The Saga of Becoming Fruitful

Archive for the ‘Infertility Costs’ Category

Comparison of Shared Risk Plans: Wrap-up (4/4)

Knowing the upfront cost for multiple IVF cycles, with a discount and a refund, is useful for those of us who don’t want to be surprised.

Theoretically, doing the shared risk plans in the best/famous clinics sounds like a good plan. There are 3 caveats I can think of though:

1. When transferring to these clinics, there are a couple of specialized pre-cycle tests that are required and the cost could easily stack up. C’s 1 day work-up costs about $2,300-$3,600 out-of-pocket. It would be good to have infertility diagnosis coverage.
2. Again, I am reminded that it is not unusual to have no blast that makes it to freeze! Still, based on the math, there are certain outcome-based/refund packages that would still be financially beneficial even if no FET was provided.
3. If your IVF protocol is not the vanilla-flavor kind, then there are other costs that may be unaccounted for. The coverage of the various shared risk plans are pretty standard - excludes medicines, pre-cycle testings, special procedures such as ICSI, PGD/PGS, CGH, services provided by other facilities, etc - but each provider has its own twists, so it may be helpful to identify what aspects are of most important to you and compare those aspects.

There you have it. I hope these set of post cut through the clutter and gave you some information that you can use. If it did, leave me a comment to let me know. If not, at least, I got to organize my thoughts!

As usual though, these previous 3 posts are in no way complete so you will have to some more detailed research that is relevant to your case.

Comparison of Shared Risk Plans: OBP (3/4)

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.

Comparison of IVF Shared Risk Plans: IntegraMed (2/4)

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.

Comparison of IVF Shared Risk Plans: ARC (1/4)

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.

Comparison of IVF (In-Vitro Fertilization) Costs

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.

Three Questions…

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.

Choosing A Home Pregnancy Test

There was a time when a woman had to wait until she misses her first period and then go to the doctor to have a pregnancy test.  That pregnancy test required killing a rabbit! But … we’ve come a long way, babe, and we can do our own test in the privacy of our own homes with the home pregnancy testers!  And sparing the rabbit, too!

However, home pregnancy testers (HPT) are NOT created equal.

Basically, some HPTs will give you results earlier (as early as 5 days) than others because they are more sensitive.  Of course, the more sensitive HPTs are typically more expensive. So eventually, it all boils down to:
- you want to know earlier if you are pregnant and pay a little bit more
- you can wait till the end of the 2 week wait and use the regular and cheaper HPTs or maybe, just have the blood test then (without using any HPTs!)

How HPTs Work
HPTs work like litmus paper in the sense that the tester needs to be wetted by the sample - in this case, the woman’s urine. It can be done by 1) urinating on the tester stick, 2) collecting urine sample and dipping the tester stick or 3) collecting urine sample and using a dropper to transfer into the tester stick.
The similarity ends there.  The HPT’s mechanism for determining pregnancy is through the detection of the pregnancy hormone, human Chorionic Gonadrotopin or hCG, in the urine.  The tester sticks are treated specially to be able to do this.

hCG is produced by the woman’s body once conception starts and its amount increases at a rapid rate - typically doubling every 2-3 days during the early pregnancy. The hCG builds up in the woman’s body that eventually, it can be passed in the urine. 

hCG levels peaks between the 8th to 11th week of the pregnancy before it slowly decreases throughout the pregnancy. Here are some guidelines from the American Pregnancy Association:

Most HPTs reportedly can detect as low as 25mIU of hCG in urine. The detection could be as early 4 days prior to or as late as 1 day after the expected period. 

One of the  HPTs that claims detection as early as 5 days prior to the expected period is the First Response Early Result (FRER) Pregnancy Test.  The mechanism it claims to use for increased sensitivity (or earlier detection) is its ability to detect another variant of the pregnancy hormone, hyperglycosylated hCG or hCG-H. hCG-H is reported to be produced even before the primary pregnancy hormone, hCG, is produced.

How Sensitive HPTs Are
Interestingly, the product packaging and inserts of the HPTs rarely claim a minimum analytical sensitivity. Nor do their own websites. There are other websites though that have listed such official sensitivity of different brands as checked versus their manufacturers.

I’m a tables-and-graphs person, so I tend to put more confidence on information that reflects thorough research.  Here’s a study done and published in 2005 showing First Response Early Result (FRER) and Clearblue Easy Earliest Results as having more accurate and higher sensitivity results.

You may say, that’s 2005 data. True.  The other manufacturers may have improved since then. As for me, I think I will stick with FRER until I can find a more recent study showing the new best thing! Moreover, my quick research on the HPT prices did not really give a significant price difference between FRER and the others.   (Except for the dollar store kind, of course!)

Really, it is your money, so you can buy whatever you want.  I was just saying!

Is the Blood Pregnancy Test Redundant?
NO. You still need to get the blood pregnancy test as it is the most sensitive pregnancy test, detecting as low as 5mIU of hCG.  So it confirms or disagrees with the HPT’s results. The blood test is still the most definitive detector of pregnancy.

Moreover, HPTs just tells you whether you are pregnant or not. Yes or No. It does not measure the amount of the hCG in your body.

So, the required beta-HCG is still necessary because that is when the quantitative level of the pregnancy hormones are baselined. Baseline beta-HCGs are later used for comparison to the next day’s beta-HCG levels to see the pregnancy hormones’ increase rate. The beta-HCG levels can give early indications on the pregnancy’s characteristics  - is it viable? potential multiple pregnancies? potential complications?

So There You Have It
If you can’t wait and are looking to get earlier results, the First Response Early Result is the best HPT.

If you are looking for the cheapest alternative, then using the dollar store kind is just as good as the expensive ones after you have missed your period.

Do you differ with my recommendations? Tell me your experience with your HPT!

Where Are You Buying Your Follistim?

Last month, I had my first cycle of Follistim. The Texas Fertility Clinic had a couple of brochures from different pharmacies where I could possibly get them from. One of the staff members though mentioned that I could get it at the lowest price at a certain pharmacy. Read more »

What’s the Financial Cost of Infertility Treatments?

How much have you spent for your infertility treatments? I imagine that we all start out thinking “whatever the cost”. As women though, we do worry and obsess about the financial cost of our infertility treatments. For some of us, it can be a real financial burden.

I did an analysis of just this year’s cost of our infertility treatments. For half the year, we now have spent about $4,500 since we started with our new Reproductive Endocrinologist due to our relocation. That was the price for infertility baselining, laparoscopy, 2 clomid cycles and 1 follistim cycle. Check out the Cost page for the detailed breakdown of our expenses so far for our infertility treatments.

With half a year to go and no baby yet, we will probably be incurring at least $3000 more for 1 IUI cycle. If we need to go beyond that - whether another IUI cycle or graduate to the more expensive IVF treatment, obviously the infertility treatments is going to cost even more. Oh my!

Will you share how much you have spent already for your fertility treatments and how you coped with it?