Advice - Getting Started with Testing

bocaburger · October 2013

I would love some advice for how to get started with infertility testing. I have read most of the posted information, but due to my specific circumstances I am looking for your thoughts and ideas as well. DH and I are temporarily living abroad (in Israel). Medical care is great here, and Israel is actually a leader in IVF treatments, but my insurance only covers urgent care - no pre-existing conditions and no preventative care - so there is absolutely NO coverage for infertility testing or treatment.

Obviously I would not be ready to have a baby if I was not prepared to pay what I need to pay... but that being said, we are both students and cash is not exactly abundant. I'm wondering, based on my symptoms, which tests you think are worth doing now, and which do you think are either less necessary or just particularly expensive?

My personal history: DH and I have been TTC for just over a year. I have irregular cycles (and always have, except when on BC). My most recent cycles were 7 weeks and then 6 weeks, but sometimes they are closer to a month apart. Based on charting, I have some anovulatory cycles (however, I am not very good at temping consistently). I also have always struggled with acne and I have a small amount of acne. Based on these symptoms, my GYN in the USA sent me for a transvaginal ultrasound, which showed multiple follicles consistent with PCOS, but I never confirmed with bloodwork. I am a healthy weight; I could certainly exercise more and eat better, but I'm not terrible at either. DH is slightly overweight and has high cholesterol. Neither of us drink much and we don't smoke. I drink coffee but cut it down to a cup a day or less when we started TTC.

Based on this: what tests should we look into getting right away? I'm assuming SA since DH has never been tested... probably bloodwork (what specifically?)... Can I get away without doing an HSG for now, since it's expensive and painful and my symptoms point towards a different issue? How much money should I be prepared to spend on out-of-pocket testing? Should we be going to an OBGYN or an RE? Is there anything else I should know?

THANK YOU so much for your help. This is all very overwhelming, so I appreciate you taking the time to answer my questions.

Twinkie0612 · October 2013

You need to do all of the initial testing before starting treatment. Just because your symptoms point to PCOS, does not mean that you do not have another fertility issue as well. I know that the HSG is expensive but it needs to be done before starting treatment. If you start treatment and do TI or IUI and find out later that you have blocked tubes, you will have wasted a lot of money on treatment that had no chance of working.

As far as OOP expenses go it will very by geography. I have no IF insurance coverage and my testing cost $2,000-$3,000 (HSG, SA, and Blood work). I did my testing through my OB/GYN, but I think it may have actually cost less if I had done it through my RE. My RE is better about billing what he can under non-IF diagnosis codes, which means the insurance will cover it. My OB/GYN (who I will not be going to once I get pregnant) refused to code even my thyroid blood work under any diagnosis other than infertility. I would not do any treatment with an OB/GYN. I did one clomid +IUI with my OB and I had to request to be monitored and even when they did monitor, I do't thin they knew what they were doing. I feel like I wasted $1,000 on that cycle.

ksgsmu · October 2013

Sorry you are here!

Go to an RE... Get the basic testing... SA for your DH... you need Day 3 bloodwork and an HSG. Work with your RE's office and most will give a discount if you pay with cash.

I know it s expensive... you might have to get very creative with your budget or take out a low interest rate credit card.

I love Israel... visit there as often as I can... my Godfather lives in Jerusalem and I love visiting him.

Good luck!

DreadGamerWife · October 2013

As the pps stated, you do need to have the 3 day introductory blood work/ultrasound, infectious disease screening, HSG and SA for your husband. While I have classic IR PCOS that was confirmed with the screenings, the work up also discovered a polyp that had to be removed and the SA showed DH had to change his meds. Now, I did most of my testing initially with my GYN (who specializes in PCOS) and then went over to the RE for a few final tests and treatment. But with an average GYN, I would get a referral to a local RE and start there.

Costs do vary based on region and sometimes, even on provider.

runforcookies · October 2013

It's so important to do ALL of the initial testing. like @twinki0612 said, what a waste of money it would be to have done IUI's or timed intercourse only to find out your tubes are blocked. Not to mention a waste of time and emotions. Those cycles are no fun and I would not want to have been able to prevent wasted cycles.

I am not sure on the specifics, but I believe that your insurance may at least be able to negotiate better rates for testing/procedures even if they don't cover it. I would call and check that out.

bocaburger · October 2013

Thanks everyone, this has been really helpful. I guess it's time to just bite the bullet and pay what it takes to do it right. I appreciate your feedback.

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