First consultation, what to expect?

Mandababy007 · August 2012

So we have our first consultation with a fertility specialist at Pacific Northwest Fertility clinic in Seattle, at the beginning of next month.

I was wondering, what should we expect on our first meeting?

Some info about us:

Using donor sperm.

Very excited to get the baby ball rolling.

Paying everything OOP.

Any advice would be GREATLY appreciated.

ball.and.chain · August 2012

Will you be seeing an RE? My RE consult was just informational; my wife and I sat in a room with her and she went over my medical history, talked to us about what we'd done so far (we'd done 3 insems at a midwife practice at that point), what her practice was like, what their procedures were, what testing she would suggest we do, different medications/treatment options and what their risks and benefits were. Kind of just a lay of the land. Your consult will probably be similar, though if you happen to be there at a point in your cycle during which they would want to do testing (e.g. CD3), they may want to do blood work and/or a transvaginal ultrasound that day, just to get the ball rolling. Usually initial testing involves blood work, a baseline transvaginal ultrasound, and an HSG (hysterosalpingogram) to make sure your tubes aren't blocked.

At our midwife consult, we were given a list of blood tests I had to have (STDs, CMV so I could choose sperm with an appropriate CMV status, antibodies for prior vaccinations, etc) and it was recommended I have a pap smear prior to starting. I didn't have to go through all of that again with the RE but if it is your first appointment, you may have to do all of that.

Have you talked to someone in the clinic's finance department about what your insurance covers (assuming you have insurance)? The finance person at my clinic called my insurance provider and found out exactly what was covered and under what circumstances, and that can be helpful because they know exactly what questions to ask. You said you were paying OOP, but it's possible the person at the clinic will find out more. It's also possible they cover testing but not fertility treatments, or procedures but not drugs, etc. Can't hurt to have them check and it might help!

Good luck!

TaylorandMel · August 2012

I completely agree with ball.and.chain, she pretty much covered it all. For you, it will depend on if you're seeing an RE or midwife, and also your hx and what fertility treatments you've done so far.

But basically there are a million ways to do things, so you'll need to discuss that with you provider and decide what's best, i.e. what blood work you've already checked & what you want to check, medicated vs. non-medicated cycles, then what type of meds (PO vs. IM), 1 or 2 insems per cycle, monitor by frequent US vs. relying heavily on OPK.

It's good to find out what their policies and procedures are, so that you're all on the same page. For example, some docs are more hurried to use meds and some people may not want that. Some people may have a limited amount of tries and want to go for the meds right away, but the doc isn't game for that. It goes a long way to like/trust your provider, because when our doc wanted to change things (esp. if it was all of a sudden) we would think "hmm, okay. she knows what she's doing."

Mandababy007 · August 2012

Thank you both for the information.

I will be working with a RE, considering I'm using Donor Sperm there has been no trying, but I do have PCOS which is why I wanted to lean towards starting off with help considering I cant try naturally, Not possible when you have to inseminate. Health insurance is not an option at this time, but I will be asking about financial details like was suggested above.

I really appreciate all the information everyone is giving, seriously helped put me in the right direction.

Two*True · August 2012

It's been 4 years since my RE consult but basically they went over all of the financial stuff first. So we knew exactly what insurance would/wouldn't pay. And in your case they should tell you exactly what their financing options are and what their OOP fee structure is. The doc spoke to us about history, our wants, and what path we felt was best. We also chose to start some of the blood work right then (but that could have been because it the timing matched cycle wise).

2moms2b · August 2012

The two pp pretty much summed up our first visit and the testing we went through (CD3, CD12 labs, genetic and immunities testing, CMV status, HSG, u/s to check my ovaries and monitor follicle development etc). Paying for it OOP is not as horrible as some would expect. Our insurance did pay for our testings but not medicine, utra sounds, sperm or insemination. They covered all of what our costs would be at our first visit.

Something we did not think about was some questions to ask the cryo lab and your RE regarding sperm shipping and storage (can get quite expensive when paying OOP). I called prior to ordering and because we ordered multiple vials at once they gave me a 20% discount. It was a huge savings! We found it was cheaper with our RE to store our sperm (free for a year vs $40 monthly with cryo lab) and it was cheaper to ship all the vials at one time. The only thing we gave up was being able to return unused vials as they left the bank. We figured our return on potential unused was less than what we would spend in shipping so we shipped all at once. Now our RE has our sperm should we want to go for a sibling or we can donate our unused to a couple if we decide to stop or just destroy the samples.

This was one aspect we did not place a big importance on at first as I literally thought oh we select a donor and order. Done. Once I started crunching numbers with all options available to us, I am really glad we did as we did pick up the phone and ask questions. It allowed us to pick the best route for us.

JoySeattle · August 2012

Welcome! As a fellow-Seattleite, I just wanted to say that I think you're already making good decisions. For example, PNW is much better compared to some of the others locally I've head about. We don't use them at this point, but will if/when we move to an RE. Also, their website it pretty extensive, so you can probably get a lot of info there before your appt if you know what you're looking for.

Definitely look into your shipping costs and storage options. PNW charges $175.00 every six months, but nothing for vials for each cycle and I've had friends who haven't been charged for storage even though they shipped more than 2 vials. Our bank charges $18-220 per shipment, so sometimes it pays to do the math as 2moms2b mentioned.

Also, I'm assuming your planning to do IUIs, so you may want to compare options when looking at donor specimen types available. PNW charges a $90 processing fee when an IUI-ready sample is thawed and prepared and a $255 processing fee when an ICI-ready sample is thawed, washed and prepared. So depending on your bank prices, one may be a better option for you if you have both choices.

Finally, my OB (through my HMO) was able to get some initial lab work covered by my insurance (which has no fertility coverage) by coding it as ob/gyn diagnostic. So you may find out from the RE what they want you to have and see if it's worth doing it all in-house with them or exploring other options to keep costs down.

Mandababy007 · August 2012

Seriously amazing advice girls.

So I called PNWF and got a price list sent over, I have no idea why I didn't think about that ahead of time. Not too bad on the prices, so far the best I've seen compared with the level of care they seem to have. Considering I call almost every day and ask questions and someone immediately emails me anything I want to know. Speedy with it also. We will be using the sperm bank that's located here in Seattle, Just happens to be where DH's favorite donor is. They ship within the Seattle/Bellevue area for free (Weird perk I guess?). If anyone needs a comparison price list for Pacific Northwest Fertility let me know and I can forward it out.

I totally appreciate the help everyone, I've gotten farther in the journey by just going by your advice that 6 months of googling to death.

JoySeattle · August 2012

Mandababy007, I sent you a PM.

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