Let's talk money

mandasd · January 2016

Hi Bumpies!
Hubs and I are back on the IVF train. Our RE moved practices a couple months ago and now we are ready to start talking IVF again. The program at the new clinic is different than the last. The old package we were going to do was the 2-cycle ATTAIN program, which cost around $19k plus medications and some tests. The new clinic has several different packages and does not offer ATTAIN program. They are offering the following cycle plans:
Single cycle $13,500 (+meds)
IVF Two Cycle $19,900 (+meds)
IVF Two Cycle + Embryo Banking $23,130 (+meds)
Success Guarantee (2 cycles but only on 1 egg retrieval, 1 fresh, one FET) $19,700 (+meds)

I believe they will also offer a military discount, but I am not sure how much yet. That being said, how do people decide to do 1 cycle, versus 2 cycles, versus success guarantee? I don't think we will go for success guarantee unless we are fine doing only 1 egg retrieval. Dr. said she believes I would only have 1-2 eggs fully matured to transfer if I do one cycle. Those odds aren't good.

She also said that since we both have issues (my low AMH, his morphed swimmers), egg donation may be optimal. However, she always encourages couples to try with their own eggs first. That makes me think, should we just go for 1 cycle and if it doesn't produce, then move to donor egg because it is just not worth it to try again?

So many decisions - I would love to hear how others decided what to do! I know this is a personal choice but we all have been in a similar boat. I wish I could say money is no option, but that is not really the case.

2015dee · January 2016

Hi @mandasand. So the Success Guarantee is 1 fresh cycle and 1 frozen cycle and costs $19,700? Do you get 100% refund if it does not work? And what if you do not have enough embryos to do a frozen, do you get your money back?

My clinic is a bit different. One cycle of IVF is $8,700 + meds + testing (which ends up around $15,000 actually...). Their "success guarantee" program is $20,500 and includes 3 fresh retrievals (and 3 frozen transfers if there are frozen embryos). If the 3 fresh and 3 frozen transfers don't work, you get a 70% refund. You have to complete all cycles within 12 months. We are really on the fence too, but we are leaning towards paying the $20,500 up front.

What is your AMH level, FSH level? Are you doing ICSI because of your DH's morphology? Have you done IVF before? Sorry for so many questions, but those things would probably factor into my decision if I were you.

mandasd · January 2016

@2015dee Thanks for the questions! The paperwork I have: "Success Guarantee Program is shared risk defined as one IVF cycle as well as all frozen embryo transfers, implanting two or more, produced as a result of the first embryo retrieval. This cycle includes one egg retrieval and all FETs until a live birth or all frozen embryos are exhausted. Success Guarantee cycle #1 refund: 80%, #2, 55%, #3 30%"

We have NOT done IVF before. I am 36 and hubby is 40. We have been trying almost 2.5 years. I tried to conceive 1.5 years with my ex-husband in my late 20s with no success (tried Clomid). That marriage dissolved. My husband had 2 miscarriages with his ex wife, they never had a baby together. His ex had a child from a previous relationship and was able to conceive #2 with her current husband. My ex was able to conceive a child with his current partner. My RE says she does not want to try clomid or IUI but go straight to IVF.

I know this is terrible but I do not have my most current blood work results. I do have these from almost a year ago:
LH: 6.8
FSH: 8.5
AMH: I think .3?? I will have to check my records later
Sperm: ?? I have to check my records later

I included ICSI in the cost above, it is $1750.

I did the genetic screening and there were no issues so they do not recommend PGS for first time, only if not successful.
PGS: $4250 for 8 embryos per cycle.

2015dee · January 2016

Yikes, that's a hard call, especially since your RE doesn't think you'll have more than 1 or 2 eggs. How do you feel about embryo adoption? If you feel comfortable with embryo adoption, I'd probably lean towards just doing 1 IVF guarantee program. If it doesn't work, you'll get almost $16k back. Does your clinic have requirements to qualify for the Success Guarantee program? I know ours has a long list of requirements....that might be worth asking. I wish I could be more help...my AMH is on the other end of the spectrum (super high because of PCOS).

mandasd · January 2016

She did not say embryo adoption - just egg donation. She said that with very strong and viable eggs, studies show that actually corrects morphed sperm. But since we both have challenges, then it can be difficult to get viable embryos. I am much more open to alternatives. But my husband is set on trying first with my egg, then egg donation, then embryo adoption, then adoption. My sister has embryos we can adopt.

There are qualifiers for success program, it's a long list.

She also said that it may be better to do sperm aspiration because sometimes ejaculation can slow those swimmers down more and taking them directly from the sack is better. My husband about died. Why are guys such babies?

mandasd · January 2016

Okay, I just looked through all my records from April 2015 (last time I was tested):
AMH 1.31
TSH: 2.320
FSH: 5.1
Estradiol: 510.8
Vitamin D (low) 27.9 (I have been on VD supplement ever since)

Last year, my ultrasound showed 2 follicles on the left and 4 on the right. Today, I had 2/2.

KLake42 · January 2016

I'm 38 with DOR, and while my clinic has a success guarantee program, they don't offer it to me, because of my age and DOR.

If they did, I would take it, in a heartbeat.

MelD17011 · January 2016

there is also a guarantee program with who I'm with if you're eligible. A little more expensive, but seems to be a good program in that you either take home a baby or get a refund. Might be worth looking into other places for ones that have something similar - even if you have to drive a little futher.

mandasd · January 2016

All the fertility clinics in San Diego are comparable in price. We considered Mexico because we live close but my hubby said no way. We could go to NorCal, Sacramento area, since we used to live there and I still have an office there I could work out of for a couple of days and stay with my parents. We would save $3-5k by doing that. My good friend is the Embrologist at the best clinic in Sacramento. So that makes me feel better - I know he'll make me a good Embryo!! It's an idea to consider, but I think my hubby is settled on our doctor here.

The only issue with the guarantee program for us is that it's only good for one retrieval. Our doctor said that she thinks we would only have 1-2 viable embryos with one cycle. So suggested that we do two cycles back to back. Freeze the first cycle embryos and then transfer a fresh embryo after the 2nd cycle, freeze anything left from the 2nd cycle, then we can have a 2nd baby in the future without having to start over and pay another $13.5k...instead we would only pay $2500 for transfer. The 2cycle program is $19.9k so we save $6400 ish

2015dee · January 2016

Ooops, sorry, @mandasand...I think I misread that as embryo adoption. According to this chart (https://www.advancedfertility.com/amh-fertility-test.htm), your AMH is in the "low normal" range. And your FSH is really good. I guess she is saying 1-2 mature eggs because of your low AFC?

It's definitely a hard choice, but I like your DH's line of thinking (try with own egg first, then donor egg, then donor embryo, then adoption). But I guess your decision is about how many times you want to try with your own eggs. I may have missed this before, but what IF treatments have you already had? Hearing that adopting your sister's embryos was an option really warmed my heart!

PS- I literally laughed out loud about your comment about men being babies. I've had two laparoscopic surgeries, 2 HSGs, tons of transvaginal ultrasounds, and lots of blood draws...and my husband complains about how it is awkward to give a sample. All I can do is laugh. Babies.

mandasd · January 2016

@2015dee my levels have been all over the map. My AMH has been .3, .8 and recent 1.3. RE thinks she can get around 10 eggs and only 1-2 will be transferable in the end (assumption). 2 cycles will guarantee family planning. I've done all the same tests as you, the bloodwork, ultrasounds, 2 HSGs, etc. we have already spent $2k in tests alone and haven't even started anything yet. It's a pain. Another thing that really bugs me is it seems like so many people are being diagnosed with low ovarian reserve or premature ovarian failure. Part of me wonders if it is just a way to get more people to go for ivf. Maybe that's silly of me to think. My husband also made a big deal about giving a sample, it's like the easiest thing compared to us ladies being poked and prodded.

After i go to these consultations I want to just get started right away but I have to remember that the next 3 months will be non stop traveling for work so targeting June is ideal. I just hate waiting!!

mandasd · January 2016

This may be a stupid question but what is a mock transfer?
also, I know meds range from $4k-8k and my RE recommends using vitaCARE prescription services. Are there any other good and affordable online fertility pharmacies??

2015dee · January 2016

No stupid questions.....this whole process is SO confusing. I believe that a mock transfer is done during the sonohystogram prior to an IVF cycle. It gives the RE an idea of where/how to place the catheter that has the embryos in it.

My RE placed my medication order through MDR pharmacy. I compared their prices to Freedom Fertility (prices are listed online), and MDR was cheaper. I think my meds are around $4500...and that doesn't include progesterone or trigger. Arg. I feel like my stim doses are really high, especially for my diagnosis, so I am going to double check everything before ordering.

BOO for having to wait until JUNE. Geesh. There is no way that you can have a week where you aren't traveling?

StephanieWalstrom · January 2016

Our first IVF cycle has totaled $30,000 including meds and PGS testing. It also includes up to a year of freezing any euploid embryos, but we only have one healthy embryo that goes back in me this Thursday!!! Happy DANCE! No refunds, no second tries. A new cycle would cost us another $30,000 as our insurance pays not one cent. We are both public school teachers and were funded by my inlaws. Good luck to all!

mandasd · January 2016

Work travel: Feb 8 days in Hawaii, April 8 days in New Orleans, May 7 days in Seattle then 4 days in Alaska to visit my cousin after the tradeshow. My dad is waiting on a lung transplant which could be any day so that will require me to be with my mom 1 week while he's in the hospital plus another week later to take care duties of dad and that will be in San Francisco. Hubs has finals in May while I'm in Seattle so we think June will be the best month!

we also are paying for this out of pocket. It will be combined savings and some financing through CapMed. Luckily my husbands law school is being paid for 100% with combined GI Bill and scholarships. I'm fortunate enough to have a very well paying job, but we are still a single earning household for a couple more years!

PCOSat25 · January 2016

@mandasand I am up on the Sacramento area!!! Just curious to know what clinic you are taking about when you say "the best in Sacramento".

mandasd · January 2016

@PCOSat25 Northern California Fertility Medical Center. They are in Roseville. They were just voted best doctors in Sacramento a few months ago. My former co-worker and friend is their embryologist there. He is one of the smartest and most awesome people that I know. He originally got his PhD and was a stem cell specialist and after he and his wife struggled with fertility, he went back and got his masters in endocrinology. They have 4 kids now! 3 by IVF, the last one natural! Hard to believe!

Are you already at a clinic or still searching for one?

mandasd · January 2016

@PCOSat25 I just read your profile and we are both military spouses! My husband was stationed at Beale AFB in Yuba City, he just retired a year ago (after 21 years). He deployed a total of 15 times during his AF career - 3 times to Iraq, 2 times to Afghanistan, countless times to other less-known middle eastern states. I met him as things were winding down but I remember the worst was his last deployment in Iraq - when they were closing that base. That deployment was scary!

PCOSat25 · January 2016

@mandasand I was hoping you were referring to NCFMC. That is my clinic! The doctors are great but I will say the office has some scheduling issues and it becomes frustrating always waiting at least 20-30 minutes after scheduled appointment time...

I am on my second IUI cycle (going in for the deed tomorrow and Wednesday). It has been slow moving. We were unsuccessful with clomid and TI. Moved on to IUI with injectables and are still having pretty mediocre and inconsistent results (just one folli after 13 days of stims). Looking into the IVF leap but unsure of finances.

My husband was active duty for 5 years out of high school, stationed in North Carolina. He is now full time on the California national guard. He did on deployment to Iraq, one to Afghanistan, and he is gearing up to go to Ukraine for 10 months. He leaves in two weeks so this is our last FRESH IUI cycle. We have banked sperm in long term storage so if this cycle is a bust we will just move on to an IUI with a frozen sample or straight to IVF.

Let me know if you start treating up here and what your experience is. I haven't had the full IVF talk with NCFMC so I would be interested to know the pricing on their packages.

mandasd · January 2016

@PCOSat25 I will keep you posted! We will probably stay in SD for treatment but we could easily do treatment in Roseville since my parents live in the area. Do you have family and friends in the area for support while your husband is deployed? If not I can PM you some people that can help you whenever needed.

mandasd · January 2016

Met with finance person at clinic today. She broke down all the packages. I do not qualify for the shared success program. I qualify for the Embryo Banking 2 cycle program, which is 2 cycles back to back, then a single FET transfer. Base package is $21,102 with military discount and ICSI (+meds).

She said they will be extremely flexible. If it turns out I stimulate really well and have enough follies that I don't need another cycle, then they will drop me to the single cycle package which is $12,380 (+meds). If after the first cycle I do not get any follies or very few, I can also move to Egg Donation. They would credit me $10,690 and I would pay the difference for the egg donor package. All in all, if I end up doing 2 cycles or donation, I am looking at $30k.

I would save anywhere from $1200-2500 if I go back to the original clinic. I really like my doctor and that is why I wanted to follow her to the new practice. So far everyone I met at both places have been wonderful. My doctor is pretty amazing - she is one of the top doctors in the nation for fertility. I don't think my hubs cares either way. The difference of $2500 is not enough to sway him one way or the other I think.

AandDM2014 · January 2016

@mandasand Does that single cycle package include the FET? That could be the way to go if you get a lot. As for switching clinics, I'd say stay with the doctor you are comfortable with. It would be worth the extra money to have a doctor you really like.

PCOSat25 · January 2016

@mandasand my parent and my in-laws live in the area so I am lucky to have a great support system here. I am glad you got a good amount of information about your options. Now it's time for the tough part of deciding what is best for you! Wishing you luck!!!

mandasd · January 2016

@AandDM2014 No, it comes with one transfer (fresh). If it does not work, then I can pay for another FET for $3960 plus medication of $600-1000. The only issue is what happens if I don't get enough follies?

Talked to hubby last night. He is very concerned about the $30k. It is like putting all our eggs in this one basket. If it doesn't work, we would be out the $30k and then have to try adoption which could be another $30k.I bet most people are going through this same issue. We don't have enough to pay all cash and so I have to figure out a way to pay for the financing option. We don't have any other debt and we own our cars, hubby's school is being covered under GI bill. But San Diego is very expensive to live so our housing costs are high. We decided last night that we need to move to a more affordable house. This will save us up to $700 a month. I just got a raise at work and I will get a bonus next pay check. But, it will not be easy financially. I feel really bad and kind of deflated.

athompson0308 · January 2016

Have any of you considered traveling for your IVF cycle? I live in upstate New York and our costs are significantly less. We paid just under 10 grand for one fresh cycle with ICSI, our meds, embryo freeze and a PESA for my hubby. I know there will be cost from travel but maybe it's worth it to look into it?

caitiemae · January 2016

If you don't have all the cash now, but are confident you can get the rest saved up within the next year, you might want to look into a credit card w no APR for a year. My husband and I had to pay oop and didn't want to deplete all our savings and decided to go this route. So happy we did! Saved us from losing money on interest from a medical loan and got us quite a few airline miles as a bonus.

mandasd · January 2016

@athompson0308 My husband is in school and cannot travel until he is done, which is 2 years. He has classes even over the summer and an internship. He is in law school. I don't want to wait until he finishes school because then I'll be 38 and he'll be 42! I cannot believe how much cheaper it is in NY. Even if we went to Mexico it would cost almost $10k for everything. I was thinking about trying NorCal since I have family there but the cost savings is peanuts compared to being here in the comfort of our own area.

mandasd · January 2016

@caitiemae great suggestion! I was going to ask my hubby about that. We don't have much debt, just my student loans. We own our cars, his school is being paid for, etc. But it's very expensive in San Diego. I don't want to be left with no savings, especially when my hubs is in school and won't be working for 2 more years. We have talked about a few ways we can cut back on stuff, and I will ask him about the credit card. Thanks!

caitiemae · January 2016

@athompson0308 less than $10k for all that? Without any insurance assistance? That's amazing! If you don't mind can you PM your clinic? We were lucky enough to have a successful first cycle but if we want to have more in the future, we will probably have to do another round and I don't know if we'll have that cash laying around in the future.

mandasd · February 2016

UPDATE
My RE gave me a bunch of lab work to do (this will be the 4th time testing my AMH, FSH, etc. at $200 a pop). They recommended that my OB order the tests and then TriCare will probably cover. I just switched to TriCare in January and my OB accepts this insurance so I asked if she can do the testing. She said yes but I would need authorization from TriCare.

SO, I called my PCM and of course they wanted to see me. I went to the clinic which is a Naval clinic in San Diego. I brought my binder with all my fertility stuff (yes, I have a binder with tabs for every single thing I've done over the past two years). My PCM was very impressed. He suggests that I go to the fertility clinic at Naval Medical Center San Diego where they perform IVF. He said there could be a short wait to get in but he will do EVERYTHING he can to get me through quickly, including calling himself and talking to some people he knows. He said he went through IVF and he knows what it's like. Plus because of my age, trying for 2+ years and the fact that there appears to be no alternative but to do IVF, he wants me to try and go to this clinic. He also said he wants me to keep him update of my progress so that he can continue to help me through it! It costs a fraction of my my specialist cost, he said around $10k which includes meds. So now I'm just waiting for my referral. I hears the wait list is a year but my doctor assured me it shouldn't take that long.

BTW- I'm 14 DPO and I know I ovulated because when we went to see the RE on January 14 the ultrasound showed I was getting ready to ovulate...so hubby and took advantage of that again this cycle. I tested two days ago and it was negative. Now I'm having sharp cramps in my right lower abdomen. I do not want to get my hopes up and I will test again later today. I'm not really sure what to think about that, it's probably just gas!

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