Question about RE — The Bump
TTC after 35

Question about RE

I've been seeing the chiro for a back discomfort recently and just realized most of our deductible is met.  Then I was thinking that we will be TTC 6 months in December and if I'm not pregnant by then I would maybe like to get some additional testing to make sure everything is ok with me on the reproductive front.  I honestly know nothing about it because it only took 1 cycle to conceive DD back in 2010.  What types of tests do they do and are they covered by your insurance?  TIA!
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Re: Question about RE

  • At the same time I'm thinking about temping next cycle.  Is it pretty easy to do?
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  • @vlagrl29 I'm not the best to answer this since I just scheduled our first RE appointment for next month; however, I have gathered that there is a huge spectrum of difference in insurance coverage. Some have lifetime limits for all things fertility related and some plans cover much more than others. Our particular clinic's website REALLY emphasizes the financial coverage aspect to the point of having prepared a downloadable list of questions to ask your insurance when you call to inquire scope of coverage AND requiring that this call to our insurance company is made prior to our first consult. 

    Like I said, others in this group who have been seeing an RE can provide more info on tests, etc, but for ours, you first go to the consult to talk through process, options, etc. then next step is bloodwork done around CD3. And that's all I know so far, but am really looking forward to appt on the 13th!

    I've never temped, only OPK, but many others on here do. I was thinking I should start this too...
    ME: 44 / DH: 46
    DD conceived naturally, born 1/9/14
    Consulted RE after trying for #2 for 1 year, 9/16
    RE diagnosis: DOR, poor egg quality
    1/2017: IUI #1, Femara, failed
    2/2017: IUI #2, Femara, failed
    3/13/17: started IVF + ICSI + PGS cycle #1, antagonist protocol (menopur/follistim/ovidrel)
    4/19/17: ER, no embryos survived past morula stage, poor egg quality given as reason
    5/3/17: started IVF + ICSI + PGS cycle #2, antagonist protocol (menopur/follistim/ovidrel)
    6/7/17: ER, 1 egg retrieved, mature but did not fertilize, poor egg quality given as reason
    7/21/17: started IVF + ICSI + PGS cycle #3, antagonist protocol (menopur/follistim/ovidrel)
    8/24/17: ER, 11 eggs retrieved, 10 mature, 7 fertilized, no embryos survived past morula stage, poor egg quality given as reason
    9/17: started IVF + ICSI + PGS cycle #4, antagonist protocol (menopur/follistim/ovidrel), started organic, non-processed, no white sugar/flour, diet with unscented/nontoxic personal care products 4 weeks before ER (books suggested it takes 2-3 months)
    10/11/17: ER, 5 eggs retrieved, 2 fertilized, 1 arrested at 3 cells and the other arrested at 5 cells, poor egg quality given as reason, doctor suggested it was time to move on to donor eggs but I asked to give it one last chance and kept on my diet/unprocessed/unscented/nontoxic products
    12/28/17: started IVF + ICSI + PGS cycle #5, microdose lupron protocol
    2/1/18: ER, 9 eggs retrieved, 6 mature and 6 fertilized, 3 survived to day 5 blastocyst, 2 PGS normal
    7/12/18: FET #1, negative
    9/21/18: FET #2 scheduled


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  • jennh75bjennh75b
    250 Love Its 100 Comments First Anniversary First Answer
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    edited September 2016
    You will need a whole month (at minimum) to do the standard testing with an RE (if this is the route you go)...different tests at different parts of your cycle.  The HSG (seeing if your tubes are clear/if there are any issues with your uterus) is the most expensive part of the testing, to my knowledge/experience, so if you can squeeze that in before the end of the year while you have your deductible met, that would probably help a lot.  

    Below is what my RE did, but I'm sure this can vary - just giving you an idea:

    CD 3 - Blood tests - LH, FSH, TSH, AMH, Hepatitis,Testosterone Free, HIV

    CD 5-10 - HSG (or what they did for me first was a test using the ultrasound and pushing saline through the tubes at the RE office which is less painful than an HSG), but it only saw that one side was clear, so I ended up getting an HSG (at a hospital) the next month on the same days - CD 5-10 - to make sure my other tube was clear

    Then when you get a positive OPK - Blood tests - Estradiol, Progesterone, LH plus an ultrasound to check for ovulation

    Your husband would need to have an SA and minor bloodwork - HIV/Hepatitis testing during that month preferrably, so then they can meet with you both to review all results together.

    As far as the insurance goes - it's really too hard to tell you what you can expect considering everyone's insurance/benefit plans are so different.  I would say that the only insurance-related barrier/concern could be how long they want you to TTC before you do all of the testing.  My insurance gave no indication that there were some sort of time constraints on starting the testing, but perhaps some insurances might want to see that you have been TTC for a certain length of time.  I've only heard of that, and it doesn't surprise me, that they may want to see that, but when you are AMA, usually the timeframes are shorter than if you are younger.  

    If you could at least make your initial RE appointment now, find out if there are any restrictions from your insurance as far as months of TTC, then you would be ahead of the game, and could start testing as soon as you get the green light from the RE/insurance.  I know that your OBGYN could do some tests, so they could offer to do some of the above I mentioned, like blood work,, etc., but my OBGYN referred me directly to an RE due to my age.  

    You really want to ask your insurance if you have fertility benefits, because these tests will often fall under that category.  Some, I'm sure, don't, but I would want to know this before any tests commence.  


    Me: 41
    Husband: 40
    TTC#1 since 9/2014
    Unexplained Infertility - Trying naturally
    laurad75
  • Well I may go ahead and call my OB in November assuming I haven't gotten a BFP by then.  CD 3 would be early December for me.  Did you basically get the referral from your OB?  Good idea to call our insurance company.  We have a really great plan so it would be awesome if it were covered.  I just downloaded FF today on my iPhone.
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    laurad75
  • Yes, my OB told me that if I were younger I could have started some of the testing/exploring with him, but because of my age and how long we had been trying, he said it made sense to start off directly with the RE.  
    Me: 41
    Husband: 40
    TTC#1 since 9/2014
    Unexplained Infertility - Trying naturally
  • It would be nice if I could start some of those tests with my OB.  If AF comes in November then I guess I will call then.  How long did you guys have to wait before you were seen by an RE?
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  • My OB has done all of the steps that @jennh75b described. I told him at our first visit that my insurance covers testing for infertility, but not any treatments for it, so when I see him he codes the visits accordingly (honestly I think he codes them as "irregular menstrual cycles"). He is also doing 3 IUIs for us (all out of pocket for me) before sending us to RE. The only step the RE would be able to do that he can't is IVF. As far as insurance goes I think if you have poor coverage for infertility (which is the case for most people) you should see if you can stick with an OB. It's easier for them to code your visits in a way that insurance will cover vs RE....since you wouldn't really see a RE for menstrual issues. 

    Should be be easy to call your insurance and see what you are covered for. 
    Me: 39 SO: 36

    Dx: low progesterone, possible DOR - officially "unexplained"

    TTC#1 since November 2015
    9/16/2016 IUI#1 - BFN
    10/12/2016 IUI#2 - BFN
    1/21/2017 Clomid/IUI#3 - BFN
    March 2017 IVF: BFP! (beta#1 191, beta#2 378!) - it's a boy! DS born 12/6/2017

    TTC #2 since July 2018
    May 2019 IVF #2: BFP! (beta#1 346, beta#2 646) - vanishing twin at 8 weeks. Baby B still going strong - due 2/8/20!
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    jennh75b
  • My insurance covered nothing except the bloodwork that tested me for STDs (required by my RE), and my vitamin D level.  Everything else has been out of pocket.

    OBs do have better chances of getting stuff covered (I think insurance companies know that REs focus on fertility, but your OB could be checking you for PCOS, endometriosis, and other stuff that affects both your health and your fertility), but OBs are not that well trained on fertility issues.  They're great at getting you healthy, not so great at getting you knocked up.  It's a good place to start, but don't waste too many cycles with them.

    Some RE clinics offer these free seminars where they talk about what they do, try to convince you to choose them (in cities where they have some competition), and if you attend the seminar, you get some sort of credit towards your initial testing. 


    Me- 39 (turning 40 in April), TTC for the first time ever (since Jan 2015), low ovarian reserve
    Married 3/14/14 to my wonderful wife, but her sperm count is rather low
    TTC with frozen donor sperm and science

    7 IUIs, 7 BFNs.
    2 IVF attempts, both cancelled and converted to IUI, both BFNs.
    Decided that my tired old ovaries are ready to retire.
    Next step- reciprocal IVF, using my wife's eggs, my uterus!  
    fresh 5 day transfer (2 embryos) 4/17/17- BFP! 
    Identical twins "due" 1/2/17 (but anticipated arrival sometime December)

    jennh75b
  • @vlagrl29 The ladies did great job answering all your questions but I thought I would pop in to encourage you to make the appt with an RE.  I would actually vote to get the referral and schedule your visit - you can always cancel if you get a BFP.  

    An OB did some of my initial CD 3 blood work just like @jennh75b described but because of my age she recommended I see an RE.  You can call your insurance company and have them go over infertility coverage to make sure you understand.  In most cases if you are 35 or older you are covered if you have been trying at least 6 months.  

    Good luck and keep us posted. 
    jennh75b
  • Wait times vary for the RE appointments....if that's what you were asking as to how long I waited.  My first RE appointment at my initial RE provider I waited over a month for.  I had to switch recently due to insurance coverage and my new RE booked me an appointment for one week later.  

    I would have a lot of incentive to get to the RE sooner than later if my deductible were already paid for the year.  Basically we took this month off but since my deductible is met for the year, H wants to try IUI so that's why I had to switch REs - my insurance covered only testing/appointments at my RE but not IUI or IVF, so I am switching to a new RE.  I have to use certain providers within my plan in order for those two procedures to be covered.  The one I'm switching to is a little more inconvenient, but oh well, we want it paid for.
    Me: 41
    Husband: 40
    TTC#1 since 9/2014
    Unexplained Infertility - Trying naturally
  • Thanks for all the advice ladies.  Looks like my next step is to call the insurance company to see what our benefits are with testing.  I think I will plan on calling my OB early November if AF comes and she what she recommends.  I fully trust her - I actually interviewed 3 different OBs before we started TTC and she was my #1 pic and is about a 30 minute drive from our house in zero traffic.  She may think I'm crazy if I call her now on cycle 4 lol.  I'm a planner and always thinking 2 steps ahead from the game because I like to be prepared.

    Also I was talking to a friend yesterday.  She said it took them 2 years to conceive her 3rd child while the others took little effort.  She told me because she was stressed trying to finish graduate school and it was a busy time for them.  It made me think.  DH has been building his studio for 1 year - new construction.  Pretty much done - painting and railings on inside need to finish and next week I will do my best to help him clean so he can unpack and then he gets temporary occupancy and has 2 months to finish outside - paint, sidewalks, and grass/minor landscaping.  I think once he actually unpacks, cleans, and is able to go back to doing photography 100% of the time instead of GC type work his stress and energy will be better.  So I was thinking maybe the stress is affecting his semen levels which would make sense.  I'm thinking of putting him on a multi vitamin and maca root supplement as well for cycle 5.  Feel free to tell me I'm nuts.  I do still have a chance of BFP - AF due October 1, but I have ZERO symptoms and really doubt I am pregnant.
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  • I think stress really has an impact. I've read this confirmed in a peer-reviewed journal, and with my husband in grad school and on campus 12 hrs per day 7 days per week, I have to wonder if that stress may be one of several factors. Best of luck with your next step in planning!
    ME: 44 / DH: 46
    DD conceived naturally, born 1/9/14
    Consulted RE after trying for #2 for 1 year, 9/16
    RE diagnosis: DOR, poor egg quality
    1/2017: IUI #1, Femara, failed
    2/2017: IUI #2, Femara, failed
    3/13/17: started IVF + ICSI + PGS cycle #1, antagonist protocol (menopur/follistim/ovidrel)
    4/19/17: ER, no embryos survived past morula stage, poor egg quality given as reason
    5/3/17: started IVF + ICSI + PGS cycle #2, antagonist protocol (menopur/follistim/ovidrel)
    6/7/17: ER, 1 egg retrieved, mature but did not fertilize, poor egg quality given as reason
    7/21/17: started IVF + ICSI + PGS cycle #3, antagonist protocol (menopur/follistim/ovidrel)
    8/24/17: ER, 11 eggs retrieved, 10 mature, 7 fertilized, no embryos survived past morula stage, poor egg quality given as reason
    9/17: started IVF + ICSI + PGS cycle #4, antagonist protocol (menopur/follistim/ovidrel), started organic, non-processed, no white sugar/flour, diet with unscented/nontoxic personal care products 4 weeks before ER (books suggested it takes 2-3 months)
    10/11/17: ER, 5 eggs retrieved, 2 fertilized, 1 arrested at 3 cells and the other arrested at 5 cells, poor egg quality given as reason, doctor suggested it was time to move on to donor eggs but I asked to give it one last chance and kept on my diet/unprocessed/unscented/nontoxic products
    12/28/17: started IVF + ICSI + PGS cycle #5, microdose lupron protocol
    2/1/18: ER, 9 eggs retrieved, 6 mature and 6 fertilized, 3 survived to day 5 blastocyst, 2 PGS normal
    7/12/18: FET #1, negative
    9/21/18: FET #2 scheduled


  • @Momifbysea I think it may. I can't wait til everything goes back to normal. Shouldn't be much longer fingers crossed. Dh has been talking about only BD every 3 days because that gives the semen time to build up which I'm fine with but not for the fertile week.
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    Momifbysea
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