IVF low stimulation cycle MLEA

mandasd

Hi all,
Hubs and I went to our first RE appointment yesterday at UCSD Reproductive Partners. We really liked Dr. Friedman and the practice. Since I'm 35 and hubby is 40, we've been TTC for 2 years, she suggested that we go straight to IVF. I actually told her I prefer not to do IUI but want to go straight to IVF. The biggest issue is that I have a low ovarian reserve. Hubs has great volume but abnormally shaped and a little slow. I had an ultrasound and my uterus is normally shaped, no blockages or abnormal findings there. I have 5 follicles on the left and 2 on the right. Obviously, that is on the low side. Dr still thinks that we can stimulate my follicles by starting an IVF cycle.

She recommends doing IVF Low Stimulation Cycle MLEA which includes the banking cycle (stimulation) and a frozen embryo transfer. Reading the forums, a lot of people do fresh transfer. It's all very confusing and so I want to make sure I have the highest success. Here is the list of my meds:
Estrace
Ganirelix
Androderm Gel and patches
Menopur & clomid
Dexamethasone
Ganirelix injections
Saizen injections
Pregnyl/lupron injections

This place is not cheap. Total cost including everything except the genetic testing is going to be about $22k for one cycle and that is with the military discount. If we decide to do the ATTAIN program, for about $28k, we will get two tries. The decision is pretty much made, but we are going to look into applying for discount drugs and see what other scholarships are available.

I am happy to hear any suggestions/feedback!

jnissa

(child mentioned) 

Hi!

Firstly, good luck. Though UCSD sounds like you're in California, so I'm surprised that you're not insurance covered for this. I thought California was a mandatory insurance covered  fertility state?

Firstly, your follicle count is low but not "no hope low." I would trust your doctor's prognosis - though many of the women here will have a better idea of your prognosis if you can remember your day three numbers for AMH and FSH counts. 

If it is a difference of $22 for one or $28 for two, I would seriously not blink at $28 for two if you can come up with the extra money. It is not at all uncommon for this to take more than one cycle. To a certain degree, there's no way to know how you would respond to a protocol until they've tried it.

Fresh cycles are generally shifting to a less common scenario. My doctor told me that in my clinic only about 30% of cycles do fresh transfers these days. There's lots of compelling evidence that a frozen cycle is more successful because your body has time to recover from all of the stimulation hormones. However, some of that data is driven by the fact that many frozen transfers now include pgd/pgs testing, which can dramatically increase success rates as well. To be honest, I find the data conflicting and confusing and right now am in the middle of trying to decide whether to do fresh or frozen with our second cycle. We were successful on our first cycle a year or so ago with a fresh transfer and now have a daughter, so I may simply be superstitious and just want to stick to my fresh transfer. I have only ever had one cycle and had a much simpler med protocol than you do, so perhaps he's leaning towards frozen because of your med cycle.

I did a low responder, all menopur cycle with amh of 1.7 and fsh of 15, so a much different line up of meds. I think actually only the menopur, I think cetrotide and then the trigger with progesterone after embryo transfer. 

What I would maybe seriously think is that a second opinion from a second clinic is worth it. I know that you are extremely comfortable with that doctor - or at a minimum asking your doctor for her logic on a frozen cycle. While fertility can be confusing and is rapidly changing, you shouldn't be expected to pay $20k for a procedure with any doubt in your head.

mandasd

Thank you for the information! My insurance through work is Blueshield PPO and covers NO fertility treatment, even testing and meds. Hubby has Tricare Prime, which also doesn't cover anything.

I had my FSH and AMH done a year ago and the AMH was very low. I had the tests redone, but honestly, I did not ask Dr. Friedman what the numbers were. I just know the AMH was still indicating that I have a low ovarian reserve, that's the only issue with me, nothing else. Hubs has lots of semen it's just "lazy," which I laugh at because he is such a laid back dude, I teased him about his sperm having his same personality.

The genetic testing is the kicker, it would cost another $6k to do that on top of the $22k for one cycle.She told me 60% of couples do it. But, they usually do it for a few reasons, including age (over 40), family balancing, and if one parent is carrying a genetic disease. I really don't think we will do the PGS or PGD unless our genetic blood work (that costs $99) comes back with something.

There are two ATTAIN programs, which is also a little confusing. The first one is a 2+2 (2 IVF cycles, 2 frozen embryo cycles) for $19k, plus the cost of the meds $4-8k, embryo cryropreservation (varies), culturing, assisted hatching. There is also the enhanced ATTAIN for $20,800 and that includes the genetic biopsys.

I was thinking about a second opinion (Dr. Kettle at SD Fertility) but I knew going into this that UCSD was going to be one of the more expensive clinics in San Diego - it's the highest rated and has a very high success rate. I also like that I see my doctor and her nurse for every appt. At the other clinics in town, you meet the doctor once and at the retrieval/transfer, otherwise you see a technician or nurse. My hubby prefers having the personal relationship with the doctor.

jnissa

"Family balancing." I've never heard it called that before. How...much of a nicer way to say that My clinic refuses to do it. 

I hear what you're saying about the personal relationship with the doctor. I chose my obgyn that way. Though to consider that many of the appointments are literally just a blood draw and a phone call later to say "stay on the medication." But it is such a confusing process that I can understand your point.

We actually just decided against the pgd. I am over 40 (41) and I was 40 when we did our first. We just figure that with how few embryos were likely to retrieve it doesn't make sense. We didn't have enough embryos for a frozen transfer last time, and I'm not comfortable not doing a fresh transfer since it worked for us last time. The big difference is that we're comfortable terminating if there were a chromosomal abnormality at our 10 week harmony test. Not everybody is, and that makes the pdg make sense. Not to talk you out of the testing, just to give you some perspective on it if the financials of it are really overwhelming. 

Honestly, if I had a change to grab that 19K package - I would. 

Knottie4978096

Just an FYI about fertility coverage in CA. If your employer has a CA based ins. plan, then it usually covers fertility diagnostics and testing. Some cover everything up to IVF and exclude that. Sometimes you get really lucky and your awesome employer has purchased a separate fertility rider that covers all things - up to the limit of the rider. I got lucky and had a policy that covered all things fertility except IVF, then I switched during open enrollment to the other work plan that covered 15k lifetime max for IVF. I was out of pocket the difference and my cycle was about 25k.

If your employer's policy is from another state then they don't have to cover infertility at all. Even if you're a CA based employee. Federal employees are also excluded from the mandate as are some collective bargaining (Union) situations.

Ok - I've been through it all. You can ask me anything. I probably even know the codes to put on the forms. Ugh.

AMT4414

My husband and I are at the same office with Dr. Friedman. I am a bit older than you, at 41, but we have the same issues with low ovarian reserve, and some sperm motility and morphology issues. We tried one round of IUI with no success and have moved forward with IVF. I was given the exact same IVF Low Stimulation Cycle MLEA protocol with the same list of meds as you. We have also decided to go with the Attain program... hoping a second round isn't necessary, but the statistics helped sway our decision. I hear you on how crazy the costs are, and we aren't military, so no discount. I am wondering if you've have any success getting any medication at a discount? And if you have any feedback on your experience so far.

mandasd

@AMT4414 that's interesting that you even tried IUI first, Brooke didn't even recommend it! We have info on apply for low cost meds, called "First Steps" program. Ask Dori for the info.

If we do Attain we won't get the military discount since that program doesnt give a military discount, only the single cycle plan.

We have $25k set aside for this so I'm just not sure we want to go to $30k Attain. We don't have decide now, we are to starting until August.

Keep in touch with your progress!

mandasd

@Knottie4978096 I looked into fertility treatment through Blue Shield and they cover nothing...not testing, blood work, office visits, medications. Nothing. If I had the HSA plan, I could use the HSA money towards treatment. But, I don't have HSA plan.

They do cover acupuncture, so I will use that benefit. If they title it: infertility, then the acupuncture will not be covered. So, I have to ask my provided to put something general, like "headaches."