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Weighing my options

12/06/2011

Belle

Dr. A or Dr. Hope?

 

This morning Mr. Husband and I went to the third and final RE in our area. Honestly, I went in with low expectations.

As we drove the 3/4 of a mile to the office Mr. Husband said, “Well, he sure gets an A+ for location.” I could not argue there. We could walk to his clinic, which is good since we only have one car. When we arrived we were the only people in a poorly decorated waiting room with uncomfortable seats. The receptionist, though, was very sweet and took care of things promptly and professionally.

We waited less than 10 minutes (unheard of in infertility land!) and were taken back to a room with two sofas, two comfy chairs and some IVF literature. I appreciated not having to spend the consultation on a table with my pants off.

A nurse came in to take my history and was very sweet and understanding of my strange medical history. After she left I could hear her briefing the doctor on my case. No one laughed at my problems and no one speculated anything super scary. I liked that she spent time explaining everything to him.

Then Dr. A came in. I was first struck by how very tall he was. Mr. Husband is 6 foot 4 inches so it takes a REALLY tall man to trump him. Dr. A also had a great head of thick hair that made me wonder, “Is there anyway we can get his hair gene added to our embryo?”*

Dr. A was very thorough in discussing our options. I explained how I hyper stimulated on just 75 iu of Gonal-F and then had a poor response to 37.5 iu. He said he would recommend the same protocol that he does with his egg donors. We would use Ganirelix and Gonal-F to produce as many eggs as possible with no worry about OHSS. I would then trigger with Lupron, retrieve the eggs, fertilize them and freeze all the embryos. One to two months later, after my ovaries had calmed down, we would do FET’s.

This protocol makes me really sad because there is a lower chance of success with a FET. However, both Dr. A and Dr. Hope are adamant about avoiding OHSS again. Dr. A explained that OHSS with pregnancy is even more serious and he would fear a potentially life-threatening situation based on my history. Mr. Husband and I agreed with him. This is just how my body is and no amount of fussing is going to change that.

Dr. A was optimistic that we might be lucky enough to get 20 + mature eggs from my crappy ovaries. In a perfect scenario, we could have enough embryos on ice that we never have to do this again. His clinic is also open to shipping our remaining embryos wherever Mr. Husband gets a job in the fall.

Then we got to the price tag. Let me first say that I did really good this time around and did not start to melt down at the talk of dollars. I am not one to drop large sums on money, especially on something that has a low rate of success. At Dr. A’s clinic, one round of IVF without medications will run me $8,250.00. Unlike many other clinics, this includes ICIS. For me, medications should be right at and additional $1,500. The additional cost to freeze the embryos is $600.

Each FET cycle will be $2,200.

I have no idea how this stacks up against other states and clinics. I know that it is more than Dr. Hope would charge, but I also realize that Dr. Hope has not performed IVF in several years. Dr. A does this on a regular basis. This is a really tough decision – I really like Dr. Hope as a person, but I don’t want to wait an indefinite amount of time for his clinic to open. I also don’t feel good about being his first IVF patient in a number of years. I do believe that practice makes perfect.

We talked with Dr. A about the shared risk programs and he gave us his honest opinion about them. The physicians he knows offering shared risk often boast that they never give money back. They choose the women who are the most likely to successfully conceive and carry a baby and then sell them a procedure that is twice the regular price. When they take home a baby the first try the doctor walks away with an extra $10k in his pocket. Dr. A said he, personally, has ethical qualms with this system. He said he considered offering it for a long time, but no matter how he spun it, he just did not feel comfortable with it. “I prefer to sleep well at night knowing I’m doing the honest thing,” he said.

I see Dr. A’s point, and if I were in his shoes I would probably feel the same way. However, no one knows how my body will react to an embryo. I also feel like having the “insurance” of shared risk will make the cycles less stressful. As I type those words I know, in my heart, that even with a 100% guarantee that this will work and I will bring home a long-legged, thin haired, dorky baby I would still be tremendously stressed. No amount of money can buy peace of mind. With that in mind, is it worth the hassle of working with a clinic an hour and a half away from home to have a shared risk program?

Mr. Husband and I gathered our things and made the pilgrimage to the checkout window to pay another $200 for another consultation. “We have a lot to discuss and decide,” I muttered. “Yeah…” he said.

As we paid I looked into the waiting room and saw one woman waiting.  “Gosh it is quiet here! Is it always this quiet or is it just like this on consultation days?” I asked.

The receptionist looked in my eyes and said, “It is always quiet here. We NEVER over book.”

Once in the safety of the car Mr. Husband and I agreed that we liked Dr. A, we liked his protocol as much as anyone would like a FET and we like that the clinic is less than a mile from our house. The real sell, though, is that they never over book. Can you imagine an IF cycle without countless hours of waiting for your doctor? My brain has a hard time wrapping itself around that!

We have a few weeks to decide still. What do you all think? How do you feel about FETs? Do you know anyone who has done a cycle like this to avoid OHSS? I would value your thoughts.

* Mr. Husband and I have terribly thin, boring hair. I spend a lot of time coloring mine and styling it and Mr. Husband spends a lot of time talking to his, asking it to please stay rooted on his head and not move south to take new residence on his back. Our  child is doomed in the hair department.

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16 Comments

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  1. December 6, 2011

    Hooray for having a good visit with Dr. A! RE shopping is difficult and finding a good doctor isn’t always an easy process. I’m glad that the visit went well!

    I’m not one to talk figures either, but figured I’d share. In WA state, where there is no insurance coverage for IF treatments, IVF runs around $12,000. I’m doing IVF at the university, so IVF (including ICSI, minus the drugs) is ~$9,600. Drugs have been ~$1000. I haven’t talked with anyone about FETs, but considering they usually do medicated FETs, I would imagine it will be a similar figure.

    Good luck with your decision!

  2. December 6, 2011

    I think Dr. A sounds really reasonable and the no overbooking? Sign me up! Good luck with whichever option you choose! (If it were me, I would not choose someone who only does this occasionally. I know how much I forget in relatively short amounts of time. Gotta keep those skills sharp!)

  3. GAgirl1 #
    December 6, 2011

    Hi! I haven’t commented before, been following your blog for only a short while.

    But, I actually got some info just today on Lupron trigger with a later FET. I’m in the middle of my first IVF cycle, have PCOS, producing a ton of follicles, and I have no signs of OHSS (yet) but my RE is being really clear that I’m not out of the woods yet and there is a chance we will need to to a Lupron trigger, freeze everything, and come back to do an FET.

    In my update to my acupuncturist, I mentioned this while also asking for an extra session to (try to) pre-empt any OHSS that might be rearing its head. Obviously I was not excited about Lupron/FET–BUT she had this to say (background is that she is a former fertility RN now runs an incredible acupuncture for fertility practice):

    “If the determination is that a lupron trigger with delayed transfer is the
    best way to go please know this is a really good plan. Pregnancy outcomes
    with this approach are excellent. It was THE topic of discussion this
    summer at the international IVF conference at UCLA that I attended (even
    though I’m not an MD.) I realize that’s not your only concern but it
    certainly is worth knowing.”

    “Excellent pregnancy outcomes”–not too shabby! I know its still FET, but I think its heartening news that all the medical types are excited about this right now. Dr A sounds like he really has his stuff together and runs a super respectable practice. I would feel in good hands with him. Good luck!!

    • December 6, 2011

      Thanks for the info and I’m glad to know you have been following. This is really encouraging and I can’t wait to share it with Mr. Husband tonight. I hope your ovaries calm down and that you avoid the OHSS monster. It’s pretty fierce and not something I would wish upon anyone. Good luck!

    • December 8, 2011

      Thanks for the input! I did some research after reading this and it seems that research is pointing to FET’s being just as good as fresh, especially in cases where OHSS is likely.

  4. December 6, 2011

    Dr. A sounds like a winner! The cost of IVF with him sounds very close to what they are at my clinic. I don’t have any experience with IVF/FETs/OHSS so can’t help you there.

    So sorry about your bad hair genes. Our kid is definitely doomed in the dork department, too.

  5. December 6, 2011

    I don’t have any advice as DH and I never did IVF. But Dr A sounds like a dream and his clinic is one that I wouldn’t have minded having access to when we had to do IUIs. No overbooking, no long waits, sounds awesome.

    I hope you and Mr Husband can come to a decision that best suits you.

  6. December 7, 2011

    I have no advice, as we are not quite where you are yet (though may be soon) but I at least wanted to say good luck! Dr. A doesn’t sound so bad at all!

  7. December 7, 2011

    Wow, it is quite a lot to consider. I am in Texas, and the price seems low compared to what I hear about here. I am paying about $2000 just for IUI’s (with meds)! IVF’s seem to run about $10000-$13000 around here. So in that area I think you are okay, even though that is still a ton of money.

    I have met several people at my clinic that have had successful FET’s so it certainly can work. I agree with you about the experience mattering, I would want an RE who does IVF routinely. I was going to my OB for IUI’s and even though I am paying a ton more for my RE, I think it’s worth it.

    If I were you….I’d make a T chart. I love those things for decision making!

    Good luck!!!

  8. December 7, 2011

    Wish I could give you advice, but really I have no clue what you should do. All I can say is trust your gut, I’m sure you guys will be able to figure out what is best for you.

  9. December 7, 2011

    I personally can’t give you any info on prices of IVF or anything regarding IVF for that matter, but I do like that sounds of Dr A. He does them often and he doesn’t over book. Good luck with your decision!

  10. December 7, 2011

    I wouldn’t be comfortable with someone who hasn’t worked with ivf protocols for some time. So I would go for the other one which was Dr A right. About the price tag, since living in UK it’s not quite right to compare but looking at it it’s a tad cheaper here. But I still have a hard time understanding why it has to be so freaking expensive. Good luck on deciding.

  11. December 7, 2011

    Hey girl.. I too would not be at all comfortable with a Dr. who does not do IVF every day. As to the price, while Dr. A sounds really nice I have to disagree with his take on Shared Risk. I view the policy as more of an insurance policy.. for some women. I can see why it may be a waste of money for a woman with a relatively mild IF history, but I feel as though of the women I have met who headed into IVF very few were successful on the first try. We all have different backgrounds but I have seen many women fail 1-2 rounds and then find success on round 3. If not for shared risk some would never have been able to afford 3 OOP IVF’s. In my case we went with shared risk for the refund- you know my history and for me the 70% refund if we do not bring a baby home form the hospital was a huge draw. If we don’t being home a living baby we can roll that refund into an adoption instead of having lost everything we invested.

    Have you searched the FF boards- there are several discussions there and on BC about the programs.

    Anyhow I know it’s a big decision and I know that only you can decide what is best for you and DH.. thinking of you with lots of hope!

  12. Rachel @ Eggs In A Row #
    December 7, 2011

    Wow. Dr. A sounds amazing…

  13. December 8, 2011

    Hi there, my friend got OHSS on her one and only cycle. She managed to get 7 eggs and all fertilised well but all had to be frozen. Round 1 – no good; round 2, no good, round 3 – BINGO. Twins. I hear about successful FET cycle all the time… and am hoping to add my number to the statistics!

    Dr A sounds like a gem – good hair AND ethical. The cost is not so much more than in Australia, though I got about half back on Medicare (the govt gives it back to me) but not much on my private health insurance as I hadn’t upgraded the cover to include IVF as I would have had to wait 12 months. And here we can also claim out of pocket expenses on tax!

  14. 2berrys #
    December 8, 2011

    Oh my, this is wonderful news! I wait, on the average, about 15 minutes just on the phone waiting for the receptionist to come back to my call after asking me to “please hold”. Sounds like you have a great plan and I bet that has to feel good.

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