What IS the next step?

Looks like this is the trend that I don’t have much time to blog until the weekend.  How’s everyone doing?  Hi to those who are here for ICLW!  This is where I am at in my TTC journey.  My husband and I have been TTC for 21 months.  That does not quite equate to 21 cycles because of my short cycles due to diminished ovarian reserve.  At one point my cycles were 23 to 24 days depending on when I ovulated.  Sometimes ovulation could be as early as CD9.  Acupuncture has helped me push back ovulation to day 12 and even 13, which makes my cycle a little longer.  Anyhow, Bob and I have done two egg retrievals.  The first one resulted in a day 6 blastocyst that was graded 2BB.  We had it frozen and was waiting for it to be transfer back at our second retrieval.  The second retrieval in September resulted in zero embryos to be transfer.  We also couldn’t transfer back our one frozen embryo because of a fibroid that looked like it was in the uterine cavity.   We have yet to do a transfer.

I am relieved to report that my visit to the RE last Thursday was great.  The fibroids are NOT in the uterine cavity!  So we’re all cleared to move onto the next step.  Now here is the fuzzy part.  What IS the next step?  Well, it all depends on what we choose to do.  

A few possible scenarios:

1) Do a fresh cycle with Dr. E and thaw Clay (our little frozen embaby) no matter what so we have something to transfer

2) Do a frozen embryo transfer only and thaw Clay

3) Begin to go down to Southern California and start trying to bank embryos at L.ife IVF hoping that we will be able to bank at least four to five blastocysts before we start doing frozen embryo transfers

Why so many choices? Well, they all have to do with money.  My husband’s employer currently offers $10,000 lifetime maximum of fertility insurance that surprisingly goes a long way when it comes to cycling with a doctor who is in network.  Compared to the $12,400 price tag as a cash-paying patient, a doctor agrees to be paid at a discounted, contractual rate by the insurance company.  Since we have not done a full cycle and just the two retrievals, we should have at least a couple of thousand dollars left.  Now here comes the problem.  Since we only have a couple of thousands left, the doctor’s office is not going to take the risk of billing the insurance company first.  Since the remaining amount is not enough to do a fresh cycle, we will become cash-paying patients if we want to do a fresh cycle that includes a retrieval and a transfer.  I have been emailing Dr. E’s financial person back and forth.  Now I understand that we will pay the whole $12400 package price up front, in full, at our first monitoring ultrasound.  We will get a super bill from Dr. E’s office with the full amount that we paid and ask the insurance company for a reimbursement of a portion of the cost.  So we will no longer have the fortunate privilege of paying a $35 copayment at every visit.  We will pay 350 times of that.  On top of that, Dr. E recommends going back to the first protocol which was 4 vials of Menopur and Omnitrope.  The reason?  I responded well to it and we have one blastocyst.  The second protocol was a lot cheaper (Femara was covered by insurance) but nothing resulted from it.  Did it really have to do with the protocol?  Or just the egg quality for that particular cycle?  Really, nobody knows.  But we would want to be safe and do the one protocol that seemed to work.  The downside is that it will cost about $5000 in medication.  Are you doing the math for me in your head?  Don’t you think that this is A. LOT. OF. MONEY for ONE CYCLE?

If I had all the money in the world, I would do a fresh cycle with Dr. E because she knows my body.  With DOR, you just need to try your luck every single cycle hoping that you will encounter that one good normal egg.  But, I don’t have all the money in the world.  So what do we do?

We could potentially just do a transfer and see if Clay would stick.  That way, insurance should cover for the whole FET and we don’t have to worry about meds and other things.  If it works, then it’d be great!  But we do want to have two children.  If we could do a fresh cycle now and gamble to get more eggs/embryos, we may have something to freeze with younger eggs/embryos so that we can help Clay get a sibling in the future.  Younger embryos are theoretically better than older embryos.  

Another question is whether or not we could switch from Insurance Company A to Insurance Company B and still get a new batch of $10,000 lifetime maximum.  If so, then we could start our new insurance in January.  If not, then we have to seriously think about how to spend our savings on subsequent IVF cycles.  

Our last resort is to travel 500 miles to L.ife IVF and try doing natural IVF or mini-IVF.  The pros are that it’s a lot cheaper ($9900 for three cycles) and the cost of medication is also a lot cheaper (Dr. Y there is known for using Clomid).  The cons are that we will have to travel there monthly to do egg retrievals and I’ll have to take a few days off each month to do that.  I was thinking that this would be the way to go since I only get one embryo or no embryo each IVF cycle so far.  The cheaper option will mean a higher chance at pregnancy but also a lot more taxing on my persistence and patience in this process.  The lab at L.ife is known to be good at culturing blastocysts.  However, recently I have read that the policy for out of town patients has changed for the worse, i.e. OOT patients do not get their instructions until noon time the next day AFTER a blood draw or a monitoring ultrasound.  L.ife is simply getting too big and a little more chaotic.  It makes me nervous to know that it will be stressful and hectic to get information and to ask questions.  

Bob and I have a lot to pray about.  If we go with Dr. E for more cycles, our IVF fund will be depleted quite quickly.  If we go with Dr. Y at L.ife, we will have more chances at a lower cost without compromising the quality of the embryos/blastocysts.  L.ife is a lot farther away and requires out of town monitoring and traveling.  I love Dr. E and love the care and attention that I get.  It’s such a tough decision.  

My thought so far: We’ll do a fresh cycle with Dr. E in November and thaw Clay no matter what.  We’ll have to pay out of pocket for this visit.  Why November?  Because Dr. E will be gone for four days in October (for Disneyland with her kids, how cute is that?) which will coincide with my egg retrieval.  I am paying HER money for the cycle so I don’t want other people to be doing my egg retrieval.  If we do a cycle in November, I’ll be guaranteed to have Dr. E doing all the procedures and also have the time to figure out the insurance money part.  If we don’t get pregnant after that, then we will most likely sign up for L.ife IVF in January as it is more wallet friendly and makes the most sense.  I will hate to part with Dr. E but financial reality will force us to do so.  

Life is so complicated when money is a requirement to do the simplest thing such as making a baby.  I know I have thought about this a lot and really want to have some control over it.  But really, who is in control?  We have to go back to God and ask God for wisdom, strength, and His timing.  Not an easy task, but I am trying to depend on Him.  And I am grateful that we have a chance and the means to try.