Learning From Our IVF Cycle

I finally summoned the courage and mental focus to speak with my RE to see what was learned from our IVF cycle. It’s been a little over a month since our negative pregnancy test (beta) and I decided I was ready to think about moving forward. Immediately after receiving our negative test results, hubby and I wrote down a list of questions to ask the RE:

  • Is there anything we should do differently going forward?
  • What is the lack of pregnancy related to? Is it age?
  • What about embryo quality?
  • Was there anything to report from the luteal phase monitoring?
  • Was the uterine lining an issue?
  • What about egg quality?

My RE was pleased with this cycle for someone my age and hormonal levels. I knew she would recommend another IVF cycle for us and this is what she said:

  • She was pleased with the follicle count and number of healthy embryos going into transfer
  • Embryo quality and uterine lining both good
  • Semen sample was very good, ICSI not necessary
  • Luteal phase blood work showed slightly low estrogen levels

She explained since none of the embryos implanted (we transferred 3), the reason is most likely due to egg quality; and something must have been faulty genetically. She was encouraging though, stating despite my low ovarian reserve; that in itself does not mean there aren’t any good quality eggs. Moving into the 2nd IVF cycle, she would make the following changes and recommendations:

  • Add Clomid to stimulate my own FSH to find better quality eggs
  • Add assisted hatching due to the thicker egg shell
  • Add Estrogen patch 2 days post transfer

She also reminded me that time is not on the side of aging women in general (not just me) and that I shouldn’t wait till the new year to start the 2nd cycle. DARN ovarian reserve!!!

The Unexpected Happens, Ya Know

By the time I had completed my first IUI, I was excited up to the point I was told I had already ovulated on my own and could not go through with the next step, which was insemination. “What a bummer I thought!” Who knew things such as this could happen. I mean, wasn’t my whole cycle being orchestrated externally by the doctor anyway? Let my personal experience be a guide before your journey begins to being open minded and flexible to the unexpected when undergoing infertility treatment. Again, no one told me this could happen. During infertility treatment, the unexpected happens, ya know!

But things like this do happen and medicine is not perfect. Okay I am starting to see how this works. I must go with the flow.

My next IUI went smoothly and I was able to finish with the insemination. Alas it was not meant to be when I found out the blood pregnancy test was negative. I was so sad when I found out. Then I felt even sadder when I had to tell my husband. Little did I know such information could bring such feelings of sadness to me. After 3 back to back cycles of IUI and numerous injections, blood draws and ultrasounds, hubby and I decided to take a break from all the poking and prodding. The weeks immediately afterwards, I was feeling pretty down and still pretty sad. I found myself crying at times watching tv or just while laying in bed for no apparent reason. I knew after a few weeks of crying, I was depressed. Even hubby became worried about my increasing silence and withdrawn attitude. I am usually a very upbeat and talkative character! For me at least, I was depressed after the third IUI cycle. Again, I wasn’t prepared for depression to hit! Who knew this could happen.

I wonder in retrospect, how many women out there undergo infertility treatment and experience no depression at all? I know today that I was definitely not the only one with feelings of depression. Why else would there be a weekly support group at the center. I unfortunately only became informed of the support group after our IVF class at the center. I didn’t think before starting these treatments I would need support, so it didn’t even occur to me to ask. If you’re contemplating infertility treatment, support is something you might find you need. Even if you don’t think you will need it (like me), knowing whether it is available will only benefit you later, if and when you should need it.

In all, a few other minor things did happen, but we dealt with them as they arose. I learned to ask many questions and not to leave anything behind or unanswered. Even if I thought it was a silly or unimportant question, I forced myself to ask.

Today, hubby and I have been through a total of 5 failed IUI’s. You want to talk about unexpected? I never expected to be at this point. After 2 additional rounds of IUI with injectable medication, we are still trying to conceive. Things you don’t expect to happen, can and do happen! Remember that! Wish us luck!

Financial Aspects of Infertility treatment

If you’re contemplating infertility treatment, there are a few pieces of information to research out. Infertility treatment can be quite costly, even if you have some form of health insurance coverage. After having gone through several IUI cycles, these were the issues and concerns I had to personally ask myself and deal with when it came to financial aspects of infertility treatment.

For those with health insurance

Does my health insurance plan cover infertility treatment? If so, does it cover only certain procedures, only ovulation induction or more advanced procedures such as IVF? This is very important to find out. I have known some friends whose health insurance plan only covers ovulation induction procedures, whereas another friend’s insurance plan covered ovulation induction as well as one IVF treatment cycle per lifetime. You should also find out whether the insurance covers any laboratory work being performed. One thing I found out in the beginning was that a certain procedure had to be performed at the hospital was not going to be covered because the hospital didn’t accept my insurance even though my doctor accepted my insurance (this didn’t even make sense to me!). For this test, I had to pay out of pocket. Some infertility centers are located within a hospital medical center and certain procedures may have to be performed at the hospital. Take it from me, ask about everything being covered! Don’t leave out one thing! For us, our plan also had out of network benefits so we could see a provider who was not in network. Not all providers take insurance. Were you aware of that??? Check to see ALL of your plan benefits. If you are able to, sometimes having the freedom of going out of network if a nice option if you needed to. Again, check and double check everything or you might find yourself with a heftier bill.

Does my provider participate with my insurance? Do I have an in-network deductible to pay before any coverage begins? For me personally, I chose a physician who was in-network for me but had to meet my in-network deductible prior to any coverage beginning. Check your deductibles to meet. Check co-pays if any.

Another piece of advice a good friend mentioned to me is checking the start and end dates of your health insurance plan year. For example, our health insurance plan year started in September 2011 and will end in August 2012. You want to be aware of this when planning treatment or doctor visits. If your year ends in July and you decide to start treatment in July, whatever amount you spend towards your deductible will be lost as August will start a new insurance calendar year. Those with Flexible spending accounts, be sure to spend the amount you already allotted so you do not lose any money.

Medications

When undergoing infertility treatment, medication (meds) is involved. Whether oral or injected, meds cost money. I can’t speak for oral meds but injectable medications can cost $300+ for a syringe. And if you need a few syringes per cycle, this can add up. Keep in mind, everyone has different requirements for the amount of hormone they will need so only your Reproductive Endocrinologist can determine this for you. You cannot determine this on your own. Check your health insurance plan to see if infertility medications are covered. If you have difficulty paying for your medications, inquire at your infertility center if they have special programs for financial difficulty. Another option is your fertility pharmacy. Many women order their infertility drugs from a specialty pharmacy that specializes in infertility drugs. Check with your specialty pharmacy to see if they have discount programs for infertility medications. A word about purchasing infertility drugs off the internet. Keep in mind some infertility drugs need special handling and refrigeration. If you buy these meds from someone other than a pharmacy, you don’t know how the medication has been handled and whether it has been stored properly. Another word on meds is if you are prescribed a brand name medication which is usually more expensive than say a generic, inquire whether the doctor approves of a generic medication which should be less cost wise.

Before hubby and I started a IUI treatment cycle, I asked the doctor’s secretary to give me all the costs possible in the cycle from the blood draws, ultrasounds, office visits, tests at the hospital (as opposed to the doctor’s office), names of meds to be used during cycle, how many syringes if she knew, sperm wash to insemination. At my center, I also had to pay a monitoring fee. Your center or physician’s office may have different tests and protocols so it’s always good to double check all costs, as best as possible.

With that said, I was always learning as I was forwarding myself along each cycle and yes, sometimes here and there came an unexpected test. But after 2 cycles, I did feel as I was getting the hang of it. Certainly be flexible to the unexpected but if you can learn as much as possible of what’s involved, you will find yourself less stressed. At least if you know a cycle can cost you at least $2000, you can budget that into your spending. I am conservative so I always give myself say an extra $800-$1000 in case of unexpected items. Tests are expensive!

BTW, my center didn’t allow a payment plan but check with your center on their payment policies.

In the beginning, doing all this research and information finding seems daunting but the more you know, the better off you will be! (I have always felt that way about life!) And remember to write everything down, and ask for individuals’ names to jot down as well. You never know when you may have to reference them.

Good luck!!!

Time Investment During IUI

Infertility treatments take time. Before starting treatment, you need to consider your time and schedule as well as your partner’s time and schedule. This means time investment. Does your job offer you a flexible time schedule or do you need to be at your desk at 8am on the dot? What is the distance between your center where you have to get bloods drawn and your work? How long will it take to get to work? Does your husband or partner travel a lot for work? If so, you may want to discuss a time for treatment when your partner is not travelling. If you are undergoing Intrauterine Insemination (IUI) or In-vitro fertilization (IVF), your cycle schedule can include the following:

  • Baseline exam, ultrasound, blood work
  • Attending an injection class (if injectable medications are used)
  • Blood drawing and ultrasound every couple of days, then every other day, then every day until the insemination or harvesting of eggs occur. This can last anywhere from 10-13 days of your treatment cycle. There is no set schedule for this monitoring phase, it depends on how your body responds to the medicine.
  • Daily injections subcutaneous , intramuscular or both depending on treatment and protocol chosen for you by your doctor
  • After IUI, suppositories may be prescribed for a couple of weeks or continued injections daily until your blood pregnancy test (IVF)
  • For IVF, you may need a Sounding Test to test your uterus
  • In IVF, there will be harvesting of eggs, and a transfer visit (to transfer the fertilized embryo(s)) to your uterus
  • Male partners also need to come in for baseline tests, injection class if performing injections, other tests if there are any infertility problems specific to partner

Just remember your protocol may be different but the above was pretty much mine. My personal experience of going through 5 IUIs, is no matter how well you have your life planned, plan for the unexpected. It’s so important, I have to say it again, plan for the unexpected. Have a mindset of going with the flow and if you have to wait 45 minutes in the morning before getting your blood work, then so be it. In undergoing treatment, you have to be flexible and anticipate delays in doctor’s offices, and sometimes delays in phone calls. My first IUI was so stressful, I didn’t know what to expect other than what they tell you on a day to day basis. All the other stuff, I had to find out on my own and when things happened unexpectedly. The good thing was my office was only 5 minutes away from the hospital center where I went for blood draw and ultrasounds. But even with that, I felt stressed. I was still working a 12 hour day seeing patients all day all the while going in almost every other day for blood work, ultrasounds and waiting for my call back in the afternoon with instructions. I was pretty stressed during my first IUI. One time during my first IUI cycle, I didn’t get a call back so of course I flipped out nervously thinking Oh no, I don’t know how much to inject of the medicine! But not to fear, I spoke to the doctor on call and got my answer. Thank goodness. I had to remember sometimes these things do happen.

So please keep in mind, going through infertility treatment, IS going to take some of your time. You will have to invest time. If you keep in mind some of the things you will have to go through and need to do, it will help you to plan for some of it. The rest, just be flexible and it will work itself out. Who needs the extra stress anyway?!!