Wednesday, October 20, 2010

The Protocol

There's all this *mysteriousness* surrounding IVF until you're in the thick of it. At least that's the way I felt. It was always this massive, expensive procedure floating out there in our future. I always thought we'd wind up here. Not that I didn't have any faith in IUI or even Moo Goo alone - I certainly did. But for whatever reason, I just felt we'd end up doing IVF before it was all over. But until now, it was always this mysterious process that I didn't worry too much about until we had to. Part of that's because I had trouble finding any detailed information on the costs beforehand. Everything I searched was so vague. It's easy to find ballpark figures, but your protocol and medication can make a big difference in overall cost. And everyone is different. But even trying to get estimates out of my doctor's office was confusing. They still give you a range. Well I'm a numbers person, y'all. I like exact figures! So hang tight, I will give you those.

And, as promised, I'm going to take you guys along for the ride. I'm guessing I'll start next Friday. That's my guess. I'm very regular, but it's still a guessing game with me to some degree. (Flo likes to keep me on my toes.) I've got my protocol laid out and my meds ready. All I have to do is call my doctor's office when I start (Day 1). The hub and I both start taking an antibiotic on Day 1. I asked the nurse why he needed one and she told me the answer and I was like, "Oh, OK that makes sense," but now I've totally forgotten the reason. Anyone know? Anyway, then they'll have me come in on Day 2 for a "suppression check" - basically an ultrasound (vaginal) and bloodwork to make sure everything's clear and good to go. And I will start my first dose of injectables that evening. I have to actually mix some of the meds before injecting - that first night should be interesting! I'm not fearful of the shots at all - moreso the mixing and not effing it up somehow. I also have to pay attention to my dosage, etc. One of my syringes is pre-filled but you only take a certain dosage. Our Injectables 101 with the nurse a couple of weeks ago was a bit overwhelming! I'm just used to popping pills and doing the occasional ready-to-go injection. So this all is certainly new.

After Day 2, they will pretty much be monitoring me everyday until the egg retrieval. So I will have to go in to the doctor's office each morning (I assume morning - I hope so) for an ultrasound to see how I'm responding to the meds. As things progress, they will adjust my dosages as necessary. So I do have more medication on hand than what my initial protocol calls for, in the event that they'll want to increase my dosage. This won't mean much to the fertiles, but I'll initially be taking Gonal-F (225iu) and Menopur (75 iu) through Day 5. I also have Ganirelix and am supposed to take that medication in with me to the doctor's office on my Day 6 visit. I guess they will give me my first dose of this? And then it looks like I'm supposed to continue the Ganirelix (250mcg) every morning until Day 10. Again, this is all my initial work-up and will probably be adjusted as I go along.

So as you can see, I spend the first 10 days or so of my cycle getting drugged up. Basically, the meds are there to make me produce LOTS of eggies! Somewhere around Day 12, they will do the egg retrieval, which is an actual surgery where I'll be knocked out. Not at all afraid of this as I've had two hysteroscopies before. The retrieval is a quick, 30 minute procedure but I'll definitely be home afterwards taking it easy. The hub also gets to do his grand performance this same day! I will of course fill y'all in on how many eggs are retrieved and of those, how many are "mature." Then the task is getting those mature eggs fertilized. They'll initially allow some sperm and egg to party on their own and see if they fertilize, but ultimately they'll use a process called "ICSI" to force fertilization.

Hopefully we will have some beautiful embryos and be able to freeze some! (A frozen IVF cycle is WAY cheaper than a fresh cycle.) Our best-case-scenario plan is to transfer one embryo on day 5 (meaning 5 days after the retrieval). Otherwise, they will transfer 1-2 embryos on day 3. Day 5 is better because the embryo is more mature and more likely to stick once transferred back. So day 5 is what we're hoping for! And you may be asking why only one embryo... Well, given my *special* uterus, my doctor is adamant that I could not carry more than twins. I will be high-risk throughout my pregnancy no matter what, so he thinks it's best to only do one embryo here. With two embryos, the chance of twins is a good 20% or so, but either of those embryos could also split... making quads a possibility. Um, no. Could you imagine?! The chance of splitting is small, but it's certainly there. I was a little discouraged about the 1 vs. 2 embryo transfer when we initially discussed it with my doctor over a year ago, but I'm totally at peace with it now. I feel like it's definitely the right decision for us.

The actual transfer is done with a catheter, and the doctor will use ultrasound to guide him. Though it's the jelly on the belly kind of ultrasound and apparently you have to have a full bladder during this process so they can contrast the bladder and uterus on screen. He told me this would be uncomfortable. So while most people would probably be freaked out about all the meds and injectables and surgery, I'm nervous about the transfer! Because I hate that full bladder feeling... hate it! Dear me, I hope he's quick.

So after the transfer, it's really just a waiting game. The first couple of weeks of November will be very intense! And then it's a wait-and-see kinda thing. As in wait and see if it worked! We are so very hopeful that we can just knock it out in one try - that would be great! But we do have a plan in place. We are doing a prepaid plan where you pay up front for several cycles at a discounted rate. It's a third party that handles these plans, but they work directly with my doctor's office. There are all kinds of options, but given my age, etc, we decided the 2+ cycle plan made the most sense. Cost was one of the things that was just so vague with IVF, like I mentioned. So I'm sharing the cost info with y'all because I know there are women out there like me trying to figure all this shit out. The ballpark figures I found online for IVF ranged from $8,000 to $18,000. Like how is that helpful? What does that include? What does that mean?! There's a honkin' huge difference between $8,000 and $18,000. Very few insurance providers will cover any part of it. I believe there are some states that address this issue and may even require providers to cover some of it - not sure. All I know is I'm in Georgia and Georgia doesn't. But certainly do your research! My insurance does not cover any part of IVF or any other "procedure" to get me pregnant. I do have partial coverage on diagnostic procedures. So back when they were trying to figure out what the hell was wrong with me, a lot of that was covered. But as soon as I started doing any assisted reproductive treatments, we were on our own. My friend and fellow IVF-er is all fired up about this insurance nonsense... It's ironic how the providers refuse to cover the procedure, so women feel the need to transfer multiple embryos (increasing their chances of success), and then end up in pre-term labor and NICU with their multiples. So now that same provider has a six figure hospital bill in their hands.

Tangent - sorry! Anyway, if we were to pay cycle-by-cycle at my clinic, we would have to put down a $12,000 deposit (for one fresh cycle). $12,000 is really their best guess at what a typical fresh IVF cycle costs a patient, but you may end up spending more or a little less - just depends. The meds, however, are a separate beast and are not included in that amount. The range the nurse quoted me on meds was $3,000-5,000. Luckily, I seem to be on the low-end this round, as my meds were just over $3,000. So the range for a fresh IVF cycle at my clinic, including meds, is $15,000 - $17,000.

We, however, chose to do the prepaid plan through ARC, a third party. This "2+ cycle" plan includes two fresh cycles and two frozen cycles. So for those four cycles, we (ahem, my sweet parents rather) paid $18,021.15 for this plan. This does not include any meds, so again we've already got $3,034.21 worth of meds on hand. (Tally: $21,055.36) And that's for just cycle #1. Should we have to go for another round, any additional meds would mean more $$$. Also not included is the surgical center fee for the egg retrieval - which is another $1500. (Tally: $22,555.36) That is also just for cycle #1, so should we have to do another fresh cycle, we'd have to pay another $1,500.

That is a whole bunch of numbers! OK but the nuts and bolts... should we get pregnant on the first try, we will have overpaid for that one cycle by about $7,500 (vs. just paying cycle-by-cycle). But hey... pregnant! So that is the risk with these prepaid plans, but the comfort is in the fact that we have a plan laid out with a lesser outlay of cash if we need the remaining cycles. It gives me a tremendous sense of peace... just knowing, alright, here's as far as we can go. And if this doesn't work, time to move on to Plan B.

As y'all know, I'm very, very excited about this process! Yes it's going to be intense and taxing on my body and spirit but I'm ready! I'm also so thankful to be in such a good spot spiritually right now. We obviously want to be parents so badly, but I'm not foolish enough to wait on a baby to make me happy. I am happy. I have an amazing husband with whom I absolutely love doing life. I have incredible friends and family who have been tremendous prayer warriors for us and have provided such unending support and love. We have two silly dogs that love us so hard and make us laugh everyday. And I have a God who is bigger than ALL of this. He wants nothing but the best for me and he's been nudging me day and night lately, reminding me that true satisfaction is only found in Him. Not in babies, husbands, friends, or even shoes. I want a baby, but I have all I could ever need.


Sasha said...

Saying a prayer for you! Thanks for all the detail- I was very in-the-dark about how it works. Other than what I know from seeing Phoebe get pregnant on Friends! :-)

Charbelle said...

You don't have to share all the details but you do and that's so wonderful!! Praying for you!!! Appreciate the reminder that true satisfaction is only found in Him!!!

Jill said...

Get it girl! You're going to do GREAT! Once the first shot is overwith and you know how to mix, it'll be smooth - I find just the first one is stressful. (seriously, call me if you want me to come over to walk you through it!) I'm really excited for you!! Praying every day for you!!

Ruth said...

I am saying a prayer it works the first time.

Preppy Pink Crocodile said...

You can do it!! I just KNOW it!! Saying lots of prayers always. Wait- can't you use the extra paid cycles for a second baby should you want to have another? Or is it only good for one bambino?

Buford Betty said...

One bambino. Once you get a live birth, you're done. Of course if we have any frozen embryos, we can come back later for a frozen cycle to get #2. MUCH cheaper - like $2700/cycle + any meds.

Julie Tiemann said...

Girl, I love how you're tearing down the mysterious walls that surround fertility issues. I know it's soooo personal, and I wouldn't expect everyone to share so openly, but I hate that there's such a stigma associated with it. I think you ROCK for sharing your journey, and I'm so excited to come along (vicariously) for the ride!! Praying!!!

Musewander said...

We went through ARC, too, and did the 2 fresh + 2 frozen plan... thankfully, got a BFP on our 2nd full "fresh" round of IVF, and have enough frozen totcicles for futures FETs (whew).

I believe I have an extra vial of, if you would feel better having a 'spare' on hand.. I'd be happy to donate it to you. It's been in our fridge for a few months now (used it in late June this year), so it should still be good. Let me know if you'd be interested in that... I know how expensive all that stuff can be!

Best of luck to you! It's exciting, and scary...but it's well worth it, in the end.

Praying it'll only take one try for you~

BroncoMom said...

Ahh Betty, will keep you in my prayers.

LSU Melanie said...

My prayers are still with ya through this journey!