$25,000

[no5no5]

If you had $25,000 (and only $25,000) to spend on infertility treatments, what would your plan be?

I'm going to be seeing a doctor in a few weeks and I need to start figuring out what I want to do and in what order. We've already done an HSG, a semen analysis, and an ultrasound of my ovaries (not included in the $25k our insurance will pay). All of that came back okay. I could probably use a full blood panel (though I'm not sure what exactly should be included), and hopefully that also won't count towards the $25k, since I've got other health issues besides infertility that could justify a workup.

Anyway, I'm horribly intimidated by the whole idea of starting infertility treatments, especially with such a hard cap on what we can try, so I hope someone has some advice.

[aggieamy]

We're doing IVF right now and initially we started it with insurance that would cover IVF. In that time we have dropped the insurance though because although they would pay up to $10k of infertility treatments we discovered that they wouldn't pay for almost anything we actually needed. Of the $26k it will cost for us to do IVF, insurance would cover about $4k of it. The major costs that we needed are for the egg donor and insurance covers none of that. I was incredibly disappointed trying to deal with insurance and found that they were more trouble than they were worth.

I guess that doesn't exactly answer the question you were asking but more of a warning to really reseach what they will cover.

[no5no5]

I appreciate the warning, but our new insurance is really phenomenal. The only thing they don't cover wrt infertility treatment is surrogacy, but that's not really on the table for us right now anyway.

[MoOnFiReGlOw]

Honestly, if I had 25k to spend on fertility treatments I'd probably go straight to IVF. Depending on where you go you may have 2 chances if you skip over the IUI's and go for it

Have you told your doc this and asked their opinion?

[no5no5]

Originally Posted by MoOnFiReGlOw

Have you told your doc this and asked their opinion?

Not yet. But I feel like I have two options: I can either go in there knowing what I want and asking for it (and maybe be persuaded otherwise) or I can go in there not knowing what I want and end up doing something totally cookie-cutter because my doctor can't be bothered to think about what is best in my situation. I mean, my track record with doctors isn't so great. Maybe the new one will be different.

I was thinking maybe skipping the IUIs might be a good idea. But jumping right into doing IVF makes me nervous too. We actually haven't even tried clomid yet, or anything like that, so we'll probably start there. I guess. And, actually, it's also possible that the infertility is secondary, so we might not need infertility treatments at all (though we've been TTC for almost 3 years now).

[MoOnFiReGlOw]

Originally Posted by no5no5

Not yet. But I feel like I have two options: I can either go in there knowing what I want and asking for it (and maybe be persuaded otherwise) or I can go in there not knowing what I want and end up doing something totally cookie-cutter because my doctor can't be bothered to think about what is best in my situation. I mean, my track record with doctors isn't so great. Maybe the new one will be different.

I was thinking maybe skipping the IUIs might be a good idea. But jumping right into doing IVF makes me nervous too. We actually haven't even tried clomid yet, or anything like that, so we'll probably start there. I guess. And, actually, it's also possible that the infertility is secondary, so we might not need infertility treatments at all (though we've been TTC for almost 3 years now).

Oic! Ok, well then yeah, its totally up to you hun! I agree though, if you want to try some clomid or whatever fertility meds are needed first then go for it. I totally agree about IUI's though, I'd skip them and go straight to the next step.

[chickeedoodle]

I'd go straight to IVF - will your insurance let you skip IUI's?? If so - go right for the big guns - you might get more than one try with the $25K, depending on the negotiated price with a fertility clinic.
Good luck!!

[poppan]

Even if the insurance let me skip straight to IVF, I would at least try clomid and possibly an IUI first. Here are my reasons.

IVF is a fairly involved and very artificial process with higher risks for you (none of us really knows what long term effects are right, of shooting our bodies full of hormones and forcing our ovaries to overproduce eggs), and with higher risk of multiple birth (I know a lot of people want to have twins, but there's also about a 1% chance of triplets, and in my journey I have seen so many heartbreaking stories where people lost their multiples to very premature birth/very late miscarriage). Clomid costs nothing--it's a prescription. It costs you one more month of waiting, one more possible BFN. Worth a try to avoid an IVF, IMHO.

Same principle when it comes to IUI's. They cost a fraction of what an IVF does. You can do it with clomid, so minimal messing around with your body. A sperm wash, insemination, and then 2WW. Again, possibly worth trying once.

I would also make sure the RE orders all the right tests for you so you can rule out male factor, etc. For example, if it's male factor you can skip the clomid+timed sex, but depending on how bad it is, you may want to do clomid+IUI. Or you could go straight to IVF. You said you have done a SA already but I'm guessing they did the normal one (machine count) and not the more specialized one with a real person looking at the sample. Stuff like that. Your RE should be able to review what you've already done and order anything still needed. Good luck!

[chickeedoodle]

Originally Posted by no5no5

Not yet. But I feel like I have two options: I can either go in there knowing what I want and asking for it (and maybe be persuaded otherwise) or I can go in there not knowing what I want and end up doing something totally cookie-cutter because my doctor can't be bothered to think about what is best in my situation. I mean, my track record with doctors isn't so great. Maybe the new one will be different.

If you feel like your Dr is treating you like everyone else - I would go to another clinic and get a second opinion. The one thing I love about my RE is she obviously treats each patient individually. She really thinks about what is best for ME and my circumstances.

I am very anti-clomid. If you are seeing a RE, ask about Femara - side effects are much less, and it's suppose to make a better quality egg, as apposed to increasing egg production. (at least that's how I understand it)

Good luck figuring this all out!

[Violet2]

First, be sure you absolutely love your clinic and RE, if not, switch, even if you have to go out of state. Do not settle--there are 'cowboy' REs out there running shoddy clinics, you don't want that.

Second, it's clomid and IUIs that have higher incidences of multiple births, not IVF as a pp suggested. The Gosselin kids, frex, are all IUI babies. The Sulyeman octuplets were IVF, but IVF that grossly violated ethical and standard-of-care guidelines.

Third, IVF is harder, more challenging and much more rigorous physically but it really gives you answers to questions like...

--will my eggs fertilize
--will we make viable embryos

This is valuable information that is hard to get from IUIs. IVF really lets you know where you stand.

That being said, there can be value in doing at least one IUI cycles (which is relatively cheap, probably around $2-3K) just to see how your body responds and how the clinic operates. IUIs are good practice in terms of building the skill set necessary for IVF as a patient (i.e. giving injections, timing etc...).

--Read all the info you can find on people like you, anecdotal and medical studies are both invaluable. Infertility treatments work best for educated patients. The IVF Connections message board was very helpful when I was doing IVF--not sure if it's still around or not.

Lastly, if you do IVF, a little tip: Ask if you can do progesterone suppositories instead of the shots. The shots are...not fun and the suppositories are effective.

V

[Violet2]

Originally Posted by no5no5

Not yet. But I feel like I have two options: I can either go in there knowing what I want and asking for it (and maybe be persuaded otherwise) or I can go in there not knowing what I want and end up doing something totally cookie-cutter because my doctor can't be bothered to think about what is best in my situation. I mean, my track record with doctors isn't so great. Maybe the new one will be different.

I was thinking maybe skipping the IUIs might be a good idea. But jumping right into doing IVF makes me nervous too. We actually haven't even tried clomid yet, or anything like that, so we'll probably start there. I guess. And, actually, it's also possible that the infertility is secondary, so we might not need infertility treatments at all (though we've been TTC for almost 3 years now).

You should definitely be reading and learning and coming up with a list of questions as well as ideas of what you want to try. However, there is also great value in listening to what the RE has to say and what they think. The ideal course is a blend of what you both think based on the available data.

V

[oceane]

Originally Posted by poppan

Even if the insurance let me skip straight to IVF, I would at least try clomid and possibly an IUI first.

yes. I understand that cost is a huge factor, but subjecting your body to this if it may not be necessary seems like not such a great idea.

[no5no5]

Yay for all the food for thought. Thanks everyone!

[poppan]

Originally Posted by Violet2

it's clomid and IUIs that have higher incidences of multiple births, not IVF as a pp suggested. The Gosselin kids, frex, are all IUI babies. The Sulyeman octuplets were IVF, but IVF that grossly violated ethical and standard-of-care guidelines.

OK... admittedly my IVF was 4 years ago, and my clomid days well before that... but as I recall, the risk of twins with clomid was roughly twice what it is in the "natural conception" world, and higher order than twins was not even on the table. Whereas (and this of course varies by how aggressive the RE/clinic is) twins occur much more than twice the natural population in IVFs.

IUI can be done with clomid or can be done with injectibles. Clomid+IUI should have no higher twinning rate than clomid+timed intercourse. I do agree with you that injectibles + IUI can result in sextuplets--of course I am of the opinion that if they see six follies/eggs that are anywhere close to maturity, it should be converted to an IVF cycle.

[Jenne]

We were in a simliar position money wise although it was our out-of-pocket funds that we had put a cap on. We started with Femara (you can get a typical dose 5mg supply for free for 3 months via the Femara website!) and had 3 pregnancies in 7 medicated cycles. I had not ovulated prior to this. I skipped clomid because I have PCOS and was annovulatory and clomid can sometimes not work. Also, clomid sticks around longer and can thin the uterine lining. Femara has a short half-life and doesn't effect the uterine lining because it acts on the brain instead of the ovaries (then the brain tells the ovaries what to do).

If we had not been successful this time we would have probably moved to injectables (low dose) for a cycle or two before heading into IVF. While the risk for multiples increases with injectables the price is so much lower and with good monitoring by an RE I trusted, I thought we could always convert to IVF if the number of follicles made us nervous.

I wish all the best of luck! Do you have a specific diagnosis yet or just "unexplained"?

Jenne

[no5no5]

Originally Posted by Jenne

Do you have a specific diagnosis yet or just "unexplained"?

Well, I've got a thyroid thing, and my levels aren't stable, so that's part of it, though my previous RE told me he didn't think it'd cause IF , and when I was on thyroid meds my issues were not totally resolved. Hopefully I can deal with that through regular monitoring (which doesn't count towards my limit). But it seems likely that I have some other as-yet undiagnosed hormonal issues, possibly pituitary or adrenal, which may or may not be contributing to the problem. Otherwise, it's unexplained.

[Violet2]

Originally Posted by poppan

OK... admittedly my IVF was 4 years ago, and my clomid days well before that... but as I recall, the risk of twins with clomid was roughly twice what it is in the "natural conception" world, and higher order than twins was not even on the table. Whereas (and this of course varies by how aggressive the RE/clinic is) twins occur much more than twice the natural population in IVFs.

IUI can be done with clomid or can be done with injectibles. Clomid+IUI should have no higher twinning rate than clomid+timed intercourse. I do agree with you that injectibles + IUI can result in sextuplets--of course I am of the opinion that if they see six follies/eggs that are anywhere close to maturity, it should be converted to an IVF cycle.

Resolve has an entire brief on this topic. It's IUIs and Clomids. Think about it, the number of eggs released is not controlled at all in IUI or with Clomid, whereas with IVF they control the number of embryos that are transferred.

IME most cycles are not canceled for 5 or 6 follicles. Clomid cycles alone are rarely monitored properly and many OBs prescribe Clomid and don't see the patient again unless they get pregnant.

Most of the multiples in the news are products of IUI or fertility drugs and not IVF.

Also you have to account for age when it comes to twins as well. Older moms have a huge increase in twins too, something that treatments just compound.

V

[Violet2]

Originally Posted by no5no5

Well, I've got a thyroid thing, and my levels aren't stable, so that's part of it, though my previous RE told me he didn't think it'd cause IF , and when I was on thyroid meds my issues were not totally resolved. Hopefully I can deal with that through regular monitoring (which doesn't count towards my limit). But it seems likely that I have some other as-yet undiagnosed hormonal issues, possibly pituitary or adrenal, which may or may not be contributing to the problem. Otherwise, it's unexplained.

I would not do IVF until you know what is up with all your hormones as that can impact the viability of a pregnancy.

V

[no5no5]

Originally Posted by Violet2

I would not do IVF until you know what is up with all your hormones as that can impact the viability of a pregnancy.

Oh, believe me, I know. That's clearly the first step...but at the same time I already know that my thyroid levels will never be perfectly stable unless I opt to remove my thyroid altogether. So I'm not going to sit around and wait for that to happen. I'll have to be satisfied with a bunch of blood work followed by regular monitoring.

[bella99]

It's actually injectables and IUI's that have the high rates of multiples. Clomid barely increases a woman's a chance of conceiving multiples. The statistical rate for twins with Clomid is 10%, triplets and higher is lower than 10%. With injectables, it's something like 25-30%. Among natural conceptions, it's about 5% I believe.

Anyway, do you know the cause of your infertility? That would make a difference in my opinion of what you should do. I had primary infertility due to anovulation, but when I DID ovulate, I was just as fertile as your average woman.

I got pregnant with my first on injectables with a very low dosage on my first cycle with injectables. I did try Clomid, got pregnant and m/c once, but moved on to injectables for a few reasons, none of which was related to Comid's ability to make me ovulate.

I guess what I am saying is that if the cause of your infertility (if you know) is clear and "easily" treated, I wouldn't jump straight to IVF, when it could be resolved with much less intervention.