Tough decision between conventional IVF and mini/natural IVF

It took me and Bob quite some time to accept the fact that natural pregnancy might not be the easiest thing for us and we should move on with something more aggressive.  We started TTC back in January 2012 and by November 2012 we started talking about attending IVF seminars.  At that time, we only had a very vague idea of what IVF actually was.  So we attended four IVF seminars at four clinics in our area in three months.  We also did two phone consultations and one in-person consultations with three reputable REs in our area.  All the doctors agreed that the chances of natural conception for us are low and IVF is the way to go.  All the doctors wanted to pump me with high dosage of drugs to get the best response out of me.  At that point, I only knew that my FSH was borderline high and my AMH was abysmal.  One of the doctors who runs a famous local clinic and is known to be aggressive wanted to do the following: do one egg retrieval, freeze those eggs, do another egg retrieval, thaw the first batch of eggs, fertilize all the eggs with ICSI, test all the embryos with comprehensive chromosomal screening (CCS), pick out the normal ones, freeze them, and do a delayed frozen embryo transfer in a subsequent month.  This all sounds very good.  Do you know how much this whole thing is going to cost?  Something close to $30,000 or even more because of all the freezing and thawing, extra testing, and all the drugs.  I wanted to shout to the financial adviser lady on the phone: “Are you kidding me? Who can afford this kind of treatment for one cycle??!?”  But I just politely asked my questions, hung up, and felt a little defeated.

Bob switched jobs last June.  His old job’s insurance was wonderful with everything else except for zero coverage for infertility.  We were pleasantly surprised to find that his new job offers a lifetime maximum of $10,000 of fertility insurance as well as  a lifetime maximum fertility drug coverage of $5,000.  This coverage should pay for most of one cycle if we go with an in network provider.  So we prefer to find a doctor who is in network so we can minimize the out-of-pocket cost.

I found Dr. E.  She has a TV presence in my area as she sometimes would appear on a local news program to talk about infertility treatments.  I have seen her talk on TV multiple times in the past.  Not in a million years did I think that I would in the future sit face-to-face with her discussing the best course of treatment for my situation.  After all the other phone and in person consultations with other doctors, I tried to schedule an in-person consultation with Dr. E.  Unfortunately, she would have to take her board exam in the month of April and could not see us until May!  And it was in March when I called.  I really wanted to go see her because of all the wonderful things that I had heard about her.  So we scheduled the appointment and patiently waited for May.

While we were waiting for Dr. E, I discovered an online forum that is dedicated solely for women with high FSH.  From there, I learned that for women with diminished ovarian reserve (DOR), conventional IVF may not be the best course of action for them because they may not respond well to high dosage of fertility drugs.  With even the highest dosage, some women have only a few follicles.  The terms mini IVF and natural IVF repeatedly came up on this forum.  There are a few clinics around the country that not only accept patients with high FSH but also offer natural and mini IVF that aims at using very low dosage of drugs to stimulate a couple of follicles with the goal of preserving egg quality.  One of the clinics happens to be in my state but a 7-hour-drive away.  It happened to offer its monthly seminar in April.  I wanted to check out what the RE there had to say about treating women with high FSH.  Since we had to wait for Dr. E’s appointment in May, I thought we might as well go check out this clinic.  I was pleasantly surprised that Bob was all game when I made the suggested.  So one fine Friday after work, the two of us went on our mini road trip to the other side of the state.

What we learned was quite fascinating.  Dr. Y believes that high dosage of fertility drugs for DOR ladies would fry the eggs.  Even if the drugs help create multiple follicles, the egg quality may not be good.  His clinic opened in 2010 and appears to have pretty good results for my condition and my age group.  Many of the ladies on the forum travel out of town to this clinic.  They do egg retrievals, try to grow the embryos to blast, and bank them by freezing them.  They will then transfer the embryos back at a later time.  Many women on this forum have gone through the conventional IVF route but often had very poor responses and were forced to cancel their cycle or had crappy embryos that didn’t result in a BFP.  At the time of the seminar, we got a 10-minute in person consultation with Dr. Y.  He learned of my FSH, AMH, and antral follicle count and said, if I were his daughter or his sister, he would urge me to do natural or mini-IVF.  He said that many of his patients treat his place as the last resort.  I could go try conventional IVF first and if it doesn’t work, come back to his practice.  Another thing is, Dr. Y’s practice offers a 3-cycle package for about $10,000.  This is so much more affordable than conventional IVF that would cost more than $10,000 for each cycle.  Everything sounds good but I wonder about logistics of traveling, out of town monitoring, and taking time off work.  Most importantly, I wonder about my response to fertility drugs.  What if I happen to be one of those lucky few who responds favorably to high dosage of drugs and could create many follicles?  Do I learn from the experience of so many women with DOR who had already gone the conventional IVF route and failed?  Or do I try my luck?

Dr. E shared her view with us during our consultation in May.  She thinks that there is no such thing as high dosage of drugs frying the eggs.  She thinks that the more follicles the better.  Given the state of my ovaries (having about six resting follicles), we shouldn’t wait and should begin IVF as soon as possible.  She will put me on 300IU of Menopur plus human growth hormone.  Dr. E is in network, I have been very impressed with how available she and her clinic staff are to questions, and she appears to know her stuff.  We finally decided to go with her for our first round of conventional IVF.  My plan B is to see how my old ovaries are going to respond to the drugs, and go from there.

We have made our choice.  If you were me, which way would you have chosen?  Local RE with high dosage of fertility drugs and conventional IVF, or out of town clinic with low/no fertility drugs and mini/natural IVF?