Extra Money and Decisions Made

It seems like I haven’t written an update about our treatment cycles for a while.  Where do I begin?

The last time I mentioned about our cycles, we had some decisions to make.  Bob and I talked and prayed about it.  We both feel that we are more comfortable with not taking any birth control pills to hold off my period until end of December.  I don’t see a point of potentially messing up the hormones in my body this late in the game.  In regards to the number of embryos to transfer, we decided that transferring six embryos is just too risky, although it could be wishful thinking that my old eggs would give me more than one normal embryo in a batch of six embryos.  But still, I do not want to take a risk of having multiples.  I have a lot of peace with these decisions.  We are going to transfer four embryos at most.  I emailed Dr. No Nonsense’s nurse to let her and Dr. NN know about our decisions.

My luteal phase is usually 13 to 16 days, mostly 14 days.  Imagine my surprise when AF arrived on day 11 past retrieval.  It had been a wonky cycle and it kept on being wonky all the way til the end.  Thank goodness I always carry some pads in my purse so I didn’t create any embarrassment for myself.  (I have never used tampons and probably never will.)  I guess one good thing about getting my period early is that it’s possible for me to cycle earlier in January after the clinic’s lab closure at the end of December.  I quickly did some math and figured out that since my period came on December 8th, my potential retrieval in December would be December 21.  The lab closes on December 22.  So if we were to do a cycle now, it’d be cutting it very close to the lab closure.  Plus we wanted to do a transfer, so it’s basically impossible to squeeze in a day-two transfer on December 23.  The lab will definitely be closed already.  So yeah, even with an unexpected early arrival of AF, I am still taking a break from cycling in December.

After my email, Dr. NN called me one day unexpectedly.  I feel so lucky that every time he calls me, I am in between clients and am available.  So far I haven’t missed a single unplanned phone call from him.  His main question for me was whether we’d still thaw and transfer embryos if we don’t make any new embryos in January.  That is such a tough question to answer.  I asked if I had to make a decision ahead of time.  He gently said, It’s better to make a decision sooner rather than later.  So I promised that I’d talk it over with Bob and get back to him.  We also talked about whether to go back on estrogen priming for the next cycle.  We both decided to do it.  I hope that it doesn’t over suppress my ovaries this time.

Many of our decision are made based on our financial means.  If we don’t make any embryos next cycle, should we or should we not transfer the frozen embryos?  We don’t know.  We have to look at our funds and see how much we need to leave for donor egg cycles.  Donor egg cycles cost a lot of money.  I don’t know if I’d ever be able to join any of the guarantee programs since I have had an abdominal myomectomy and may not have the kind of “healthy” uterus that some programs require.  How much more money should we put into these cycles with my own eggs?  Bob promised that he would look at our finances and help me make a decision on the weekend.

I knew that we didn’t use up all of the prepaid services for our failed cycle.  We had no embryos to freeze so we’d definitely be credited back the fees for cryopreservation.  I sent an email to the billing person regarding the remaining balance on my account.   A week went by without a response from her.  So I wrote again.  She responded immediately and said she’d look at my account and let me know.  A few more days went by without a response.  So I wrote a third email, to which she responded with a new fees schedule for the next cycle.  I opened the word document and was blown away by the amount that was credited back to us.   Rather than just crediting about $750 to us for the cryopreservation fees, we can carry over $4300 to our new cycle.  So we only have to pay $2700 for our next fresh, thaw, and transfer cycle.  I am sure it was because my little egg failed to fertilize.  However, I am not so sure why they’d credit so much money to me after doing many monitoring ultrasounds and a whole egg retrieval.  She didn’t itemize the services that are being refunded to us so I have no way of knowing, but I’d take it when someone wants to give  me back a substantial amount of money.  This lady’s math is horrible though.  She miscalculated the amount that is due for the next cycle by $40.  This is not the first time I’ve found calculation errors made by her.

So with this new information, our decision making has been a little different.  It leaves us more money than expected.  Bob said that he’s comfortable with not transferring any frozen embryos if this next cycle again doesn’t yield any fresh embryos, because the refund gives us a chance to do another fresh cycle in February.  We’ll give it our all to do two more fresh cycles and see what we can do with my own eggs.  After that, we’ll move full force into donor egg cycles if our effort doesn’t result in a baby for us with my own genetic material.

So that’s the new plan!  I am so happy that we have come to a conclusion and are at peace with the decisions we have made.  It’s been nice not to have to think much about doing a cycle at this moment, although I should start checking my basal body temperature so estrogen priming can begin seven days after ovulation.   Thank you all for commenting the last time and giving us your feedback and thoughts!    I will do a post soon about my thoughts and research on donor egg cycles.

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.