cost of fertility treatments

IVF 101- The Players

This blog exists mostly as a way for me to fuel my never-ending obsession with getting pregnant. But its not the only reason. I blog to help other couples dealing with infertility. I blog to educate those who are not going through this journey to give them a little glimpse into this world so they can help those imprisoned in it .

For most of you, a post describing the basics stages of IVF will be all too familiar and remedial. If that is true for you, stop for a moment and think about it. Do you remember that almost-impossible-to-recall time when you didn’t know everything about IVF? When you had to ask what IVF stood for? This article is for those who still retain that blissful ignorance and for those that love and want to understand them.

So for those who don’t know, IVF stands for In Vitro Fertlization, which is Latin for fertilization that takes place in vitro or outside of the body. You would think that since the the first test tube baby was born fairly recently in 1978, we could just drop the fancy Latin and call it HMC for “Hail Mary Conception ” or  LDE “Last Ditch Effort.” After all, it is the final option couples explore when trying to conceive, usually after trying everything else. But like everything with IVF, its too intricate for a simple and descriptive name.  IVF is complicated on every measurable level beginning with the number of people involved in the process.

Your Baby Dream Team- The Players

Reproductive Endocrinologist– Your main dude or dudette. He creates your treatment plan, makes adjustments to your medication, and will perform your retrieval and transfer. In some smaller clinics you interact with your RE frequently and he is actively involved in regular discussions with you. In larger clinics you never see your RE and even need to schedule time with him to ask questions. Some clinics actually have the audacity to charge for consultation time with the RE if it is outside of the regular communication plan. I have been billed only twice for consultations at two different clinics. In both cases I called and had it waived. Always remember you are the patient, which means you are paying the bills and have a right to your information and feedback from your doctor. Most RE’s are terrific, but if that is not what you experience use your voice. It also helps if you try to pack as much into your planned communication with your doctor and come prepared. Many clinics have multiple REs so the person you consult with may not be the one who performs your procedures depending on timing.

Embryologist– Your embryo’s main dude or dudette. She manages the lab and takes care of the eggs once your RE retrieves them. She and her team are the lucky ones who get to create the life by joining your eggs and sperm, and then monitor them as they grow into embryos. She also manages the storage process in the event you need to freeze your would-be-babies for later.  In most clinics you rarely interact directly with the Embryologist. Sometimes she will call you with fertilization or embryo quality results, but in many offices the nurses or RE handle that. She will be present at transfer to assist the RE in getting your embryos from point A to point B. Like REs, many clinics have multiple embryologists.

Master and Creator

Nurses– Your translators and best friends. They speak fluent Reproductive Endocrinoligist and will be the people you interact with most often. They order your meds, take your frantic calls, tell you when to take what and will even show you how. Because they regularly deal with desperate women who are hopped up on hormones, they may very well be the most patient and wonderful people on the planet. Some clinics assign you one nurse who helps you manage your plan, while some take more of a triage approach where you work with whoever is available. There are advantages and disadvantages to both. If you are using donor eggs, there will usually be special nurses to work with you and your donor to coordinate communication and timing.

Sonographers (ultrasound techs)- Your examiners. These people will regularly violate you with a large wand to determine if your lining is thick enough and has the right number of layers (three!) for transfer. They also monitor the size of your ovaries and the number and size of your egg containing follicles through the course of your IVF cycle. Once you start taking medications to stimulate the ovaries you will see the sonographer every two to three days. When you are close to retrieval your appointments may be daily. They will also monitor your pregnancy until you graduate to a plain old obstetrician at about 10 to 12 weeks. In some clinics, nurses are trained techs and also perform this function. Its worth noting that for a sonographer, a trans-vaginal follicular ultrasound is the most complicated test that they do. It’s like Rodney Dangerfield’s Triple Lindy for sonographers. Your tech will be trying to count and concentrate which usually means their eyes are squinted and their mouths are open. This is normal and does not mean anything is wrong. Let them do their thing and then ask them questions when they are done. Its hard work and I have only met a few that can carry on a conversation while performing a follicular scan.

Third Parties– Your saviors. In the event that you need to use someone else’s “stuff” to get knocked up you may find yourself working with a surrogate, gestational carrier, egg donor, or sperm donor. Even people that use gestational carriers and surrogates get confused on the difference. A surrogate is a saint of a woman who will give you both her eggs and her body.  A gestational carrier is a saint of a woman who will give you only her body, you have to provide the eggs.

Pharmacy– Your dealer. Fertility drugs are not your average, every day, run-of-the-mill medications. You cannot find most of what you will need at your local Rite Aid or Walgreens. Instead you will need to use a specialty pharmacy. There are several national chains and larger cities will also have local options. Without insurance, the medications can run up to as much as $6000 per cycle for women who need a lot of juice to get their reproductive system to react. Prices vary a great deal and its worth the time and annoyance to call around and get quotes on the more expensive medications. For instance, I found that one pharmacy offered the HCG trigger shot for $88 while another charged $250. Shop around and ask about rebate programs if you self-pay.

Phlebotomist– Your own personal vampire. If you are undergoing IVF you are probably no stranger to the phlebotomist but you are about to potentially add her to your Christmas list given how much time you will spend with her. In some clinics, nurses also draw labs. Some clinics have you visit a third party lab for blood draws. Wherever you go, you will likely have blood work done every time you have an ultrasound or diagnostic appointment. Just accept the fact that you will look like a heroin addict by the time you get knocked up. And take it from me, don’t volunteer to allow someone in training use your veins for practice. They can learn on happy pregnant people who don’t have to do this every other day.  Trust me on this one, you are not being mean. Just say no.

Image by Thirteen of Clubs vis Flickr

Image by Thirteen of Clubs via Flickr

Counselor– Your lifeline. Most clinics have someone on staff available to you and your partner for free. Many clinics even host support groups for patients. I strongly encourage you to take advantage of this if it is available to you. Even for the strongest of us, IVF is emotional torture and the process is especially hard on relationships. These people have tools that can help you cope that may or may not increase your odds of success, but even if they don’t directly help you conceive, I guarantee they will increase the odds of your relationship surviving IVF. Don’t wait until you feel like you need it. Start dealing with your volatile emotions now.

Billing– Your necessary evil. These people will work with your insurance if you have coverage to make sure as much is covered as possible. They are also Gestapo like in their ability to put fear into you if you are not up to date on your payments prior to your procedures. Nothing can throw a wrench into your baby making plans like having a treatment threatened to be cancelled until you pony up some cash. Stay up to date on your payments, but more importantly spend time with them in the beginning to ensure you understand all your options and the full costs. Many clinics offer special packages for those who qualify and one of my biggest regrets is not exploring options when I was young enough to take advantage of them.

That is your dream team.  Hopefully it helps you understand why your clinic might make you feel a little bit like a football that is being thrown back and forth. Sometimes it seems like there is very little forward motion, but don’t let that deceive you. All of these people are on your side and are working hard to take some yards against infertility and arrive at your joint goal of having a healthy baby. IVF is complicated. Because of this you need a number of people who specialize in small parts of it to help you along the way. It may feel clunky and disconnected at times as a result, but its part of the process.

Image by Mark McGee via Flickr

Image by Mark McGee via Flickr

Ultimately though, you are the most important member of your dream team. Its important for you to understand the process, learn about IVF, and question your team when appropriate. While all these people are working for you, nobody cares about your success the way that you do.  And mistakes do happen. I have run out of medications on the weekend, not knowing the clinic expected me to know I needed more meds when my dosages were increased. I have experienced nurses failing to order meds and even certain procedures. I even had a pharmacy send a refrigerated medication using regular ground transportation and it was ruined by the time it arrived. Stuff happens and you have to be vigilant to avoid letting it throw off your cycle.

You are your own best advocate in a complicated process, which we discuss in more detail in IVF 102- The Process.

 

Stolen Pens

I have been thinking a lot lately about whether or not to share the names of my clinics and have decided against it. However where we are currently going will become increasingly obvious to some of you as we tell our stories. It will be very apparent to you if are at all experienced with IVF and have done any research on the best clinics. It will also be clear to you if you watch a certain reality show on E!

If you do watch that show you have met my doctor, a couple of the nurses, and have seen the building that we affectionately call “The Mecca of Fertility.”

Hint. Hint.

Google it if you want. If you look hard enough you will find it. But I didn’t tell you. Not officially. Being new to this blogging stuff I am not sure that refraining from spilling the beans protects me from legal action but I feel better being a little discrete. If I become pregnant and famous I am sure the clinic would love for me to plaster its name everywhere, not that it needs more publicity. But until that time and not knowing the outcome I think its best if I take the safe route. Especially given the story I am about to tell you.

So yes, our clinic is world famous. The founder is our doctor and he literally wrote the book on assisted reproduction (another reason to fall madly in love with him as discussed in a previous blog). Couples from all over the world come to our clinic in the hopes that their dreams will be realized.  It is the clinic of choice for those that can afford to travel and pay for the best. It is where celebrities go to get help with baby making when they hit the conception wall.

Yes, our clinic is the clinic of the stars and it has the price tag to match. And it is that price tag that turned the Winslow’s into thieves one day in August of 2013.

Most of the clinic’s clients are like us. They have been through multiple cycles at clinics closer to home and have switched hoping to break a losing streak. As result, the clinic is dealing with patients that have already had extensive fertility testing. But that doesn’t matter, every patient has to go back through all the testing again. The clinic feels they are the best, have the best labs, the best doctors, and their reputation is not going on the line based on shoddy work done by a previous clinic.

So no matter what your history the clinic does all the diagnostic testing from scratch in a session they call a “One Day Work Up.” In our case it meant a flight out to see them to do a myriad of tests and an orientation session. This day was spent waiting to meet with billing, waiting to meet with our assigned nurse, waiting to see the doctor for a variety of tests, waiting to give blood and other samples. It was a day of waiting, waiting, waiting. For each appointment we had to check in at one of three reception areas.

Each of these reception areas had an ever so tempting cup of brand new pens with the clinic’s name and logo on it. Nice pens. The good stuff. The kind you would expect from a celebrity’s clinic.

Bored from all the waiting, we decided to make a game of stealing the pens. Our goal was to take as many of those pens home as humanly possible thinking that it would help justify the expensive price tag of the trip. Each time we would check in for an appointment we would find a reason to have to write something down, use a new pen, and take it back to the waiting area with us to stash in my purse. We laughed so hard each time we would successfully “steal” a pen that was clearly there for us to take anyway.

We passed time dividing the number of pens into our estimate of what one full cycle at the clinic would cost us.  This gave us an estimated value of each pen. The more we would take, the more the value of each pen would decline. When it was all said and done, over the course of the day we took 6 beautiful pens. Since that time we have added two more pens from subsequent visits.

Based on our number of pens and what we have spent so far each pen has a value that is still more than some people’s used cars.  As a result, I use these pens all the time. I feel like I have to get my money’s worth.

I also have a sense of pride and a flittering of hope every time I touch one. As much as I like to joke about stealing the pens and the price of the clinic, whatever we end up spending is worth every hard earned dollar . We know that before we give up on the dream of having a sibling for Spork we will have gone to the best and given it our all.

We are uniquely blessed to have the ability to be able to do this. We would never have been able to afford it even two years ago. But we have had a lucky couple of years that have made it possible to shell out the big bucks for the big guns. It means postponing a new addition to the house and really tightening the belt, but I can’t think of another thing I would rather have more than this.

The results of our One Day Work Up didn’t tell us anything new. We looked good on paper. My hormone levels, resting follicle count, and other key factors all were perfect. Bill’s little swimmers were in Michael Phelps like condition. The doctor said he didn’t usually see patients like us. His cases are usually more difficult.

Since then we learned our embryonic cells divide a little more slowly than they should and the optimism has faded ever so slightly. Its a sign that my advanced maternal age could be the reason we are having so much trouble this time. But we are still making genetically viable embryos and that is why we chose this clinic. They were the best to help us answer whether there was still hope for us, and there is.

Whatever the outcome is for our family, Bill and I will be able to rest easy knowing that we have given it our best shot. But if the worst happens, if it doesn’t work, at least we’ll have the pens. All eight pens…and counting.