The Potential Costs of IVF…

Although I’m still hopeful that I’ll get pregnant with less invasive and expensive means, I have to be realistic that we may have to resort to IVF in order to have a kid (or, at least, any faint hope of having a kid.) IVF, i.e., “In-Vitro Fertilization,” is a fairly common practice nowadays. When I tell people that I’m having trouble getting pregnant, everyone  jumps to share with me how they know “so and so” who got pregnant with IVF. Simple.

In many cases, these friends of friends lived in a state where IVF is covered by insurance. They mention their friend had to “pay a lot,” but don’t realize that “a lot” is actually co-pays and deductibles, which is still a lot, but it’s not the a lot a lot that is what IVF costs without any infertility coverage, which is the case for most women/couples in America. (Only Massachusetts, New Jersey, Maryland, Connecticut and Illinois require insurance coverage of IVF — elsewhere it’s up to your company if and what they want to cover, which is usually nothing unless you work for Facebook or Google or a giant bank.)

The average cost of a “fresh cycle” of IVF in the US is $12,000-$16,000. Think that’s a lot of money? That doesn’t include any of the medication required  (that’s an extra $3000-$5000+), or optional add ons, such as embryo biopsy and screening. If you get enough eggs out in round one, they can be frozen (and fertilized), for an annual fee, and then frozen cycles later are a little cheaper, at $3000-$5000+ per cycle, plus medications and the optional costs.

According to AdvancedFertility.com, IVF with preimplantation genetic testing (with meds) and a subsequent frozen embryo transfer usually costs about $17,000 – $25,000 in the US.

For women under 35, there is a 47.5% chance that $25,000 will amount to a child. There’s more than a 50% chance that you won’t get pregnant, and that $25,000 will be out the door, never to be seen again. When you turn 35, your chances of live birth decrease slightly to 39.6%. After you turn 38, those go down much more to 28%.

It’s a strange industry — medical clinics set up to give you hope, but also provide a realism in how you’re throwing substantial money at something that may not work, not to mention that if you do have a kid you really need that money to feed, clothe and shelter it. As a woman gets older, the clock is ticking, and suddenly money seems less important than just giving it all you’ve got to have a child. Maybe it won’t work, and maybe you’ll be $100k poorer for it, but at least you’ll know you tried.

Or, perhaps, you move to a state where they cover a cycle or two of IVF.

Getting Pregnant Attempt Updates…

I’m not pregnant (yet/still.) This cycle I was traveling when AF came, and I had my Femera prescription with me, so I took it, hoping that I wouldn’t ovulate before I got back to the west coast and, you know, near the other person I need in order to get pregnant (my husband, not my doctor.)

I also ordered a too-expensive bluetooth-enabled thermometer and started charting with the Kindara app, despite knowing that with PCOS charting is pretty much a hopeless cause. I guess, in my delusion, I’m hoping with the eating healthy and weight loss (plus the Femera) my body will just WORK for once, and then charting might make some sense.

My chart so far this month actually looks fairly healthy, although I only had EWCM for one day vs the 4-5 days that the internet says is normal. I did have a temperature spike, but it’s hard to say if that’s because on the east coast my temp was lower and then on the west coast it was higher… I flew to west coast on CD 15 sooooo… it could just be due to that.

I really wasn’t supposed to take the Femera this cycle, as my RE prescribed it with the expectation I would come in for two ultrasounds ($700) and then get my trigger shot (~$100) but I wasn’t here in time for any of that, and I didn’t want to waste the cycle since AF came early (on time) due to having taken the Femera with Trigger shot the cycle before. I never have 28-day cycles (I think my ‘normal’ is 35 but sometimes it can be 3-5 months before a period comes, though it’s been getting more regular lately.) It’s hard to know if I’m actually ovulating — with the Femera and Trigger shot last month I supposedly did, but I don’t trust my doctor yet.

I’m on a waiting list for a well-regarded IVF clinic, and I should be off that waiting list early next year. My HOPE is to be pregnant by then, but that’s going to be tough given I’m traveling too much. That’s my fault. But my husband and I are going on a trip *together* for our very belated honeymoon. I’ll be charting during the trip and maybe I can ovulate on my own – TBD if my RE will prescribe me Femera if I tell them I won’t be around for those ultrasounds.

And… there is the chance I could be pregnant right now. Super slim chance, since I didn’t actually see my husband until late CD15 and based on the chart I think I ovulated on CD14 – since the egg lasts 12-24 hours and sperm takes 6 hours to get to the egg, if my observations are accurate about CD14 then it’s impossible I’m pregnant right now. However, I’ve read mixed things about the EWCM – if it’s supposed to happen WHILE you ovulate, or in the days leading up to ovulation when you’re most fertile. Given I only had EWCM one day, I have no idea what it means, if anything.

The picture below is my current chart. Sorry it’s so blurry, but basically what it is showing is that based on my past cycles they expect me to ovulate between CD23-CD26, but that isn’t accurate since I took Femera this cycle so all bets are off. The noticeable change is the temperature, but as noted above up to CD 15 I was on the east coast, and then CD16 started temping on west coast, so that could explain the change. I’m also getting used to the temping in the am so the first few days I did get up before taking my temp, which should make my temp recording higher than it actually is — so that makes me think the temp increase on CD16 might be significant.

The other notable element of my charting is that my cheapo ovulation strips had a medium-shaded line on CD13 & CD14. The more expensive OPK did not give me any positive results on either of those days, using the same sample at the same time. Women with PCOS supposedly have high levels of LH to begin with so these tests are also not very accurate, but I’m hopeful with the Femera this could mean something. Then again, if it does, I likely ovulated on CD13 or CD14, which was too early given I was still a country away from my husband! But it’s definitely good news if I was able to ovulate with the Femera alone. It has me thinking maybe I should have went to a OB/GYN before RE and possibly tried that, since OB/GYN are not making all their $$ from infertility treatments they’re less likely to suggest expensive treatment until it’s necessary. I’m turning 34 in 2 months, so all of this may very well be necessary… but maybe I don’t need $700 ultrasounds and $100 trigger shots every month. Maybe the cheapo Femera and charting and eating healthy will work.

On CD13 and CD14 I definitely felt cramping in left ovary (I felt that last month too on the Femera, but that could be eggs growing, not necessarily releasing.) So maybe I did ovulate on the 13/14. Maybe I ovulated on the 15 because LH rises before you ovulate, and maybe I’m pregnant right now. Wishful thinking.

OR maybe I haven’t ovulated yet. The early temps could all be wrong, and I could see another spike in temp later in this cycle. My hope, if I’m not pregnant, is that I get my period on Wednesday, which would mean that I probably ovulated without the trigger shot “on time” with the Femera alone, which I could report to my RE and request for another Femera cycle without the expensive ultrasounds.

I wish some/any of this were covered by insurance. I know what I’m doing right now is so much cheaper than IVF will be, if we have to go that route, but it still is so much money. $800 a month for ultrasounds and trigger shot. It will be about $1500 if we do IUI. And I probably should get an HSG test which is – I don’t know yet – but I think another $1000. It adds up fast. Yes, I want kids and yes, I’m at the point in my life when I’m running out of options (especially if I want to have two.) I’m trying to remain optimistic but once my husband and I return from our honeymoon, we really have to get serious about this and that means seriously ready to pay whatever it takes to have a child.

In the meantime, I’m really focused on weight loss. I can’t say I’m super healthy as I haven’t been exercising (but our honeymoon will be composed mostly of hikes and lots of walking and healthy-ish eating every day) — BUT after going to a health resort in August I’ve lost 10 pounds, and I’m down 20 from my highest last year. I’m still ~30 pounds over a healthy BMI at 135, and I feel like if I can get there in a healthy, keep by blood sugars stable and eat 3 balanced meals a day sort of way, I can do this all naturally. I just have to heal my body. I’m not into holistic health BS but I know my body, and eating healthy and getting the right nutrition is legit.

At this point, I’m aiming for 5 pounds loss per month (hoping honeymoon really is going to be a loss month!) — 165 now, 160 by October, 155 by November and 150 by Jan 1. I can lose more than that (at the health resort I lost 5 pounds in one week!) but I’m trying to be realistic and take this slow. I’ll deal with figuring out the exercise routine when I’m back. I’m going to heal my body through treating it right, eating real foods, and getting the right nutrients through eating a lot of vegetables, lean meats and complex carbs. Simple. Maybe that will save me $50k of IVF/baby-making costs. I hope so.

Not Pregnant, Not Surprised.

When there were two beautiful properly-sized follicles on my first ultrasound post starting Femera, I had this surge of optimism in my mind that I maybe would be lucky and this try would take. I knew, scientifically, that even in the perfect setup odds of getting pregnant any cycle are less than 1-in-5, so I *shouldn’t* get my hopes up… but odds are still odds, and they’re not impossible.

When I felt cramps in my ovaries and could almost feel my eggs releasing, I thought maybe they were the ones. When I had a strange cramping sensation a few days before I was supposed to get my period, I thought maybe something took… but then a few days later, in unfortunate perfect timing, came the standard setup of cramps and bleeding. No dice.

Due to travels this summer, it’s going to be challenging to find time to try another cycle that works for the doctors and my husband and I. It’s hard to time these things since my period is so irregular anyway, and I need to be available for an ultrasound on the 9th day of my cycle along with the 11th day, and to be able to complete triggering and the following required acts for the few days following. This time I’m traveling internationally so I have to skip this cycle. Each missed cycle feels like a lost roll of the dice – will I look back in a few years and wish I just never left my area until I managed to get pregnant?

I’m not doing myself any favors by being out of town so much — I’m pretty much committed to traveling through October and then heads down and really focusing on getting pregnant (since I’ll be 34 somehow in November.) Thirty-four will be the year when I’ll be stabbing myself with tons of hormones, spending my savings on IVF, and maybe, if I’m lucky, being able to enjoy the wonders of pregnancy and having a child. My doctor says I need 2 more tries with the Femera and Trigger shot alone before we do anything else (though I can opt for a tube test to make sure they aren’t blocked… which I’ll have to do before IUI or IVF… but everything I’ve read about that test makes me cringe (sounds painful) so I’m avoiding… so far we know my (major) problem is that I don’t ovulate, and Femera seemed to “Fix” that, so maybe that’s all that needs to be fixed. Why believe something else is wrong with me for no reason other than being completely unlucky?

So I haven’t written here in a while because I was hoping if I didn’t think about it or write about it I’d be pregnant. That didn’t work. I’m not. On to cycle two… eventually…

 

First HCG Shot: How it Felt and the TWW

Last night, I had to – for the first time in my life – self-inject a drug into myself. I realize that diabetics and others have to do this regularly, and it’s not that big of a deal, but I let my fear-of-needles take a hold of me, which led to an hour-or-so panic attack and my poor husband trying to help me calm down, accomplished only by a shot of whiskey and finally getting up the guts to poke my stomach fat with the needle, injecting 1cc of HCG and water mix to “trigger” ovulation.

Admittedly, it wasn’t that painful – the injection itself didn’t hurt (I guess it’s a good thing I have so much fat) and it was only slightly uncomfortable when my husband helped me inject the substance – and then it was over. There was slight soreness at the site of the injection, but mostly I just felt a little dizzy and warm for a few minutes – I’m not sure if that was the medication or me just breathing for the first time in an hour.

The process of setting up the injections wasn’t that hard — we had a vial of water and one of powder, and we had to mix 1cc of water into the powder vial and shake it for 30 seconds, then the mixture was ready to be stabbed injected into my body.

As per doctor’s orders, we are to have TI twice this week, once after the injection and once two days later for the the best chance of insemination. I really wonder if this will work — there are so many variables that have to be right to get pregnant, it’s amazing anyone ever does. Now we enter the “TWW” – two week wait – and see if anything stuck. I don’t expect to get pregnant this cycle, though it could happen.

Cycle 1 CD11 2nd Ultrasound & Trigger Shot

So far, so good. I went in today for my second ultrasound of the cycle (another $350) and was informed that each ovary has one mature follicle — 17.7mm on my left and 19.4mm on my right. My lining is 9.6mm, which is good I guess (they didn’t tell me anything was abnormal with the lining) and DH and I are set to stab me (ahem, take my first “trigger shot”) tonight and then we’re instructed to have TI twice this week. And then we have our TWW (two week wait) and see if it worked – if not, we repeat the same thing again.

I wasn’t thrilled with my doctor’s bedside manner today – I understand he is much more engaged with patients who require IVF and my current treatment is fairly basic, but I’m paying $350 per appointment, it would be nice if I didn’t feel like I was being a nuisance asking questions. Apparently I should have taken better notes during the consultation (which was almost a year ago because I took some time before I decided to get started) — or I’m asking too many questions in general and should just do what they tell me to and not really know what is going on. I like to understand things, esp. medical-related things happening to my body, so I do ask a lot of questions.

If this cycle works, great. I’ll be freaked out in the way anyone is when they realize they’re about to bring another life into the world and there will be a nine month wait when they blow up like a watermelon leading up to the most painful experience in a normal human’s life (other than, you know, death, or, as my husband reminds me, stepping on a lego) — but also, ecstatic. And odds are still very slim right now… even super healthy women at my age only have a 20% or so chance of getting pregnant each month.

There’s also a slim chance that I’ll get pregnant with twins. I asked the doctor if the trigger should might make both of the mature follicles release eggs and he looked at me like I’m dumb and said “might? It will.” Now, just because two mature eggs release does not mean both (or either) will be fertilized and even if they are there are a host of things that could go wrong which is why it’s unlikely in any given cycle I’ll get pregnant at all. I’m saying this based on Internet research, not based on what my doctor told me, because he didn’t seem interested in explaining much of anything to me.

If it works, it works. I guess the TWW starts on the 13, with testing starting on the 27. That’s all we do at this point… trigger… TI… x2… then wait. It’s basically like normal reproduction with the added help of ensuring mature follicles and knowing when you’re ovulating.

Please send baby dust our way.

Ideal Follicle Size for Ovulation…

As any woman with infertility, I’m learning a lot more about pregnancy and getting pregnant than most people would know in their lifetimes, unless they happen to be gynecologists or reproductive endocrinologists.

I’ve learned in order to ovulate you need follicles large enough to release an egg each month. The ideal follicule size for the “leading follicle” is 23 to 28mm, and you should have one follicle at least 18mm before “triggering” (i.e. stabbing yourself in the stomach/butt with HCG to induce ovulation) — although according to the internet some fertility specialists say the follicle just needs to be 14mm before triggering and you can still get pregnant. Mostly I’m reading it’s 18mm minimum, so I’m not that far off…

I was told by a fertility nurse that follicles should grow at about 2mm per day. At my CD9 appointment, I had 14mm and 9mm follicles on the right and 12mm on the left, so that sounds good, I think? I’ll be going in for my next ultrasound on Sunday, so if the 2mm a day growth projection is right I should have 20mm, 14mm and 18mm follicles ready to go. I’m not sure exactly when they stop growing, but that seems promising.

 

First Femera Cycle, Ultrasound CD 9

Throughout this process of infertility, I’m trying to not get my hopes up. I know that even if I do happen to get pregnant in any given cycle, odds of miscarriage due to PCOS are high. However, I know that just getting pregnant will be a miracle, and every step towards that feels just as significant.

Today, I went in for my first ultrasound to track my progress on cycle 1 of Femera (Letrozole.) I’m glad that I’m going to an infertility specialist who understands PCOS, as apparently many women start with infertility treatments (meds only) via their gynecologist, and in that case many start out with Clomid which has more side effects and is less effective for women with PCOS in most cases.

Admittedly, I expected for this first cycle to have no results. When I went in for my mid-cycle ultrasound (non medicated) during my consultation, I was told I have a lot of follicles but they weren’t growing, and follicles have to grow to create eggs. You only need one good egg a month to get pregnant, but with the signal from my brain not making it to my ovaries, no eggs were being released, and pregnancy couldn’t happen.

So I went in to this appointment expecting the worst — if Femera didn’t cause any follicular growth, then I would need to move on to harsher interventions (injections, then IVF, or straight to IVF) — and given I’m already 33.5, time is ticking on peak fertility even if I were a completely healthy woman… I’d like to have my first child before I turn 35, which means I only have nine more months to get pregnant. Honestly, with the hope to have two kids total (three max, but two would be great), I know it’s best to have my second by 36/37, which gives very little time in between one and two even if I can get pregnant right away. I’d rather have more time with #1 (get pregnant sooner) and not feel so rushed into #2. And this isn’t all in my head — my infertility doc told me that as long as I have my second basically right away, whatever method gets me pregnant this time (i.e. Femera alone) should work again. Once I get into my later 30s, things just get a lot harder (i.e. more expensive) for everyone, even the healthiest of women.

I was a ball of emotions and bit my tongue not to cry when the nurse showed one sizable follicle on my left ovary, and another on my right. It’s too early to tell if they’ll be big enough to release an egg in a few days (and I have to go back for another $350 ultrasound on Sunday to find out), but the progress looks good. It clearly looks like the medicine worked in stimulating my ovaries to start doing their job. That alone is an incredible feeling —  maybe I can get pregnant after all with only thousands of dollars of intervention (instead of tens of thousands.)

I asked the nurse a zillion questions at the appointment today because I realized I didn’t understand what was going on — I had met with the doctor for a consultation a little under a year ago now, and at that point I wasn’t really ready to get started and I planned to meet a few other clinics to discuss options… but other clinics all had wait lists or super pricey consultation appointments, and this place had as good of reviews as any of them (and some just did IVF so if this doc wanted to start with basic meds that would be way less expensive, who was I to say I needed to freeze eggs, fertilize them “off site,” and implant them in order to make this work?)… so here I am, at this clinic because… they’ve been the most responsive and they’re working with me on what the minimal intervention needs to be to get my husband and I pregnant, and keep us pregnant (well, for nine months.)

Apparently they want me to have 2-3 healthy, large follicles in my cycle, and they’ll know that via ultrasound (hopefully by Sunday, though based on how everything is going I have a strange feeling they’ll want to give me another ultrasound next week if everything hasn’t grown enough yet by Sunday…) and once they see the follicles looking healthy they have me stab myself with an HCG shot to tell my ovaries to release the egg(s), and then DH and I (Dear Husband and I) have “TI” (timed intercourse) — hey I’m starting to get the hang of these infertility acronyms — and then, we wait…

There are plenty of reasons why, even with healthy follicles and an egg released, we won’t get pregnant, especially on our first try. We still don’t know what my fallopian tubes look like (an HSG test, not to be confused with HCG (Human Growth Hormone), also known as a hysterosalpingogram test, is a special X-ray tests that sees if your tubes (you have two) are blocked in any way, preventing a fertilized egg from making it to your uterus. In reality I could have a problem with this, but having PCOS makes me no more or less likely to have an issue with my tubes than any other healthy woman. Thus, the cost of test doesn’t make sense right now, unless there are other reasons to believe my tubes are broken (there aren’t.) The test can cost anywhere from $800-$3000, and while it may at some point be necessary, I’m trying to avoid unnecessary expenditures and this one seems unnecessary. The doctor said it was my choice — certain bloodwork was not my choice to do before we started any treatment (about $1000 worth of bloodwork) but the HSG test can wait, so it will wait.

Other than my tubes needing to function (at least one of them), I also need to be able to produce a thick enough uterine lining for the egg to stick. They are able to measure this via the ultrasound and right now it’s not thick enough, but the nurse seemed to think it’s en route to the appropriate thickness. I’ll find out Sunday when I see the doctor if there are any issues there. They apparently give you more/other drugs to help with this if it’s an issue. DH seems to be fully functional (his tests came back normal) so right now it’s my body that has to work.

But, it’s kind of crazy to think that this could work. I mean, if Femera makes me ovulate and everything else is normal then there is a 1-in-5 chance that we will get pregnant this cycle. With 2-3 good eggs, we could end up with twins (even triplets), although that’s quite unlikely with Femera (vs Clomid.) This office also doesn’t like multiples (beyond twins) so if you are showing too many eggs they won’t do the HCG shot to release the eggs. So things have to be just right on any given cycle for pregnancy to occur…

Then you wait and hope to not have a miscarriage, since women with PCOS are at very high risk for losing their babies, esp in the first trimester. I’m still hopeful that this will work… just seeing those beautiful follicles on the ultrasound gives me real, and I think rational, hope. I’ll follow up on Sunday to share how my follicles are looking and what our next steps are.