereas Ovarian Resistance is generally what can happen in the decade or so before that.  In her words, ovarian resistance means that my ovaries don't like to play so we are forcing them to with the IVF meds.

This left me with a much better hope and a brighter outlook on the success of the cycle.  My Use By Date no longer seems right around the corner.

So we are ready to go again, ready to hunt for that missing piece to our puzzle, and no longer feeling like that piece will be difficult to find.

Is it Monday yet?

Monday is the big day, the meeting that will get the ball rolling again for the 3rd time.  I'm getting antsy for the day to come and part of me wonders if I'll be able to wait until the fall to do the cycle.  It's really for the best interests of my family to wait until then, but part of me hopes that the doc says we need to go sooner rather than later.

The one thing that made me sad in making this appointment was that I realized this had become routine; almost like scheduling a dentist appointment.  I never thought I would be at that point in my life where IVF is now a routine thing to do.  It should never have to be that way for anyone; IVF should be something rare and unique, not something you schedule like a dentist appointment.

IVF 101: FAQ about IVF

1. Does insurance cover any of it?
1. No, it does not cover any of the costs associated with IVF.  Some states require coverage, but Minnesota does not.  Our insurance will cover up to $2,000 in infertility services up to but not including IVF.
2. Can you make payments?
1. No, all of the money must be paid upfront.  If you don't use all of what you paid in, you get a refund check once everything is completed.  This happened the last time we did IVF.
3. How much does it cost?
1. Our clinic breaks it down as follows:
1. Medications: estimated at $3,000 for a woman under 35.
2. Monitoring (includes ultrasounds and blood work): estimated at $2,436
3. ART services (includes egg retrieval, embryo transfer, anesthesia, and lab costs): $7,444
4. ICSI: $1,000
5. Grand total: estimated at $13,880
6. If we decide to freeze any remaining embryos, there is an additional $1,000 for freezing plus a $550 yearly fee.
4. How long does a cycle take?
1. Approximately 5 to 6 weeks from start to finish, usually on the longer end.
1. My last cycle was like this:
1. Sign paperwork and make pre-payment.
2. Three weeks of birth control to regulate my cycle.
3. Ten to 14 days of shots, with visits to the clinic for blood work and transvaginal ultrasounds.   Meds are adjusted as needed based on these tests.
4. Egg retrieval
5. Depending on how many embryos there are and their quality, embryo transfer is either 3 or 6 days after egg retrieval.  The longer the better because it means stronger embryos.  Some people opt to freeze at this point and transfer later in what's known as a Frozen Embryo Transfer (FET). I've always done a fresh transfer.
6. Another 10 to 14 days before blood pregnancy test.
5. Can any of the meds be taken orally?
1. Unfortunately not.  Almost all IVF meds are shot based.  Stimulation and suppression drugs are subcutaneous shots; the trigger shot and post transfer progesterone in oil shots are intramuscular.  Some women have used progesterone suppositories, but success rates seem to be stronger for the shot based progesterone (at least in the viewpoint of my doctors).
6. Does every IVF patient use the same drugs in the same amount?
1. No, each cycle is tailored to each patient's needs.  Adjustments to medications are even made during the course of the cycle.  There are some standard meds on the market though.
2. In addition, each IVF patient attends a "shot class" where a patient is taught how to mix the meds, and the proper way to inject them.
7. Where do you get these drugs?
1. There are pharmacies that specialize in fertility medications; almost all are mail order and ship FedEx.  I've used pharmacies on the East Coast in past for my meds.  They supply everything that's needed: the meds, any mixing agents (some meds are in powder form), needles, swabs, and Sharps container.
8. Do the shots hurt?
1. The subcutaneous shots don't really hurt.  It's a bit like getting pinched.  The intramuscular shots are quite uncomfortable and can leave bruises.

It's time for IVF101! First up, terminology.

I said in a previous post that I would be answering some common questions about IVF.  First we'll start with terminology.

Intramuscular shot: A shot into a muscle, usually the butt.

Subcutaneous shot: A shot under the skin; for fertility meds, this usually means in the stomach.

hCG: human chorionic gonadotropin

Egg retrieval: A surgical procedure where the doctor uses an ultrasound guided needle to go through the wall of the uterus (going up through the vagina) to collect the follicles (eggs).
 
Embryo transfer: The transfer of a fertilized embryo into the uterus.

ICSI (intracytoplasmic sperm injection): A procedure where one sperm is injected directly into the egg.

Trigger shot: An intra-muscular shot of hCG to tell my body to release the follicles (eggs) that have been growing.  Retrieval takes place 36 hours after this shot.

Stimulation drugs: Drugs that tell my body to grow follicles (eggs).  In other words, to stimulate my ovaries.

Suppression drugs: Drugs that keep my body from ovulatin and from only growing one follicle (egg).  The goal is multiple follicles; I had 22 in my last cycle.  A good goal is 10 to 15.

I'll continue to add to this list as I find more terms that need definition.