Posts from — November 2008

Outcome-Based Plan (OBP) is out-of state S’ own in-house program. As the name implies, the plan is based on the outcome - the desired outcome being to have a “live birth”. Otherwise, a refund is provided by the clinic.

It was refreshing to see a clinic to have it’s own in-house financing program but at the same time, it may be a 2-edged sword. Would they do anything unethical or against your will to make the cycle a success?

Anyhow, here’s what I got re OBP:

1. Plans

• One OBP cycle costs $17,900 for 1 egg retrieval (ER) and how ever many frozen embryo transfers (FET) it takes to use up all frozen embryos or until a live birth is achieved, whichever comes first. This is the same cost for all patients! How simple is that?
• The difference is actually in how much is refunded. The 3 numbers after the plan name (x/y/z) actually refers to refund percentages.

Plan 1A (100/75/50):Female patient < 30 years of age at cycle start
Plan 2A (75/55/35): Female patient 30-34 years of age at cycle start
Plan 3A (65/45/25): Female patient 35 - 38 years of age at cycle start
Plan 4A (60/35/10): Female patient 39 - 41 years of age at cycle start

For example… if I qualify under Plan 4A, I would be refunded 60% ($10,740) after the 1st IVF cycle , 35% ($6,265) after the 2nd IVF cycle, and 10% ($1,790) after the 3rd IVF cycle - with no live birth.

• In case you are using donor egg and/or surrogacy, they have a separate group of “Third-Party Parenting” set of plans.

2. Qualifications
OBP has the most well-defined criteria for qualification. I will quote them verbatim here as it speaks for itself and so that I will not misrepresent them. Moreover, qualification is done for every OBP cycle.

· All indicated screening/pre-cycle testing must be completed prior to the start of suppression therapy.

· Patient/ovum donor/embryo recipient must be of sufficient physical and mental health to undertake a pregnancy.

· Patient/ovum donor does not harbor any genetic or chromosomal deficiencies that might increase the likelihood of predictable birth defects in offspring.

· Patient/ovum donor must be able to demonstrate the ability to produce an adequate number of eggs by responding normally to a prescribed regimen of controlled ovarian stimulation with < 600 IU/day fertility medications as measured by blood tests for FSH and Estradiol drawn on the third day of a normal menstrual cycle with results of both in compliance with standards established by S’s laboratory,

· Patient/embryo recipients with alloimmune implantation problems as evidenced by the sharing of certain DQa and/or HLA similarities with the sperm provider are not eligible for participation in the OBP.

· Patient/embryo recipient must have a normal uterus/uterine cavity as assessed by fluid ultrasonography (FUS), hysteroscopy, or Magnetic Resonance Imaging (MRI).

· Patient/embryo recipient must have a uterine lining measuring at least 9.0 mm in thickness on the day of the hCG trigger, or following estrogen administration for embryo recipients undergoing ovum donation, gestational surrogacy or FET.

· In the absence of sperm in the male ejaculate, male partner must have normal testicular function (serum FSH <12 MIU/ml). If the FSH is >12 MIU/ml the couple must be willing if need be to use sperm from a qualified sperm donor.

· All sperm providers, regardless of their basic sperm parameters, who have not previously fathered a child or initiated a pregnancy that has advanced beyond the 12^th week, as well as those suffering from male infertility must have a Sperm DNA Integrity Assay (SDIA)^SM done, and the result must be normal or become normal after treatment. In cases where sperm providers are undergoing TESE, donor sperm back-up must be utilized.

· All participants must comply with all recommended medical protocols and directives related to treatment as prescribed by the SIRM physician and/or his/her designee.

· Patients undergoing Preimplantation Genetic Diagnosis (PGD) of their embryos will not be eligible to participate in the OBP.

· The patient cannot have had more than two (2) previous failed IVF cycles using the same type of procedure contemplated in the upcoming OBP.

· There can be no history of:

• Patient/ovum donor blood tests for FSH and Estradiol drawn on cycle day 3 with results of > 9.0 MIU/ml and >70 pg/ml, respectively;
• Patient/embryo recipient endometrial thickness < 9 mm as measured by ultrasound exam at the time of ovulation, or abnormal endometrial thickening during stimulation with fertility medications for IVF;
• Patient/embryo recipient having abnormal contour of the uterine cavity as evidenced by sonohysterogram, or hysteroscopy, that has or may have compromised implantation, normal placentation, fetal growth and development, or substantially increased the risk of premature delivery;
• Patient having two (2) or more previous failed IVF cycles using her own oocytes, ovum donation and/or surrogacy, depending upon the plan of treatment desired and/or recommended;
• Male partner FSH of > 12 MIU/ml or previous testicular biopsy showing abnormal spermatogenesis in cases TESE is being performed for non-obstructive azospermia.

3. Application - With the above details, you can actually self-select or deselect yourself already. But the process appears to be simply:

• Get all those tests done (You will need to get Lab requests from them for some special tests such as alloimmune and SDIA tests because they require them to be done by certain labs.)
• Read, understand, sign and submit the OBP Agreement form.
• Wait for results. (Don’t know how long it takes them to process this.)
• There is also “OBP on Contingency” clause that may still be a possibility even if you do not meet the above criteria. You may want to explore that further. On the other hand, it is also an out for them if during the process, you become disqualified.

IntegraMed’s webpage, program and application process is more straightforward than ARC.

1. Shared Risk Refund Program
IntegraMed offers 1 plan only - “up to three IVF cycles and three frozen embryo transfers… and up to 100% of the program fees are refunded” - which is similar to ARC’s 3-Cycle Plus with Refund Guarantee.

2. Qualifications

• Women’s Age - ability to complete all three IVF cycles prior to the woman’s 38th birthday (unless donor eggs are being used)
• Day 3 Hormone Tests - FSH and E2 within normal limits
• Semen Analysis
• Evaluation of Fallopian Tubes and Uterine Cavity
• Body Mass Index (BMI)
• Need for Preimplantation Genetic Diagnosis Testing (PGD)
• Medical history, including highest recorded FSH, prior IUI and IVF cycles and pregnancy loss history (miscarriage)

3. Application

• It is nice that application is free!
• It is also nice that you can “pre-apply” online.
• On the online form, it shows >38 age option for the age. So even if you read that one of the qualifications is to be <38 age, that sort of give you some hope.

4. Financing

• IntegraMed also uses Capital One Healthcare Finance.
• “*Rates for our program range from 1.99% APR - 25.99% APR. Upon approval, the Annual Percentage Rate available to you will be determined by the term for which you apply and your credit standing and other factors as determined by Capital One. These rates are available for a limited time and are not available in all areas. “

…..

As for me, I completed the form and I got an email response to call them. When I called them, they told me that I do not qualify since I am >38 years young - which I already knew about. Would it not be more efficient for everyone if they just did not add that >35 age option in their form??? Maybe they have that option for the donor egg program? Or were they just wanting to capture information from everyone, I wonder.

Anyhow, similar question as yesterday for you… What was your experience with IntegraMed? If you can, please describe your case/plan, how much your package costs and what you liked/learned from it.

As our insurance covers fertility diagnosis only, it was time to explore more ways to finance an IVF treatment aside from paying out-of pocket completely. Well, technically, these programs still require us to pay out-of pocket but they may still be of some help .

They call these “shared risk plan” because the patient and the provider shares that risk of failure to bring home a baby. They share the risk by the patient paying a known fixed payment, typically with a premium; while by the provider providing a partial refund when a “live birth” is not produced.

Anyway, I looked into ARC, Integramed and OBP. Below is what I found out about ARC (Advanced Reproductive Care, Inc). I will do another post on IntegraMed and OBP since each one may take up a lot of space.

ARC (My current fertility clinic, T, is affiliated with ARC)
ARC’s webpage is a bit confusing to me - its content seems to be “circular”. So it took me some time to differentiate the various things they offer.

1. IVF Packages

• One-cycle Plus - 1 fresh and 1 frozen embryo transfer
• Two-cycle Plus - 2 fresh and 2 frozen embryo transfer
• Three-cycle Plus - 3 fresh and 3 frozen embryo transfer (Everyone qualifies!)

2. Refund

• ARC Refund Guarantee is an add-on plan where some of the money you paid for IVF will be refunded to you if you do not have a “live birth” after receiving the IVF treatment/s .
• This are links to ARC’s write-up or visual on the Advantages of Purchasing Three-Cycles Plus with Refund Guarantee Vs. Purchasing IVF Cycles One-At-A-Time. Caution… Sales Pitch!
• There is not much information on how much will be refunded but I suspect, it will be based on age, clinical risk factors and how many IVF cycles are used.
• Everyone qualifies for the Refund, but you have to first qualify for any of the above IVF packages.

3. DISQualifications for IVF Packages - You cannot find these in their webpages but these “key factors” are buried in their PDF Application form. “If you have any of these factors, you will not qualify for the Select Program. However, you can still participate in the Classic 3-Cycle Refund Program, which accepts all patients.”

• 38 years or older unless using donor eggs (treatment must finish by 38th birthday)
• Abnormal uterus
• Body Mass Index over 30
• FSH and Estradiol levels over normal limits
• Untreated Hydrosalpinx
• Low Antral Follicle Count
• Prior failed IVF cycle or miscarriage

4. Application

• ARC has a $75 non-refundable processing fee that will be used towards the treatment if you proceed in getting into one of their IVF Packages.
• You can only find out if you qualify and what the cost quotes are after submitting your application. Of course, we all know that the cost will be based on age and clinical factors.
• Application forms are available online by PDF download. You need to Fax/Mail back the completed form. They do not accept emailed application forms.

5. Financing and Other Programs

• Aside from the 3 IVF Packages and Refunds, ARC offers plans for various medical services (IUI, tubal reversal, donor egg, etc) and Pharmaceutical care (ARC Pharmacy Plan)
• ARC Affordable Payment Plan is through Capital One Healthcare Finance or CareCredit. You still have to qualify separately with them.

…..

As for me… Obviously, I only qualify to their “Classic 3-Cycle Refund Program, which accepts all patients.” I have not proceeded with sending my application form to ARC though because we are now seeking second (and third) opinions from other providers.

How about you? What was your experience with ARC? If you can, please describe your case/plan, how much your package costs and what you liked/learned from it.

Have you ever found yourself tearing up while singing a song?

Lately I find myself doing this at church. Twice, to be exact in the last month. Wanted to share with you one of the songs - maybe some of you feel similarly, maybe some of you may be encouraged by it.

ENOUGH
(Written by Chris Tomlin and Louie Giglio)

All of You is more than enough for all of me
For every thirst and every need
You satisfy me with Your love
And all I have in You is more than enough

You are my supply
My breath of life
And still more awesome than I know
You are my reward
worth living for
And still more awesome than I know

All of You is more than enough for all of me
For every thirst and every need
You satisfy me with Your love
And all I have in You is more than enough

You’re my sacrifice
Of greatest price
And still more awesome than I know
You’re the coming King
You are everything
And still more awesome than I know

More than all I want
More than all I need
You are more than enough for me
More than all I know
More than all I can say
You are more than enough for me

…..

I cry because I realize that in my flesh, I am still seeking to satisfy my desire to have a child.

I cry because I realize I may not have a child and therefore, I have “nothing”.

I cry because I am reminded that God is whom all I need and that He is whom all I should want.

It’s tough and God continues to work in my heart. That’s why perhaps the song speaks to me.

…..

But meanwhile, I count my blessings.

I am thankful for being alive, for having all my senses and my body is complete. I am thankful for having lived a full life and seen a lot in this world. I am thankful for family and friends who have colored my life. But most of all, I am thankful for having God who loves me, who is faithful to me even if I am not and who is more than enough.

Happy thanksgiving!

As you know, I am looking into 3 fertility centers for possible IVF treatment. One of the things we are comparing is, of course, the cost of having IVF. I’m sharing what I learned about how much it costs at 3 different fertility centers to give you an idea.

Let’s call the 3 fertility centers that I looked into as:
T - my current fertility center
C - highly-rated fertility center, out-of-state
S - famous fertility center, out-of-state

Comparison of IVF Treatments

*Based on other bloggers’ experience, this is what CGH costs.
**Based on Egg/Embryo Banking costs

Going from my current fertility center to out-of-state would be $2-4K more expensive in terms of the IVF treatment.

Comparison of Miscellaneous Costs

*Based on 20% co-pay of $3600
**Assumption only based on 20% co-pay of C ($3600). Actual tests taken right now costs ~$1600.
***Assuming medicines are equal

However, additional $3-4K costs are incurred due to out-of-state travel and additional pre-treatment tests.

Comparison of Grand Total Cost of IVF Treatments

So all-in-all, changing clinics would be $5-8K more. And this is only for 1 cycle!

That is the price of going to fertility center which:
- Offers CGH as a pre-implantation genetic testing method (instead of FISH)
- Has higher live birth success rate (almost double for C. As for S, I need to dig into the CDC data to have comparable data because S reports it differently.)

…..

It’s still not an assurance though that everyone takes home a baby even after spending $$$. I have known about people from both sides of the statistics, even for the highest-rated fertility center.

And it really makes me think twice… a lot… if IVF is worth all the money, all the trouble, all the anxiety, all the stress, all the heartache…

DH says that he’d spend the money to have a chance anyway.

The practical side of this journey boils down to 3 questions for me. I have a definite answer for one while the 2 others are still unknown to me.

1. If I had all the money in the world, would I go through IVF?
YES

2. If I go through IVF, what method/strategy are we going to employ?
???

3. If I go through IVF, which fertility clinic are we going to go to?
???

I’m still “working” on the last 2 questions…

…..

Meanwhile… Of course, I do not have all the money in the world, so I’m looking into how to minimize the impact of having IVF to our finances. And even if we have some amount saved up, the current economy calls for more austere living.

So, believe it or not, I’m actually looking into companies with the best infertility coverage and checking their available job lists! These companies are mostly in unrelated fields where I have expertise on - banking/finance, pharmaceutical, software, etc. I’m open to starting at entry level at these entirely new fields, specially the banking/finance world. The thought of it makes me a bit anxious though.

Any of you have good infertility coverage? Please share what infertility coverage you have, what company you work for, what insurance company you have.

I’m back, finally. Took me longer than I expected but just in time for ICLW.

Glad to be back, though!

Talk to all of you soon…