Journey through infertility ain’t easy nor cheap. Still, God is good…

CCRM fees are big. And non-negotiable too. (I did ask them if they had “recession pricing and payment plan”, to which the Business Office said “no” to.)

So every penny counts when planning for the multiple trips to Denver.

This is the expense breakdown of our 1 day work-up last December:

• Airplane ticket - 700 (United)
• Hotel - 100+ (Staybridge)
• Car rental/Gas/GPS - 65 (Thrifty Compact)
• Toll fees - 15
• Food - 20 (hotel had hot breakfast and we were not able to have lunch)

TOTAL ~ $900

For the Egg Retrieval, we hope we just need to stay for 10 days. Here is the breakdown of the expenses

• Airplane ticket - 550 (Southwest)
• Hotel - 560 (Hyatt Place Denver South)
• Car rental - 175 (Thrifty Full Size)
• Gas - 50
• Toll Fees - 30
• Food ~ 500 (hotel has continental breakfast)

TOTAL ~ $1900

With the 1 day trip ($900) vs the 10 day trip ($1900) difference being ~$1000, it means that on the average the latter trip is costing us ~$110 dollars for the hotel, car rental/gas/toll fees and food. Compare that with $100+/day just for the hotel on the former trip! Now that is what I call frugalicious!

How did I do this? Read on… [Read more →]

Last week, I was catching up with some of my fellow IF bloggers posts that I have missed in the last 2 months. One thing that caught my eyes was Mamasoon’s CGH results - or should that be “no results”.

So I sent an email to my IVF Nurse and asked her about a “recent botch up of CGH test” and whether microarray is applicable for my egg (not embryo) case, does CGH and microarray differ in cost, and whether microarray is “safer” than CGH. She did not send me an email response but when we talked on the phone she told me she would get me the answers to my questions.

Last Monday, I got a surprise call from Dr Sch instead He sounded a bit miffed (I think) but he does understand that we in the IF blogosphere have a unique culture such that word gets out fast here. He said that it was not a botch job (like someone dropped an embryo or someone skipped work, etc.) but was instead attributed to the variations in the enzyme/reagent used. (I used to work with chemicals too so I understand what he means. It is still is not acceptable not to have quality control on the incoming enzyme/reagents though.)

Dr Sch stated that the choice of CGH vs microarray was typically made by them based on which lab has a shorter turnaround for the load that they have at the time that the samples are available. He also stated that they do not favor one test over the other and in fact, consider them equivalent. (I wonder if they did a study on this?) I do remember him saying these on our first phone consult though so he is still consistent. He did say that if I wanted to choose one over the other that I was welcome to do so. Based on what he said though, I would like to go for whichever would have faster results when my samples are available. Any of you have an opinion?

I told him that I needed to ask those questions I asked because of the “data” I got from the web. And I backtracked, I called it “information” instead of data. And that’s when he gently laughed and said “that anything you read in the web, you should not treat it as “data”". I agree. But I still would ask. No harm in asking, right? I’m paying good money for all these!

Guess where I am right now? Yes, I am now in Denver and probably will be for the next 10 days.

I had an appointment for Ultrasound and bloodwork at 8:15 am earlier today. I thought I had plenty of time but guess what greeted me when I opened the curtains:

SNOW!!! Yaix!!!

I wasn’t prepared for it. I knew it was going to get cold that’s why I packed my thick winter jackets and turtle neck shirts.  But not snow!

That explains the brush inside the rental car! I was wondering why they left their “cleaning” stuff inside the car! Now, I’m glad they did. I further gave away my being snow-ignoramus though when I opened the driver seat door and snow went in and deposited on the seat!  (I started to get worried that when I turn on the car heater that my seat would be all wet!) Anyhow, I actually enjoyed brushing off the powdery snow off the car - it was easy-peasy!

When I was done brushing off the snow, I only had 10 minutes till my appointment. So I drove off … and when I made the left turn into the major street… I lost control of my car and made a 180 degree!!! It was a good thing that there was no car right behind me… I guess they stayed away because the rental car had an Oklahoma plate.

There I was in the middle of the road, facing the wrong direction!!! I was shaken but I couldn’t help but grin. I waved at the oncoming traffic and they let me maneuver.  Then I was on my way… I was a bit frazzled but I thought it was more funny than embarassing. I just praise God for protecting me!

I got there on time - ultrasound showed my ovaries were on track. They should call in later today what my Follistim dosages are for the next 2 days.

Here’s my schedule in the next few days:
3/12 Thu - Ultrasound/Bloodwork. IVF Physical
3/13 Fri - Genetic Counseling with Danielle
3/14 Sat - Ultrasound/Bloodwork. Back-up Freeze #1
3/15 Sun - Ultrasound/Bloodwork
3/16 Mon - Ultrasound/Bloodwork. Back-up Freeze #2

Will keep you posted, I promise!

Who says you have to be on Day 5 to go for the 1 day work-up? The center website says so… the center documents says so and then the people scheduling it say so too.

But guess what? My period did not actually come in time for the 1 day work-up. (For someone like me who has her period once every 3-6 months, I expected that my period was not going to cooperate. Indeed… the 10 days of provera (supposedly on time for the 1 day work-up) was not enough to push it.  It took about 7 days of Prometrium (after the 1 day work-up) to coax it out of me.) But I still went through the 1 day work-up.

My conclusion? You really don’t have to be on Day 5… they just need you to get there so as to establish you as a patient. (Some of the doctors are not licensed in your state and thus, they have to see you face to face first before they can claim you as a patient and start your formal medical care and prescribing meds to buy and take.)

Here goes my recollection of the 1 day work-up we had at the yearend last year:
New Patient Consult - Dr Sch was out the whole week so Dr Gus was the one who saw us. Pleasant, smiling guy. Talked about not a lot of data on frozen eggs yet.

Hysteroscopy - All clear! Dr Gus performed this.

Semen Analysis and ASAB - Count and motility were excellent. Morphology still was low. ICSI is unavoidable. $2800 ka-ching!!! BTW, although the center was beautiful, going down to the batcave….uurrmm basement … to submit the samples was a bit eerie and cold. I guess our precious eggs, sperms and embryos need a cooler, darker place to stay???

Baseline Ultrasound and Doppler - Some regrowth of my dermoid cysts on both ovaries. Good blood flow! Linda, the nice sonologist, did this.

Nurse Consultation - The big book is given. Rhonda was thorough in going through what information we could find there. I got a free 600 IU Follistim!

Genetic Counselling - DH and I were not yet on the same page on whether to do CGH on the egg or the embryo when we talked to Danielle. (We have since then resolved that we are going to go for egg CGH.) New thing I learned from Danielle is that the Day 5 embryo biopsy done by CCRM for the CGH samples are multi-cell, not just a single cell sample. I think that multi-cell decreases the error vs single cell sample. Danielle mentioned also that there is 1 lady who is opting for egg CGH (Polly, I think she must have meant you!) so we could at least have a data point before we do it.

Rhonda later called in mid-January to say that the lady who was doing the egg CGH changed her mind. And what that meant was that I would be their first patient (guinea pig) to do the egg CGH. Yay! (Polly, you better hurry up… you go first! Aww… I just checked your blog and I am indeed going to be the first guinea pig with you coming in later this month)

As for all the rest of those genetic testings? We declined them all.

FLC Consent Review - Won’t mention names but she might have just as well left us with the forms for us to read and sign. Bummer that because of my age and my “infectious” disease results (nurses say that it is not contagious) that I cannot be an embryo donor!

Not that I will have many egg/embryo to donate or that we would want to be (DH is not comfy with that… yet), but it just doesn’t seem right that if we are willing and there is a willing couple that their criteria precludes us from having that option.

Also because of the “infectious” disease, any embryo (or egg) that needs long term storage will have to be sent out to a special storage. Talk about stressing the egg/embryo further!

How many times do I need to bring out my card for payment???
This is the only thing that sort of odd in this place. You have to draw out your card a couple of times to pay for the semen analysis, the consult, the hysteroscopy  and of course the deposit.  And they do this in 3 areas of the center. Can they just please swipe the card once and in 1 place? I know that CCRM and FLC are 2 different entities but do they really have to a ping-pong on us from 1 receptionist to the other???

All in all though, it was an efficient day. We were able to go home that night. I was just glad it was over so that we could move forward in this saga of becoming fruitful.

Well, gals, I am still very much alive! I’m sorry I have not been posting here but life goes on.  The details did not seem very exciting and I was busy working on some goals that blogging fell into the wayside.

Anyhow, after the one-day work-up in CCRM end of last year, we basically followed through with the necessary things to be done:
1. Physical exam and Mammogram - all clear
2. Clomid Test - I did it anyway so that I don’t need to redo it, just in case. All good.
3. Waited for my period to arrive to start the birth control pills
3. Paid for the IVF/ICSI/CGH - $$$ (I asked about “recession pricing or payment plan”.  They have none.)
4. Started the Lupron/Dexamethasone/Menopur/Follistim protocol - 1st ultrasound today show both ovaries responding as expected - 8-10 eggs @~10mm on the left and 10-12 eggs @~10m on the right.

I still owe you stories about the 1 day work-up. I’ll try to recall that but if not, then I’ll just tell you stories about what’s going on now!

It has been a busy, busy December. I am looking forward to a new year…
Meanwhile, apologies to you gals for not keeping you updated. Here are what has happened (aka alibis):

- Decorated our house, by myself for the first time
- Put together our annual letter and sent it out (probably to about 100 of them, mostly to the US but also to 7 other countries)
Canada, Philippines, Australia, New Zealand, India, Germany, Malaysia,
- Prepared for Christmas party at home (I have now successfully cooked turkey successfully twice!)
- Bought and prepared gifts for the immediate family.
- Partied/Dined from the 21st to the 24th
- Visited my sister and the rest of the family in Canada
- Surprise, surprise… Had our 1-day work-up in CCRM

Yes, after a 1-day work-up in CCRM, we are now in the Denver International Airport waiting for our return flight. I will write more about it in the next posts

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.

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.