IVF consult

[oregonduck]

We are getting prepared to set up and appointment for an IVF consult. We each have a packet to fill out with insurance forms before they will schedule it. The office requires a $400 deposit but my insurance covers IVF, so maybe we can get it waived. I have 3 cycles of Clomid left but need to schedule my appointment soon because my doctor said it takes 2-3 months to get an appointment with the IVF doc.

What exactly do they do at an IVF consult? I'm kinda nervous. I'm sure he will need an SA and I will have an HSG, but do they just talk to us? Make sure we can pay? I don't know if the doc will recommend IUI or IVF. My insurance only covers a $3500 lifetime limit; that's barely one cycle, so I want to make it count. Right now, my doc categorizes me as "unexplained infertility" until we have him tested and whatever tests they want to do for me. I'm kinda excited about IVF because I just have a feeling the Clomid isn't going to do it for me again and this is how I'm going to get my baby.

Any advice? What should I take to the appointment? I'm scared and excited at the same time. Do they usually recommend IUI first before IVF?

[Julia'sMom]

I haven't followed along with your journey. Are you doing the clomid with an ob, or with an re? If you're with an re, you've probably had most of the required tests. Although, I'm surprised you haven't had a hsg or SA yet, since both of those were required before I started clomid. :

Yes, IUI is typically preferred to IVF. If you've only done clomid, then they could have you go onto injectibles with IUI. Have you responded to the clomid? Oh, and check out costs. The last I knew, IVF is about $10,000 for one try. (I have insurance, so we didn't shop around and just went where we had to).

As for the consult, typically it's just talking with the doctor. They'll go over your history, any tests you have had done already, what tests you will need and what the plan will be for your situation. It might be better if you can get the SA and HSG done prior to the consult, as the results may help in the RE's determination of your plan. Oh, I forgot, they required a std panel for both my dh and myself prior to ivf and recommended the cystic fibrosis screening.

Just a note of caution, IVF is a big deal. Yet, it doesn't guarantee a pregnancy, as some of the success rates are still only 60% (check with your clinic). And you have the same chance of loss with IVF as with any conception. Infertility if hard, and even harder with a loss.

Also, once we started on ivf, there was no going back. Insurance will not cover any injectible iui's or anything else, because they don't believe in going backwards, unless your RE is willing to fight for you. So, if the IVF doesn't work, we really don't have anywhere else to go, since I don't know of anything further and trying injectibles with iui is off the table. Make sure you are prepared. Good luck.

[oregonduck]

Thank you so much for your advice, J'sMom. You had such nice things to say when I whined on another post.

I got pregnant on my first Clomid cycle in Sept. 08 but m/c at 11 weeks. Started Clomid again (50mg.) My OB didn't see any reason to increase the Clomid dose since she says I'm ovulating--all my day 23 progesterone levels have been in the high 20's with one at 30.6.

I will try to get DH to do the SA and see if my OB can get me in for an HSG. I didn't think of the not going back once IVF starts. You gave me lots of things to think about. The local fertility clinic here quotes $8,750 for an IVF cycle, not including meds and necessary tests before cycle. My insurance covers 80% of IVF/IUI up to the $3500 limit. Not horrible, but not great either.

Again, thanks so much for your support. I'll be keeping my fingers and toes crossed for your cycle also!

Ok, I'm gonna try this editing thing again. Seems to have swallowed my first post.

[LisaG]

We already had a SA and HSG done prior to our IVF consult, but our clinic wanted most tests done at their labs, so dh did another SA. At our consult the doc went over my history with us and we had time to pick his brain. They did an in office hysteroscopy/mock transfer, an ultrasound to check blood flow to the uterus, bloodwork for both dh and I re: communicable diseases and I had to have day 3 bloodwork done to check estrogen and FSH levels.

There was a LOT of paperwork to go over - potential risks/side effects, legal aspects (if you have frozen embryos left over and you and your partner divorce or one dies, what do you want to have happen to the embryos) and overview of the process. We were also shown how to administer the meds and got a chance to practice.

I typed up a summary of my medical history in chronological order and took copies of all my labwork and operative reports. I also had a list of questions - after reviewing my medical history what did they think my odds for success were, what type of protocol would they suggest, do they use anesthesia during egg retrieval, do they usually do a 3 day or 5 day transfer, do recommend bedrest post transfer - if so, how long, what kind of monitoring do they do during the stim phase, do they do any type of immune testing prior to starting your IVF cycle (check for thyroid antibodies, anti-nuclear antibodies, anti-cardio lipin antibodies, etc.).

Best of luck with everything!

[oregonduck]

Oh wow, LisaG, more stuff for me to think about! I was thinking about just going to the clinic tomorrow with the paperwork because I had some questions for them. Maybe I will write all this down and ask them about the SA and HSG since neither have been done yet. I'm not as organized as you, but know I have to fill out a release for my OB to give my records to the fertility clinic so they will have most records they need...I think.

I am wondering how it will affect my work schedule. I work retail and have a fairly regular schedule, but still do an odd mix of opening shifts and closing shifts. Has the medications and/or procedures really kept you from working or caused any major discomforts? I need to talk to my HR manager and direct boss and find out what kind of time I will be able to take off and ask the clinic if time off will be necessary.

Thanks a bunch and congrats on your little miracle!

[Julia'sMom]

LisaG is right on! Ask if they want tests done thru their clinic, or elsewhere. Also, you can probably get a copy of the consents (a ton of papers) to read thru and discuss prior to signing. At the consult with the RE, we didn't do any of that detail work. We had to schedule a "nurse teach" later on to go over injection and med protocol and all the releases.

As far as time, check with the hours of your clinic. Hours for the lab personnel and hours for the dr. My lab opens at 6:00 for blood and u/s monitoring, so I was able to easily go before work, and not have to take time off. I did have to take time off when a dr appointment was needed, since the high and mighty RE didn't arrive until 9-10am.

For ivf, you'll need to take off the day of ER and ET, minimum. If you overstim, hopefully not, you might need some extra days after retrieval. If the lab recommends bedrest, you might need extra days after transfer. However, those days might also occur on a weekend, so it's tough to plan. I ended up calling in the morning of ER, since we didn't know the schedule until the day before.

[lushlife]

I am a little surprised that they are requiring a $400 deposit. Can you get it back if you don't like the counsult? Does it go towards your treatments?
The initial visit to the RE is usually an interview in which the Doc or nurse will go over all of your files, tests, medical history, family history and recent temp charting. My RE gave me a full exam inside and out. He even did a breast exam and sent me for a mamagram. They will do a transvaginal sonogram to look at your ovaries and your lining as well, so don't be surprised. The doctor may have you go for more blood draws and pannels before even strarting you on a cycle. Most docs will try the least invaisive procedures first and then go for the IVF as a last resort.
Good luck!

[LisaG]

Originally Posted by oregonduck

Oh wow, LisaG, more stuff for me to think about!

Sorry if that was information overload! I'm a bit of an info junkie

Our first consult may be different from the norm because our clinic works with a lot of out of town patients and is set up to cover as much as possible in 1 day.

As for scheduling and being able to work - how you feel during suppression and stims varies from person to person. In general your abdomen will feel large/bloated and maybe a bit tender the closer you get to egg retrieval. You'll be tender and bloated 2-3 days post ER or more if you hyperstim. Some women feel pretty emotional from the meds. Like Julia'sMom said, it can be a bit tricky to plan since ER and ET isn't written in stone but depends on how your body responds and how the embryo's develop.

[oregonduck]

Ah, no worries. I have plenty of time to think about this information overload before I actually go in. It will be at least 3 months. I would hate to be put on the spot in the doc's office having to make a decision and not be fully informed.

So, pretty much symptoms vary from person to person and reaction to hormones? That makes sense. As long as the process doesn't require me to take a lot of time off, my employer will work around my doctor appointments and if I'm feeling crappy, they will be totally fine with me staying home. They know what I'm going through and know about the miscarriage last November (right as the holiday season was getting into swing!) And the short time I was pregnant, they sent me home many times..."Kim? Are you feeling ok?" "You look like you're going to get sick" "Go home!" I guess running behind clothing racks so people don't see you heaving and trying not to vomit is a good sign that I didn't feel well. Hehehe.

I did call the clinic yesterday. The $400 deposit is refundable if my insurance is billed and pays. And I don't have to pay the $400 until the day of my appointment. Maybe it is just assurance that you are serious about the process and not wasting the doc's time, since I'm pretty sure there is only one doc who does IVF in town...I sure hope we like the consult!

I also asked about the SA and HSG tests and if we should get them done before the first appointment. They would prefer to do them at their office so they can be sure it is done correctly, especially the SA. So, we get to wait on those. Thanks for bringing that up LisaG.

Thanks for all the helpful advice ladies. I'm sure more questions will pop up.