Help please. Hard decision.

cshm11 · January 2015

Hey ladies... So basically this is our situation. We have Tricare which doesn't cover IF treatment beyond meds and monitoring. IUIs are $200 OOP. IVF is $7750 OOP not including meds (because my base doctor agreed to get me the meds, thank goodness) without PGD, but $12000 OOP for IVF with PGD, plus $250 per embryo over 8. If we get a secondary insurance, we will have to do 2 more IUIs before IVF, but they will cover multiple FETs if the first transfer fails. They won't cover PGD though. After meeting our deductible ($3250), it would cost us $4100 OOP for PGD plus $250 per embryo over 8, plus a monthly premium of $280 and a $40 copay per visit, plus $35-150 per medication. But again, it would cover multiple FETs.

I'm torn. Do we continue with IUIs and hope it works? Do we pay OOP for IVF without PGD? Do we try to pay for IVF OOP with PGD? Do we get insurance and do IVF, or IVF with PGD? I'm so overwhelmed by our options and would love some input.

pettycrocker · January 2015

Yea... if your IUIs are only $200 OOP, I would definitely try several IUI cycles before jumping into IVF. Then you can always put money aside every month towards possible IVF if needed, if you don't end up needing it in the future, you have a little nest egg started for IUI baby. If it was me I would probably try 5 or 6 IUIs, which gives you great chances of success with IUI, and also gives you 6ish months to save for potential IVF.

Frenchteachermama · January 2015

potatocastillo said:

Yea... if your IUIs are only $200 OOP, I would definitely try several IUI cycles before jumping into IVF. Then you can always put money aside every month towards possible IVF if needed, if you don't end up needing it in the future, you have a little nest egg started for IUI baby. If it was me I would probably try 5 or 6 IUIs, which gives you great chances of success with IUI, and also gives you 6ish months to save for potential IVF.

I was going to say this!

efhoping2010 · January 2015

I agree with pp, iui seems smart financially.

Also why would you need PGD at such a young age? Do you have an egg quality issue? Have you ever had Day 3 labs drawn?

BDevereaux · January 2015

I agree with potatocastillo, as well.

Our insurance does cover half of the IUI fee, but even if it didn't, I'd much rather try the more cost effective treatment first before moving on to IVF, for which we have zero coverage.

What does your doctor think? I'd say, if they think IUI is worth a shot, then definitely give it a go.

Good luck and keep us posted!

cshm11 · January 2015

They said IUI is worth a shot but only increases our chance of conception from 12% to 12-15% and my chance of miscarriage is still 75%. Since my doctor won't do injectables, I would have to get insurance to do IUIs with injectables because the price goes from $200 up to $1000 per IUI.

The PGD at my age is to help prevent miscarriage due to chromosomal abnormality, as my doctors said early losses are chromosomal in nature 95% of the time and despite starting Lovenox and baby aspirin for antiphospholipid antibody syndrome, my chances of miscarrying are still high, and IUI doesn't reduce that at all.

I am not in any rush to jump to IVF, but if I want a chance with it or IUIs with injectables, I have to get the insurance by Feb 15. The infertility mandate in my state ends at the end of this year, so it won't be an option next year.

So basically, if I want a chance with IUIs with injectables or IVF, we need to decide and get the insurance soon. If we want to stick to IUIs with Femara only, or only have one shot at IVF with no PGD and no additional transfers, we can wait.

Jodee37 · January 2015

cshm11 said:

The PGD at my age is to help prevent miscarriage due to chromosomal abnormality, as my doctors said early losses are chromosomal in nature 95% of the time and despite starting Lovenox and baby aspirin for antiphospholipid antibody syndrome, my chances of miscarrying are still high, and IUI doesn't reduce that at all.

do as many IUIs as you can. your call if you want to do injectables or not.

as for your m/c hx and APS, Lovenox has shown to be quite effective in reducing the risk of m/c due to a diagnosed clotting disorder (like your APS). Wether you do IUI or IVF.

I see you are pretty young, so AMA is not an issue in m/c rate. what is your AFC if you don't mind me asking? AMH?

pettycrocker · January 2015

Meh... even with that information, I'd probably just stick with clomid/femara IUIs for the time being at $200 a pop, and put money aside for the IVF if needed in the future. 12% is actually pretty great for IUIs, I was told I had 10% chance whether we did clomid IUIs or inject IUIs. How did you respond to your Clomid IUI? I see it was a BFN but how many follicles did you get and what was your dosage?

cshm11 · January 2015

I can't do Clomid again. It was a TI cycle, not an IUI. I was on 100mg CD 5-9. My lining was 5mm, I got 1 follicle, and I had vision changes with it

But Femara seems to work great for me. I got a 10-12mm lining (I can't remember the exact number but I remember it was between those two), 2 follicles, 22mm and 27mm, one on each ovary, and my AFC was 20 on CD 3. I will have to look up my CD 3 blood work. My estradiol was a little on the high side but I was told it was still fine and everything else (LH, FSH, AMH) was "beautiful". All the good test results and my age are the reasons we have a 12-15% chance. I guess mainly I'm just terrified of another miscarriage. But I think you all are right, I'm just going to keep on with IUIs and Femara. Even if we have to pay full price for IVF & PGD later (the current price of $7550 + $4100 for PGD is through a clinical trial) we can cross that bridge if we get to it.

efhoping2010 · January 2015

It is up to you, were you selected for the clinical trial?

cshm11 · January 2015

efhoping2010 said:

It is up to you, were you selected for the clinical trial?

Yes, I was. That's the discounted rate. Normally, we are looking at $30k for everything OOP, because for $7750 they are including all the ultrasounds, blood work, natural killer cell testing, DNA fragmentation and semen analysis for DH, anesthesia, egg retrieval, ICSI, assisted hatching, embryo transfer, and embryo storage for 3 months. The $4100 is $1850 for embryo biopsy and $2250 for PGD for up to 8 embryos, and then an additional $250 per each embryo over 8. Additional FETs are $2700 and we can't do that OOP, but if we get insurance, those are all covered because our deductible will be met.

So if we pass this up, we are looking at a minimum of $20k but closer to the $30k to have the same things done. With the insurance, we would be paying $6500 OOP for the IVF and then the genetic testing isn't covered, so $4100 plus $250 per additional embryo. But still, that's $10.5k OOP rather than $20-30k. If we did one of those multiple cycle discount setups, we could get multiple cycles for about $20-30k but the genetic testing is almost always additional.

But if we can get pregnant and not miscarry with just IUI, it would save a huge sum of money. The problem is, I can wait until I know if this IUI worked before I decide, but I can't do 2, 3, 4, or however many IUIs and then move to IVF for the same cost. The clinical trial is first come, first serve, so if I pass it up, I can't opt back in if they're full.

cshm11 · January 2015

This is why I'm feeling very torn. I really want to give the IUI's a chance. But if I pass it up, we will have to wait 5-7 years to pay for it OOP (when I have my nursing anesthesia degree and start working).

efhoping2010 · January 2015

If it is a one time thing for the trial and you have the money currently then that changes things.

May I ask what clinic you are using?

I am about to potentially spend 30k, gulp, for something similar.

Best of luck on your decision.

cshm11 · January 2015

efhoping2010 said:

If it is a one time thing for the trial and you have the money currently then that changes things.
May I ask what clinic you are using?
I am about to potentially spend 30k, gulp, for something similar.
Best of luck on your decision.

Sorry, I wasn't thinking to explain that. Yes, it's a trial and a one time thing. I'm going to MCRM Fertility in Chesterfield, MO. MCRM = Missouri Center for Reproductive Medicine, and it's with Dr. Ahlering.

cshm11 · January 2015

Just searched it again. Seems they changed it from clinical trial to a good will reduced cost program: https://www.mcrmfertility.com/mcrm-focus-on-fertility-blog/2014/december/mcrm-to-offer-good-will-reduced-cost-care-for-re.aspx

And here are their 2014 IVF success rates. Which is amazing. I was trying to find this for the person who told me that my chance was around 33% per cycle and that I was being lied to if I was told 70% but here are the stats: https://www.mcrmfertility.com/mcrm-focus-on-fertility-blog/2015/january/2014-ivf-success-rates-at-mcrm-fertility.aspx

Jen071407 · January 2015

Hmm, the first come, first serve thing changes things. I say go for it. It increases your chances, and costs less than if you wait. I know some people feel you need to exhaust all options before going to IVF, but sometimes the added benefit of less emotional toll (i.e. lowering your risk for mc again because of pgd testing) might be worth it.

ellebelle2384 · January 2015

ITA with @Jen071407‌ That makes it tougher. Nothing about this is a guarantee but if you would be kicking yourself later for passing this up now I would go for it.

jen4ny · January 2015

That is a tough decision. I was going to say try the IUIs first but if you have this one shot deal at IVF at a more affordable cost I would probably say go for that.

Jodee37 · January 2015

I am the person who side eyed that 70% statistic. And I'm side eyeing it more now after reading it on their website.

They are making the claim that at the year end of 2014 they had a 70% pregnancy rate for all their COMPLETED fresh transfers among alllll their clients (no matter their diagnosis). Which is a super vague and inflated statistic for many reasons.

1. They're lumping everyone together. Um, last I checked the 39 year old with shittastic eggs does not have the same chances of getting pregnant as the 23 year old missing her tubes from a ruptured appendix. It's ridiculous and downright laughable to lump everyone together and say "you all have the same chance."

2. 70% pregnancy rate. Meaning a positive beta. Okay... I'm side eyeing that because it doesn't account for the unfortunate losses that do happen after a positive HCG after ivf. Most places report their live birth rate. It's a more acceptable and reputable statistic.
I looked for them on the sart.org website to look at their stats for attempts live births singletons multiples etc but they aren't listed. More side eyes.

3. It's not saying 70% for the first IVF attempt. They are saying allllllll completed ones. That could very well mean that each woman had to do 20 IVF cycles to achieve a pregnancy. But if all women did 20 cycles you bet your sweet ass you'd have some insane statistic like 70%.

I'm not here to argue or pop your balloon. I'm just saying be a wise consumer here. Do your research. Read articles. IVF is not something you should just jump into blindly. And with the closest clinic either because why not it's close. I hope you do a bunch of IUIs. And I hope you get your rainbow very very soon and don't have to do IVF. I don't wish it on anyone.

And I would hate for you to believe you have a 70% pregnancy rate leaving the starting gate. Because that's just cruel of your RE to let patients think that. And be crushed when it doesn't happen instantaneously.

cshm11 · January 2015

DH and I talked, and then talked with our current OB. We decided against IVF for now.

We are setting a limit on IUIs to 5 more cycles (6 total) because that's $1200 and because that will be 12 cycles of TTC and then we will move on from there. This is cycle 7 TTC #3, with 2 losses since we started TTC this time around. And if we hit the 12 month mark, we will reevaluate.

fuzzbumble · January 2015

Jodee37 said:

I am the person who side eyed that 70% statistic. And I'm side eyeing it more now after reading it on their website. They are making the claim that at the year end of 2014 they had a 70% pregnancy rate for all their COMPLETED fresh transfers among alllll their clients (no matter their diagnosis). Which is a super vague and inflated statistic for many reasons. 1. They're lumping everyone together. Um, last I checked the 39 year old with shittastic eggs does not have the same chances of getting pregnant as the 23 year old missing her tubes from a ruptured appendix. It's ridiculous and downright laughable to lump everyone together and say "you all have the same chance." 2. 70% pregnancy rate. Meaning a positive beta. Okay... I'm side eyeing that because it doesn't account for the unfortunate losses that do happen after a positive HCG after ivf. Most places report their live birth rate. It's a more acceptable and reputable statistic. I looked for them on the sart.org website to look at their stats for attempts live births singletons multiples etc but they aren't listed. More side eyes. 3. It's not saying 70% for the first IVF attempt. They are saying allllllll completed ones. That could very well mean that each woman had to do 20 IVF cycles to achieve a pregnancy. But if all women did 20 cycles you bet your sweet ass you'd have some insane statistic like 70%. I'm not here to argue or pop your balloon. I'm just saying be a wise consumer here. Do your research. Read articles. IVF is not something you should just jump into blindly. And with the closest clinic either because why not it's close. I hope you do a bunch of IUIs. And I hope you get your rainbow very very soon and don't have to do IVF. I don't wish it on anyone. And I would hate for you to believe you have a 70% pregnancy rate leaving the starting gate. Because that's just cruel of your RE to let patients think that. And be crushed when it doesn't happen instantaneously.

All of this.

I was promised a 70% success rate too. Look where that got me! Three shady little embies, fighting for their lives right now. We are not statistics. Sure, 70% of their cycles in that year yielded a pregnancy. But that means jack fucking shit when it comes down to it. I went from being in the 70% to being in the 1%. And when that happens, statistics can suck a dick.

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