Then Comes Maybe

Two perspectives on one couple's struggle with infertility

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The Price of Infertility

February 05, 2018 by Melissa Andersen in She Says

Much of this blog is (and will continue to be) dedicated to the emotional, mental, and physical effects of infertility. But no discussion of infertility is complete without an examination of a much more tangible effect - one that often precludes a couple’s fertility journey: the financial one. There’s a devastating lack of insurance coverage for fertility treatments in this country, and even when insurance does kick in, it rarely covers everything. For far too many couples, this immense financial burden is so devastating that it stops their dreams of having a baby right in their tracks. For those couples, treatments like IVF are not even an option; if it doesn’t happen naturally, it doesn’t happen at all. And for those who can scrape enough money together to afford just one cycle, they often feel pressured to make risky decisions to boost their odds of conception.

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When we first started looking into IVF many months ago, we found plenty of answers to our questions about the procedure itself, and some information about the testing leading up to it. What we were missing (and especially as the Type As we both are) was a step-by-step breakdown of what IVF entails and what it costs. We saw plenty of numbers being thrown around, but those numbers differed wildly, from the low thousands to $30,000 or more.

With the stress of our diagnosis, the treatments ahead, and, oh yeah, the fact that there is still no guarantee we will have a baby at the end of it all, we now faced another giant question mark: the massive blow to our bank account. I’m self-employed and while Bobby has a traditional nine-to-five that provides insurance coverage, like many small businesses in this country, his company’s insurance plan options offer no fertility coverage. None. And it’s not like we went for the skimpy insurance plan. I’m a living kidney donor, so we always make sure to get the best insurance plan offered through his job. We’ve been told that some of our diagnostic testing will be covered (i.e. the first - and only the first - visit to the urologist, blood work, and the like - essentially anything that happened before the infertility diagnosis), but the actual IVF procedures, medications, etc. are all out of pocket. (Note: We’ve already seen pushback from our insurance company on the diagnostic testing, so even that coverage is up in the air at this point).

Insurance companies robbing the infertile

Insurance companies robbing the infertile

While many states have mandates that a certain percentage of fertility treatments have to be covered, and some companies opt to offer it of their own accord, there are countless people in the same boat as us (I’ll save my rant about how we’re one of the only developed countries that doesn’t offer fertility coverage for another post). IVF and infertility are already full of what-ifs, and price shouldn’t be one of them. So we decided that in the name of transparency, we’re going to do a series of updates on where we currently are in the process, how much each step is costing us, and the total we’ve paid out of pocket (or are committed to pay) so far (hell, we’ve already talked in depth about Bobby’s sperm and my transvaginal ultrasounds, so why get sheepish now?). While every couple has a different experience with cost (and there are many factors that affect prices), we hope that we can offer a bit of insight for those who are facing this long road with us.

Here’s what we’ve done so far:

  • Urology: Bobby had three semen analyses done before we received the official diagnosis of infertility. Bobby is in the midst of pushing his insurance company to cover all of these visits under “diagnostic coverage.” Cost: TBD/pending insurance coverage

  • Natural supplements: While Bobby was undergoing treatment for his morphology issues, he decided to go bonkers and buy every single supplement he found associated with fertility (like I said, we’re Type As). Conservative estimate of additional supplements: $600 (some are ongoing)

  • First fertility specialist visit: When it came time to see a specialist, we did a lot of research and decided to go with IRMS (The Institute for Reproductive Medicine and Science at Saint Barnabas) in Livingston, NJ, which we’d heard and read a lot of good things about. (BONUS: If I do get pregnant, Saint Barnabas has an incredible NICU). During this first visit we met with our doctor, discussed options, gave blood for health screenings and genetic testing, and met with the financial coordinator. I also had a pap smear and a transvaginal ultrasound done to see how my ovaries looked and how many follicles I have (good marks on both counts). Co-pay: $30

  • Day 3 blood draw: On the third day of my next menstrual cycle, I had to report back to the clinic to have my blood taken for baseline hormone testing. This gives the doctor a picture of my hormone levels so she can tell if my reproductive system is functioning properly. Luckily, everything came back perfect. Cost: TBD/pending insurance coverage

  • Saline sonogram: Between days 5 and 10 of your menstrual cycle, patients have a saline sonogram performed. I went on day 6. I was a little nervous about this procedure because I had read that many people found it painful. Essentially, this is a vaginal ultrasound where a saline solution is injected into the uterus so the doctor can get a clear picture of your uterus and evaluate its health, as well as identify any growths or abnormalities. I did experience some discomfort during the procedure, but it was very quick (a few minutes) and I had only mild cramping afterwards. My uterus checked out a-ok. Cost: TBD/pending insurance coverage

  • Carrier testing: As I mentioned in my last blog post, Bobby and I are opting to do everything we can to achieve the best possible outcome (a healthy baby) in one round of IVF. In addition to having our embryos genetically tested (that comes later), we also had our own blood tested to see if either of us are carriers. According to Counsyl (the organization that conducted our DNA tests through our fertility clinic), “Carrier testing is a way to see whether we carry certain mutations in our DNA that may not affect us, but can cause our children to inherit a disease. If both parents are carriers of the same mutation, their child has a significant chance of suffering from a serious genetic disease, like cystic fibrosis, spinal muscular atrophy (SMA), fragile X, sickle cell disease, or Tay-Sachs disease.” Fortunately, both of our tests came back negative. Estimated out-of-pocket cost: $67.32 x 2 tests = $134.64 (pending insurance coverage)

Here’s where we are RIGHT NOW:

  • Round 1 medications: For us, this was the first major cost of the process. According to our clinic, most couples can expect their medications for one cycle to be between $5,000 and $8,000. However, because I don’t have any fertility issues myself or any underlying health concerns, our clinic estimated our cost to be on the lower end - somewhere between $4,000 and $5,000. Since we’re paying out of pocket, our clinic was careful to order slightly less medication than I will likely need in my first round so that there is no risk of overbuying and paying for medication I won’t end up using. We ordered through a specialty pharmacy that offers discounts for out-of-pocket patients. Below is a list of all the meds and prices for the first round (I will most likely have to order more of certain medications before the cycle is complete, depending on how my body responds and other factors. Therefore, our total round 1 meds cost could increase):

Out of pocket meds:

  • Follistim: 2 units at $862.80 each: $1,725.60
  • Menopur: 10 units at $82.99 each: $829.90
  • Ganirelix: 4 units at $139.95 each: $559.80
  • Pregnyl: 1 unit at $101.09 each: $101.09

Covered by insurance (with copay):

  • Medrol (prednisone): $10
  • Doxycycline (antibiotics for Bobby): $10
  • Doxycycline (antibiotics for me): $8.64
  • Progesterone in oil: $10

Total for cycle 1 medications so far (including pharmacy discounts): $3,055.03

  • IVF with ICSI (Intracytoplasmic sperm injection) and Embryo Freezing: This is the big whopper of IVF costs. It covers everything performed by our clinic while in-cycle, including monitoring (the blood draws and ultrasounds I will be getting almost daily), procedure/embryology (egg retrieval, sperm prep, ICSI, culture, assisted hatching, and more), embryo biopsies for genetic testing (PGD), embryo cryopreservation, and up to one year of embryo storage. Normally this would cost $17,175, but the clinic provides a discount for out-of-pocket patients. Cost due in full prior to cycle initiation: $14,000

  • Anesthesia/facility fees: The retrieval process is performed by my IRMS doctor, but the procedure requires anesthesia and the use of St. Barnabas facilities. Cost: $1,600

  • Preimplantation Genetic Screening (PGS): While our clinic, IRMS, does the biopsy of our embryos, the actual testing is done off-site through a reprogenetics lab. We won’t know final costs until we know how many fertilized embryos we end up with (if any). Cost: $850 base fee + $250 per embryo

GRAND TOTAL OF PAID AND COMMITTED COSTS SO FAR: $19,285.03

February 05, 2018 /Melissa Andersen
fertility, in vitro fertilization, infertility, fertility medications, ivf, health insurance
She Says
3 Comments
Angel and the Badman directed by James Edward Grant

Angel and the Badman directed by James Edward Grant

The Great Fertility Hand-Off

January 26, 2018 by Melissa Andersen in She Says

I received a package today. Normally, mail time is a highlight of my day (#realtalk #oldandsad). Aside from all the bills (SO MANY BILLS), it usually brings with it all kinds of fun stuff. Paychecks! Birthday cards! That thing I ordered from Amazon! Today was no exception. FedEx appeared, dropped off the goods, and I tore it open. I was excited. I knew exactly what it was and I was ready for it. But when I opened it, all that excitement quickly turned into something else.

Something heavy.

Something messy.

And the worst: something totally out of my control. 

This package contained the torch of the IVF Olympics, the first symbol of The Great Fertility Hand-Off: my first cycle of IVF medications.

My kitchen island looks more like a torture chamber these days.

My kitchen island looks more like a torture chamber these days.

And just like that, all the pressure of this whole making-a-baby escapade transferred from Bobby (where I liked it just fine, thankyouverymuch) to me.

You see, in theory, all of this medical intervention we're using to get pregnant is an effort to bypass Bobby's fertility issue: his low morphology. 

[Before we move on, I need to take a moment to say congratulations to Bobby's little swimmers. His most recent semen analysis showed that he has 2% - not 0% - morphology. Go, Bobby tadpoles, go!]

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As I was saying, until now, the reason we weren't having any success was because of an issue with Bobby. I felt safe in my cocoon of fertility, a cozy spot from which I played the role of supportive wife as Bobby grappled with what I know was an incredibly emotional process for both of us, but especially him. And Bobby handled the stress like a pro, probably way better than I would have. Ok, definitely way better than I would have. There was a brief moment early on in this process where I was mistakenly told I might have premature ovarian failure and I didn't handle it with nearly as much maturity as Bobby handled his diagnosis (think tears and all the emotions and lots of self-pity). Yes, this has been so hard on Bobby, but for the most part, he handled the immense weight of his infertility diagnosis with grace, sensitivity, and humor, and I've watched in awe with an ever-deepening love and overwhelming appreciation for this man every step of the way.

But now, with IVF and ICSI (pronounced ick-see), we're sidestepping the problem that has been holding us back. From here on out, if we don't conceive, IT'S ALL MY FAULT. Yes, yes, I know that's totally irrational, but irrational fears are still fears nonetheless. And this fear is real.

WARNING: I'm about to say all kinds of words about the female anatomy and menstrual cycles. If you find that kind of stuff offensive, this probably isn't the blog for you (also, grow up).

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For all you natural conceivers out there who are fortunate enough to not have to know a thing about this, there are many steps in the IVF treatment cycle, and thus many places where my body can fail me (and us) in making a baby. Here's a brief rundown:

PHASE 1: STIMULATION

It all starts with day 2 of my cycle. That's when I officially begin treatment - and by treatment I mean up to 3 self-administered injections daily, oral medications, and a few 1.5" needles straight into the coolie (in addition to about 10 check-ups over the course of 2 weeks to do blood work and barrel-of-laughs transvaginal ultrasounds. Did I mention how fun this is going to be?). The aim here is to stimulate my ovaries just enough to make a whole bunch of eggs (the body normally makes about 1 on its own each month) so they can be harvested later.

How I can fail: Mix the medications incorrectly; inject myself incorrectly; accidentally hit a major artery and bleed out (kidding); OHSS, or ovarian hyperstimulation syndrome, in which my ovaries go bonkers from all the hormones and I end up in the hospital or, you know, dead (not kidding, but this is very, very rare).

PHASE 2: RETRIEVAL

After about two weeks of medications - and assuming I don't screw them up - it's time for the docs to put me under anesthesia, poke holes in my uterus, and retrieve the follicles growing on my ovaries (which hopefully contain some eggs) with a little sucky tubey thing. Meanwhile, Bobby is in another room providing a sample so his sperm can be whisked away, injected into my eggs (that's the ICSI part), and then cultured in a petrie dish for a few days. Isn't it romantic? Upside: I get drugged up. Downside: Did you read the poking holes in my uterus part?

How I can fail: Not produce enough eggs; not produce healthy eggs; not produce any eggs at all. No pressure.

THE WAIT

At this point, many people would begin gearing up for transfer day (more on that below). However, Bobby and I have opted to put all of our eggs in one basket (see what I did there?) and get genetic testing done on our embryos (assuming we come away with any). Because we're footing this procedure 100% out of pocket, we want to do everything and anything that will give us the best chances for a healthy pregnancy in one cycle (again, no pressure!). Genetic testing will help us eliminate any embryos that likely wouldn't have made it very far once transferred back into my uterus anyway. This takes about two weeks, so the embryos are frozen and then transferred during my next cycle about one month later.

How I can fail: Oh, there are many ways, but for this month, none have to do with fertility.

PHASE 3: LUTEAL PHASE

A mostly meds-free month will have elapsed by this point, and then, right about halfway through my cycle, Bobby will give me progesterone shots (those 1.5" needles in the booty again, oof) for 5 consecutive nights leading up to transfer day. This is to hopefully thicken my endometrial lining and create a cozy, welcoming environment for our embryo.

How I can fail: Not produce an endometrial lining that's thick enough; produce an endometrial lining that is too thick. Essentially, tell my poor little embryo that there's no room at the inn.

PHASE 4: TRANSFER & THE TWW

This is the biggie, guys. On day 5 of my luteal phase, I'll head back to the clinic to have our 5-day-old embryo transferred into my uterus with what is, as I understand, the spitball method. No anesthesia here, unfortunately. Just a quick wham, bam, hope you implant, mam. We go home and then begin what all of us on the TTC (trying to conceive) journey refer to as the dreaded TWW - the two week wait. And there's not much more to it than that: for two weeks, we wait, and hope, and pray (even though we're not the praying type) that our embryo implants and I'm officially pregnant.

How I can fail: Oh, just like, not implanting or getting pregnant, essentially flushing about $20,000 (give or take) right down the drain along with our hopes and dreams of becoming parents and being left with nothing but the painful choice of giving up or starting the whole process again.

So here we go. If all goes according to plan, this time next week I'll be injecting myself for the very first time and the weight of it all will officially be on my shoulders.

Body, don't fail me now.

January 26, 2018 /Melissa Andersen
fertility, fertility warriors, ivf, icsi, male factor infertility, infertility, fertility medications
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