Phoebe: My RE Wrote Back!

While he didn’t answer any of my questions about IVF, he did respond to a few of my queries.

Regarding the CGH test, which is a new DNA test I read about in the Fertility Advocate blog, a test that one clinic feels so confident in that they are offering a refund plan based on it:  CGH is still experimental.  Not of proven benefit yet.

Regarding IVF Refund Programs:  Most “refund programs” have a catch – they profit by charging more up front.

Regarding why the supersonic semen analysis is not done on every patient (ostensibly saving them time and money):  The SCSA test is a newer sperm test.  “How” it is used in reproductive medicine is still being established - which is why it is not ordered initially in all patients.  It does not predict outcome in all patients.

I asked him what we would do next if my husband’s varicocele repair was effective.  He said we’d try a couple more IUI’s.  I assume that if the varicocele repair isn’t effective, we’ll move on to IVF, in which case dude will have to get around to answering my questions.

Emotionally, I am feeling really down.  Don’t know why, other than it all feels very overwhelming, what with other things that we are doing in our lives right now.  Job, school (both of which I am really not into and yet they are a big portion of my life), buying a house, bad economy, etc.  And my poor husband has such a good attitude about the surgery, but we were reading about the aftermath and whatnot and I can tell he is worried about the pain.  Wouldn’t it be nice to just f**k and have a baby like normal people?

Phoebe

Phoebe: IVF Refund Plans. Really?

I have been doing a lot of fertility research lately.  Thank god for my meaningless job and the internet and all of you amazing people out there spouting off about this stuff.  One of the things I heard on the Twin Peas podcast is that fertility clinics are suffering in the economic downturn.  You wouldn’t know it from walking into mine, but if this is the case, isn’t it time they started offering discounts?  One of the myths that was dispelled on this podcast is that doctors can’t negotiate prices.  It turns out doctors are the only people who can negotiate prices.  In fact, a friend of mine had two failed IVF’s with a doctor and after she switched, he offered her a free one if she was willing to come back.  Sounds like they have some pull after all.

On a blog called The Fertility Advocate, I read about a clinic called SIRM that has offices all around the US and is offering a risk-sharing plan “for qualified patients.” In other words, they don’t make you a baby, you don’t pay.

Here is the link: http://www.thefertilityadvocate.com/wpblog/?p=753

Can anyone speak to the legitimacy of something like this? It seems too good to be true. Like, they’ll get you in the door and then figure out “oh gee that’s so funny ’cause you’re not qualified.”

I contacted this SIRM joint to see what they had to say. Here’s how it went down:

Hello,

I have had two unsuccessful IUI’s and we recently learned from a fertility urologist that my husband has pretty severe male factor infertility. He has a varicocele that is likely the cause of 57% of his sperm having damaged DNA. I am about to turn 37, so we feel we cannot wait six months to see if the varicocele repair surgery will be effective. We are in the process of beginning an IVF cycle now that will involve taking the sperm directly from the testicle, rather than from the ejaculate. I start Lupron injections on Monday, 3/30. I read about your CGH risk-sharing plan, and would like more information on it. It would be nice if our fertility clinic shared in some of the risk we are taking on. Especially in these times, $20k is a lot of money. Please contact me at xxx xxx xxxx.

Thank you,

Phoebe

The prompt reply:

Dear Phoebe,

Your timing is great in inquiring about risk sharing because we released another program that screens all embryos for chromosomal problems and if you have normal embryos and don’t become pregnant you get 100% of the medical fees refunded. I would highly encourage you to call Jennifer at the front desk tomorrow and set up a free consultation with me. Once we determine the specifics of your case, you can talk to our office manager, Linda, and get all the details of the full refund program. Additionally, there are other programs such as the two-cycle program or the outcome based program, which re the most popular programs. All of the programs are much less than the amount you’ve mentioned below with up to 100% refund.

Hope to speak with you soon.

Aykut Bayrak, M.D.

Medical Director

SIRM – Los Angeles

1520 E Chevy Chase Drive, Ste. 101

Los Angeles, CA 91206

Tel: (818) 291-1985

Fax: (818) 291-1986

www.haveababy.com

I got online and starting asking other advocates if they had heard about such a thing. One woman who is an attorney specializing in fertility asked me if I had read the contract associated with the risk-sharing plan.

Dr. Bayrak,

Thank you for your prompt response. Would you be willing to show me the contracts involved with the risk-sharing plans you mentioned in your previous email?

Thank you so much,

Phoebe

Again came the prompt reply:

Let’s evaluate you first to determine which type of treatment and plan would best work for you. The we can give you the specifics. Please contact us at the number below for a consultation.

Aykut Bayrak, M.D.

I am somewhat suspicious, but now that my husband and I have decided to get his varicocele repaired, I am thinking it might not be a bad idea to go in and get the consultation. What harm can it cause?

I also sent a long email to my RE with a litany of questions about the consent forms and the IVF procedure. My final question was about the risk-sharing plan and how he felt about such things. I have not yet gotten a reply. I am glad that I decided not to start Lupron injections TODAY. They asked me to sign their consent forms promptly. Ironically, one of the things they want me to sign says that I HAVE BEEN COUNSELED BY MY DOCTOR.  They really expect me to spend $20k and sign my life away without being counseled?  I won’t get an oil change without talking to someone.

Now that we’re going the varicocele repair route, I have at least three months if not more to chill and figure things out.  In that time, I’m glad I can drink ‘caf coffee again and exercise whenever I want. I am also thinking about fertility acupuncture. Anyone know whether it’s covered by insurance and/or whether or not it is effective?

Please advise, ya’ll…

Phoebe

Phoebe: Decisions, Decisions. Now it’s Varicocele Repair.

After much back and forth and back and forth and back and forth and back and forth (seriously, people, make up your frigging minds), my husband is calling today to schedule his varicocele repair. The doctor said that we could see changes as soon as three months from now and we’ll definitely know something in six months. At my age (37 in April), that’s not too long to wait, according to most everyone we’ve talked to. The procedure is covered by insurance (we think), and we can always do IVF if it’s not successful. Going to email my doctor’s office now and tell them we’re holding off on IVF. They will have to wait to get my $24k. Let’s hope we don’t have to go there!

Later today update: the varicocele repair surgery is scheduled for April 17.  BTW, the reproductive urologist pointed out that DNA fragmentation is more important than morphology or motility in predicting pregnancy, and yet it is not part of the initial semen analysis given by most clinics.  I realize the test is expensive, but people should be given the option, for Chrissakes.  Had we done that “expensive” test, we wouldn’t have lost more money and time on pointless IUI’s.

Just sayin’,

Phoebe

Phoebe: IVF Consent Forms Have Officially Freaked Us Out

We spent last night reading “bedtime stories” or, as the lawyers call them, consent forms.  Holy shit, they just led to more questions.  One of the things they wanted me to attest to is that I have been counseled by the doctor who has explained what the procedure consists of, and what the risks are.  Um, no.  The doctor has not even contacted us.  For $20,000 +, I’m calling that some shitty customer service.  Anyway, here are some questions.  Can anyone answer them?
1.  We read that ICSI is riskier than “regular IVF,” but then we were also told in the same breath that these studies were statistically insignificant.  What gives?

2.  Why were we given an ICSI consent form?  Is that just in case fertilization is unsuccessful?

3.  Should we do genetic testing and/or counseling?

4.  When is Assisted Hatching used?  In every case?  How is it determined whether or not it will be used?

5.  We got an estimate from the billing person at our RE’s office for around $15-16,000 for IVF.  Does this typically include ICSI and/or Assisted Hatching?  If not, what are the additional costs of those?

6.  What is the basic information a couple needs to hear from their doctor before moving forward with IVF?

Octo-Mom To Be (joking, joking.),

Phoebe

Phoebe: Back from Asia, Leaning Toward IVF

The pregnancy test, as suspected, was negative.  Before my trip, the doctor gave me a prescription for birth control pills just in case we wanted to start IVF right away this upcoming cycle.  Why do they give you birth control for IVF?  I have no idea.  Anyway, my husband and I are going back and forth trying to decide whether to get the varicocele repair surgery, which is 90% covered by insurance, or just go for IVF, which is going to come in at around $20,000, actually $24,000 with the added procedure of taking the sperm directly from my husband’s testicles.

While I was in Asia, my husband was trying to get an opinion from our doctors in time for me to either start taking the pills (day 2 of my cycle) or not.  This didn’t happen.  He still hasn’t gotten an opinion from his urologist, but our RE said basically we could go either way.  On one hand, we could get the varicocele repair and wait six months.  The risk is that a) my eggs could be degraded by then, although it’s not super likely (as far as age is concerned, 37 is kind of on the bubble) and b) the varicocele repair might not even do the trick.  In fact, my husband showed his test results to his dad’s friend, a urologist, but not a fertility urologist, who said the varicocele doesn’t look big enough to make a difference even if it is repaired.  We’re still waiting for a reply from the fertility urologist about this.  The RE also said that if money were no object, he would suggest going to IVF right away.  We do have the money in savings, only it was for a house.  But if that’s the case, we could just buy a cheaper house.  So basically, the RE left it up to us.  Either way, he told my husband I should start taking the pills regardless so that we could have the choice of doing IVF this cycle.  I started the pills on day 5 or 6 of my cycle (hard to tell since I was 15 hours ahead), and I hope that’s ok!  I just put in a call to my nurse at my RE’s office to let her know the latest.  Tomorrow I am supposed to go in for “Lupron Injection Lessons.”

Before I left for Asia, I talked to a nurse who said that if I were to go to IVF I would start taking injections two weeks after starting the pill.  The RE said I would take them one week after starting.  So I have a message into their office to clear that up.  And if it is all good, I gotta talk to the husband to figure out whether we’re IVF-ing it this cycle.  I have a feeling we are.  The odds of success with the ball slicing are like 66%.  That sounds pretty damn good to me!  Also, who knows?  We could have twins.  Two for the price of one…  That makes the bargain hunter in me all tingly.

Later today update:  OK, we’re IVF-ing.  It’s official.  Apparently, it’s OK that I didn’t start my pills until day 5 of my cycle.  My doctor’s office just sent me a shitload of consent forms that have to be witnessed by a non-family member.  I am now officially overwhelmed.  I will start my injections on March 30th and the “retrieval” will take place around April 20th.  Freaked out!

Phoebe

Phoebe: Supersonic Semen Analysis Results

My husband got the results of his supersonic semen analysis and they were not good.  57% of his sperm have damaged DNA caused by a varicose vein that is squeezing his left nut.  What does this all mean?  Well, his urologist said that IUI’s with this condition are pointless and that we should move immediately to IVF.  He gave two options:

1.  My husband could have a surgery to correct the varicosele, but we would have to wait six months before trying again to get pregnant.

2. They could proceed with the IVF cycle and, instead of using sperm from the ejaculate, actually make an incision in his scrotum to get the sperm directly from the testicles.  Ouch, but I love my husband because he didn’t even flinch at the thought.  Dude is hell  bent on having a baby.  The urologist has found this procedure to lead to 65% effectiveness in IVF.  Of course it costs $4000 and is not covered by insurance.

We are in the process of getting this big equity loan to buy a new house because, let’s face it, this is a good time to buy a house.  Now it looks as if we are probably not going to buy a new house for a while, which is OK, but who the hell wants the loan anymore?  Argh.  Obviously the baby is the priority, so there you go.  IVF, here we come. And then once we get pregnant, my husband can have the surgery for when we try to have another kid…

The news is disappointing, but it feels good to know exactly what’s going on inside my husband’s scrotum.  I have always wondered.

Of course I am still getting the pregnancy test Thursday and you never know, but the odds are VERY SLIM that I am actually pregnant.  I leave for Singapore Thursday night.  Does anyone know what the IVF cycle is like?  Is it something I can start while I’m overseas or is it more involved than that?

Lemme know…

Update:  My mom pointed out that if the varicosele surgery is covered by insurance, then maybe we should get that.  Six months isn’t that long to wait.  I turn 37 in April.  Thoughts on that plan from the peanut gallery?

Yours in ball-choking veins,

Phoebe

Phoebe: Pregnancy Test Next Thursday

Normally I would just wait for my period, but I am leaving town two days before it would likely come. So my RE is having me come in for a blood pregnancy test 12 days after my procedure that will determine our next course of action. Either I’m pregnant, in which case we know what the course of action is there, or I’m not. If I’m not, then the doctor will either prescribe more Clomid or start me on injectables since the last round of Clomid only produced one egg. I don’t think we can consider IVF at this stage with me leaving town for ten days.

My husband went for a scrotal ultrasound (it was a bummer for all involved), and we are waiting for the results. His urologist’s initial thought is that he has a varicocele. Here is a definition: A varicocele is a varicose vein in the cord that connects to the testicle. (A varicose vein is one that is abnormally enlarged and twisted.) Varicoceles are found in 15% to 20% of all men and in 25% to 40% of infertile men.

It can be corrected with surgery, but that would put our reproductive efforts off for about six months, so we are not sure how to proceed there. Anyway, he got a supersonic semen analysis and the aforementioned bummer of a scrotal ultrasound, so we’ll wait for the doctor’s assessment in order to figure out where to go on that.

Meantime, every gas pang and slight cramp I feel is immediately presumed to be implantation. I’m trying not to drive myself crazy with it, but failing miserably on that front.

Just very excited to be doing this…

Woo hoo!

Phoebe

Phoebe: Post-IUI Fertility Cost, Going OOT and Pity Party Update

I know when we have a baby, we won’t care how much we spent, but still…

I got the IUI on 2/28, which means I will know something by 3/14.  Thing is, I am leaving town for 10 days on March 12th, so I emailed my RE to see if I can take a pregnancy test before then.  This way, I can start up the new cycle without a hitch if I need to.  Otherwise, I have to wait until yet another cycle goes by before starting again.  And with me, you never know when the next cycle is coming.  Could be 34 days, could be 60.  The other benefit to knowing before I go is that I will know whether I can take Ambien for the 18-hour coach flight or drink during my trip.  A girl’s got to have her priorities.

BTW, I re-read my Pity Party entry and I sound so bitter.  For the record, this blog is intended to record all of our thoughts and feelings, including the bitter ones, so there it stands.  But here is something positive to balance it out:  I have a wonderful, supportive husband and we are growing closer and closer as we go through this experience together.  I know that we will have a family, and in the meantime we are well aware of and taking advantage of the fact that, without kids, we have extra time to spend together and have lots of quiet and friend time.  We are reveling in that because we know our friends with children cannot easily enjoy the odd spontaneous dinner or movie, party or gig (I’m in a band), or even just a quiet moment to relax for that matter.  As soon as we started seeing the RE, we both decided that we would take it easy, be patient and live in the moment.  In other words, not to see ourselves now as lacking, but just in a different phase of life.  I would hate to have wasted the early years of our marriage feeling a void instead of enjoying all the things we have to be grateful for such as each other, our work, fun, our families, our friends, our home and, as Maggie said, the resources to even pursue fertility treatments.  I regret having spent the time from age 25-35 stressing about getting married (when will it be?  who will it be?  is it you?) instead of just enjoying being single.  It will happen.  In the mean time, life awaits!

Love,

Phoebe

Phoebe: IUI Numero Dos Complete

Went in yesterday morning to get IUI number two. After looking at the ultrasound, the doctor said our timing was perfect. I had just ovulated, and we were working with a good specimen. Since it was a Saturday, it wasn’t my usual doctor, who is quite stoic unless you ask him specific questions. This guy was recounting his entire vacation schedule (he takes the same vacations every year – wtf?) while possibly conceiving my child. It’s an odd way to do it, folks. I’m not gonna lie.
Does anyone know a rule about exercise? When I got my first IUI, the Dr. told me to wait three days before exercising and cut down to three days a week of exercising in general while trying to get pregnant. Yesterday, I asked the sub and he said to exercise whenever it makes you feel good. He didn’t think it would affect my fertility at all. I have a mind to err on the side of caution, but, since my two Dr.’s can’t agree, I was curious what others think…

Cautiously optimistic,

Phoebe