Would this upset you? (Transfer related)

curlylocks3

Prior to my FET I had consented for assisted hatching on the embryos if needed. On the day of transfer (10/1) we sat down with an embryologist to sign the final consent for transfer. We were given pictures of our two thawed embryos- nothing else in writing/on paper but I distinctly remember asking if assisted hatching had been done and being told no, the embryos were expanding well on their own (one better than the other) and it had not been needed. 

I knew that both ICSI (which we had done) and AH can increase the odds of an embryo splitting and since we were transferring two I was nervous about the possibility of triplets. My RE had been reassuring that triplets would be unlikely but I remember being relieved that I felt the chances were lower since we hadn't done AH as well. I just found out today that, in fact, both embryos had assisted hatching. 

So, am I over-reacting to be upset by this? Its not the end of the world, and I am incredibly grateful for both our babies, and obviously I would have been okay with it being done since I had consented, but I really feel like this should have been communicated on the day of and makes me wonder what else I was told incorrectly. 

ETA: I'm probably more upset because this is on top of receiving a bill saying I owe $5,575 immediately and its my first time ever getting a bill from them. We've had numerous billing issues with them in the past (pay $2K today or we won't do your transfer tomorrow, pay $2500 today or your ER that is probably 3 days away is cancelled) but this takes the cake. 

BzeetyD

In some labs ICSI and AH (and PGD) are considered very similar because in all of these cases the outer shell is tampered with and weakened by the process. In our clinic in MN many times AH isn't done if ICSI is done because in a way, it's already been done, if that makes sense. Perhaps your clinic classifies them in a similar way, exchanging one meaning for the other?

I understand that you wanted to know and that what you were told was apparently initially incorrect. I think it is something to bring up with your RE or embryologist, if you feel strongly about it but I would do it in a calm and professional manner (as a lot of time has passed) and then more importantly try to move beyond it, emotionally.

Crystal120410

My re lab does icsi and ah on everyone. It's not something that is discussed and I wouldn't have even known it unless I asked. Their logic is it raises success rates. It didn't bother me that it wasn't discussed.

auntjessy

I understand why you're upset, on both accounts.  I wouldn't be upset if they forgot to tell me, but if I asked and was told "no" incorrectly, I'd probably be pretty unhappy - especially if my decision on how many to transfer was based on that answer.  

  

On billing - I don't know where you go, but at my clinic the entire thing had to be paid upfront before they would prescribe the injectables.  They estimated cost on the high end, and I was told that if it cost less for some reason, it'd be refunded (yeah, right).  Every bill I've ever received from them or from the lab has been due immediately, but I've never received a 5K bill, either.  At the very least, I'd be panicking about a 5K bill I didn't know I owed.   

FutureMrsW9

I don't think you're being unreasonable.  You asked a specific question about AH and were given misinformation.  I'm assuming the bill you got includes the AH and that's how you found out they did it?  If that's the case I wouldn't pay for that portion of it based on what happened.  While, yes, you consented, you also asked if it was actually done and told that it wasn't.  That would also make me nervous about other things they may have misinformed you about - it's definitely something to bring up with your RE and the embryologist.

auntjessy, my clinic makes you pay for everything up front before they'll even prescribe you injectibles so there shouldn't be any surprise bills.  That would royally infuriate me if I got a bill from them now 4 months after the fact.

curlylocks3

Thanks for the feedback everyone. I think what BzeetyD said about moving past it emotionally is key- I need to put this behind me because ultimately if we went back in time I wouldn't have done anything differently and I wouldn't have cared that it was done if I weren't finding out now, like this.

As for the bill, we do have some insurance coverage so prior to cycling what they estimated my percentage would be would have to be prepaid, which we did.
The problem then was that we were carrying a balance from our IUIs that we were paying off from an HSA account with each paycheck. I had specifically, multiple times, asked if it all needed to be paid off before IVF since I know that's a policy at many clinics; each time I was told no, we could keep paying increments. Apparently everyone we spoke to was incorrect and it DID need to be paid off, hence that last minute phone call. I chalked it up to human error and my fault for not getting it in writing.
The second time was because I did my fresh cycle at the end of July and the embryos were frozen at the beginning of August, FET planned for 10/1. Based on those dates and their billing cycle the embryo freeze wouldn't show up until the September statements, which hadn't even been sent out yet when I got my phone call saying I needed to pay it right then. Based on what had happened before ER I had tried several times to find out the final cost of freezing (which I knew insurance wouldn't cover) but kept being told they couldn't give me a bill because the system hadn't generated one yet. Then when they called, I pointed out I still hadn't received a bill and they agreed I wouldn't have, but they still needed the money.
Oh and we also discovered that they tried to bill us for "records storage" starting six months before I was a patient.
I loved my RE and nurses and feel I got excellent medical care from them but their billing department is an absolute nightmare.

curlylocks3

Oh and the bill that started all of this is because my insurance is denying all claims related to my FET due to "inadequate records or information". Which tells me something was not submitted on the REs end because based on my talks with their insurance person as well as my own insurance company this should have been covered. Can't find out until tomorrow what was missing though because insurance is closed for weekend and MLK day.

BBColt78

I could be reading your post incorrectly, so do let me know if so.

At my office (and others could be different), the Assisted Hatching is done right before the transfer. So, that morning when I discussed my embies with embryology, AH had not been used yet. I'm wondering if there was some confusion just on the part of wording? They hadn't been given AH when you chatted, but it was done right before the process? I could be wrong.

The ICSI would be done before freezing and the AH is done after. They are totally different processes so I don't think referring to them as one should have been an issue.

Again, offices are different but my RE looked at us like we had five heads when he learned we wanted to think about AH. It is normal procedure for every FET in his office. When I consulted my friend off record (who is the embryologist at the office), she said AH really is necessary for FET. It's because the outer layer of the embie is much tougher in and FET because it had been frozen. That makes it more difficult for the outer layer to shed and attach. They did give me a less than 1% chance of triplets from transferring two, which we did do with AH.

I can totally understand your concern. If I were you, I would be LIVID about the miscommunication. As an outsider who doesn't have the emotions in play, at this point you can bring it up to them or let it go.

Edit: Reading comp fail on my end. . . big time. Somehow I didn't notice your ticker, therefore you don't need the percent chance of trips. I'm an airhead.

curlylocks3

BBColt78 said:

I could be reading your post incorrectly, so do let me know if so.

At my office (and others could be different), the Assisted Hatching is done right before the transfer. So, that morning when I discussed my embies with embryology, AH had not been used yet. I'm wondering if there was some confusion just on the part of wording? They hadn't been given AH when you chatted, but it was done right before the process? I could be wrong.

The ICSI would be done before freezing and the AH is done after. They are totally different processes so I don't think referring to them as one should have been an issue.

Again, offices are different but my RE looked at us like we had five heads when he learned we wanted to think about AH. It is normal procedure for every FET in his office. When I consulted my friend off record (who is the embryologist at the office), she said AH really is necessary for FET. It's because the outer layer of the embie is much tougher in and FET because it had been frozen. That makes it more difficult for the outer layer to shed and attach. They did give me a less than 1% chance of triplets from transferring two, which we did do with AH.

I can totally understand your concern. If I were you, I would be LIVID about the miscommunication. As an outsider who doesn't have the emotions in play, at this point you can bring it up to them or let it go.

Edit: Reading comp fail on my end. . . big time. Somehow I didn't notice your ticker, therefore you don't need the percent chance of trips. I'm an airhead.

Perhaps the bolded is where the confusion came in as well? All I knew is that AH was done on day of transfer, did not know the specific timeline of stuff. My RE had told me that AH was far more likely to be done with a FET- which I was totally on board with. Its just that since I asked and was told it wasn't that I felt totally thrown off learning it had been done.
Thanks for sharing your perspective though- it makes me feel better because I really couldn't come up with a scenario where someone who said she had been the one to thaw the embryos wouldn't correctly know if AH had been done.