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Sunday, May 30, 2010

The Post Where I Over-Analyze My Over-Analyzation, and Then Some

Slight change of plans. Our quote from Dr. Big Time's shared risk plan came in. Sheesh!

In my second to last post I mentioned that we are thinking about doing a refund (or "shared risk") plan. Out of the 3 IVF REs we've seen, 2 offer a shared risk plan: Dr. Big Time and Dr. Immunity. The details of the plans are different in ways, but at their most basic they are the same: you pay a large sum up front (does not include meds or anesthesia), and get up to 3 fresh and 3 frozen cycles, and a portion of your money back if at the end you don't get a baby.

Dr. Immunity's plan costs $19,050. The refund at the end (with no baby) would be $4475. The refund is small, but the initial cost is also, comparatively, small. However, Dr. Immunity's success rates are all over the place. For 2008, Percentage of Transfers Resulting in Live Births:
  • Under 35 - 54% (National Average - 47.3%)
  • 35-37 - 32% (National Average - 37.3%)
  • 38-40 - 10.7% (National Average - 28.2%)
  • 41-42 - 35% (National Average - 16.7%)
Dr. Big Time's plan costs $36, 772. The refund at the end (with no baby) would be $26,009. The refund, obviously, is rather large, but the initial cost is also rather large. And Dr. Big Time's success rates are pretty good. For 2008, Percentage of Transfers Resulting in Live Births:
  • Under 35 - 51.9% (National Average - 47.3%)
  • 35-37 - 44.4% (National Average - 37.3%)
  • 38-40 - 31.1% (National Average - 28.2%)
  • 41-42 - 18.2% (National Average - 16.7%)
Another thing to take into consideration is Dr. Immunity's total cycles for the year are 584, while Dr. Big Time's clinic did 2,028. This could be a partial explanation of why Dr. Immunity's success rates are all over the place.

So, how does this change our plans? Well, first of all, I don't think we can do Dr. Big Time's shared risk program. Here's the thing, the worst case scenario financially is that I do all six cycles (3 fresh, 3 frozen) before I get pregnant. In that scenario, we would not get a refund, plus we will have to have spent money each time on meds and anesthesia, which I guess could be about $14,000, in addition to the original $36, 772, for a grand total of $50,772.

I can't do it.

Spending $50,000 on a baby... I mean... I just don't think I can do it. Ugh. The thing is, we have the money. We don't have much more than that though, so pretty much we would be in a position that we have spent ALL OUR MONEY and are now pregnant. And maybe with twins (Dr. Big Time has a 32.3% twins rate). It feels irresponsible to do that. Of course, there are a lot of couples out there that get pregnant with twins and probably don't have a lot of savings and they make do. We could, too. I know we could. But we have a choice here. We don't have to do it that way.

The thing that I find so difficult to wrap my head around is that the very reason I qualify for these shared risk programs is that, based on my stats, I am likely to not end up having to get a refund. I am likely to get pregnant from IVF (again, based on my stats, not on my own feeling about it, which is that I'M BROKEN AND I'LL NEVER HAVE CHILDREN! WAAAAAH!!). I am (fairly) young, and so far no one had found anything wrong with me. I SHOULDN'T do the shared risk program for the same reason I am covered under the shared risk program: based on my stats I am likely to have success with IVF.

Okay, next (I feel like this post is scattered all over the place, but I'm gathering my thoughts on all this as I type, sorry!). What is our maximum budget for IVF? Hubs and I talked it over, and we think we'd like to try to not go much over $30,000. And although 3 fresh and 3 frozen cycles would give me a really really good chance of getting pregnant, I can't help but think it's a little overkill. (Oh boy do I hope those words don't come back to haunt me. Please please don't come back to haunt me, words...)

Okay, let's do a little exercise. Let's take 100 women between the ages of 35-37. Let's say they go to Dr. Big Time, and they are in it to win it: 3 fresh, 3 frozen, or until they're knocked up. Based on his stats here's how it would go:
  • 1st Fresh IVF: Out of 100, 44% (44 women) would get pregnant, leaving 56 women not pregnant
  • 1st Frozen: Out of 56, 30% (17 women) would get pregnant (btw, 30.2% is their success rate for FET), leaving 39 not preggers.
  • 2nd Fresh: Out of 39, 44% (17 women) would get pregnant, leaving 22.
  • 2nd Frozen: Out of 22, 30% (6.6, but lets round down and say 6 women) would get pregnant, leaving 16.
  • 3rd Fresh: Out of 16, 44% (7 women) would get pregnant, leaving 9.
  • 3rd Frozen: Out of 9, 30% (3 women) would get pregnant, leaving 6.
So, we have a 94% success rate. Not bad odds. BUT, if you look at the difference between the results of the 2nd frozen and the final 3rd frozen, they are only 10% different (i.e. 84% are pregnant after the 2nd frozen, while 94% are pregnant after the 3rd frozen).

If I paid for the cycles one by one, and it took 2 fresh and 2 frozen for me to get pregnant, I would pay:
  • $9,215 x 2 (for fresh IVF cycles)
  • $3,500 x2 (for frozen cycles, and I actually don't know how much their FETs cost, so this is just an undereducated guess)
  • $750 x 2 (anesthesia)
  • $4000 x 2 (meds, which I hope is an overestimation)
  • Total: $34,930
That number is more in the ballpark of what we would want to spend (not that I want to spend any of it, but you see what I'm saying).

Now, the final option would be to go with Dr. Immunity's 3 fresh/3 frozen shared risk plan. Total cost if it takes all 6 cycles to get knocked up: $32,550 (approximately, obviously). Of course, his success rates are lower, so my exercise above would look very different for him (I'm not going to show you that one, because I'm guessing you can't take much more of this!!).

Based on all of the above, we are now thinking we will either do a cycle by cycle with Dr. Big Time (up to 2 fresh and 2 frozen), or the shared risk with Dr. Immunity. And we have decided to wait until all of our immunity tests come back before we decide, which we found out could be up to a month (oh, yeah, they took 26 VIALS OF BLOOD FROM ME, HOLY SMOKES!). Which means we won't start our IVF next month as planned. We'll probably start in July.

And finally, I just want to say that I realize that all of our planning and figuring things out and all of my little "exercises" could add up to diddly-squat when we finally do an IVF. For example, we may find that my eggs SUCK, in which case if we didn't sign up for the shared risk, we may wish we had, as it would then be more likely (I would think) that we would need all the cycles, imagining that if my eggs are crap I might not be able to do the FETs at all.

So, that's it! If you've read this far, congratulations! You either: A) really care about my life (thank you! you are so sweet!), or B) are as obsessed with IVF costs and success rates as I am (you should really chill out about that. seriously.)

Saturday, May 22, 2010

Friday, August 7th, 2009: The Day I Got My Stupid BFP

Well, at the very least I had to look up the exact date on FF. It's not like I have the date memorized or anything. And no, I never calculated my due date. I didn't really think much of it at all at the time. And I still think it was total BS...

So why do I still think about it?

Why can I remember exactly where I was and what I was doing when I got that phone call?

Okay, let me back up. So, I've never gotten a BFP, but last year, in August, I got a stupid BFP. What's a stupid BFP? One that only serves to get your hopes up but doesn't mean s--t. At 9dpo (yeah, that's right, 9 stupid days past ovulation) I went in for a beta. It was my first cycle at the RE. A clomid cycle. No IUI, just "timed intercourse." Oh, and I should mention that we had been married for just over a month, so it wasn't like it was THE MOST PERFECT TIMING EVER. Especially since we'd been trying, and worrying about trying, for the last 8 months or so (you know: what if we're successful and I can't fit into my dress? and all that BS). Anyway, why was my RE doing a beta at 9dpo? Who knows! At the time, it being my first cycle with the RE, I thought that was just the way it was done. (Oh, when you're seeing a professional, you don't have to wait the whole stupid 14 days! Woo-hoo!) Anyway, every cycle after that they told me to come in at 14 days, so that was wrong. Maybe it was for the progesterone level? But isn't that supposed to be 7dpo? So, who knows why, but they did my beta at 9dpo. And guess what? It was positive. Or, stupid positive. As in, not really positive at all. But boy was I ignorant back then.

So the call goes like this:

Jane: Hello?
RE: We got your pregnancy test result back, and it is positive...
Jane: (heart racing) Oh, okay?
RE: But it's a little low. It's at 9. So we need to retest it on Monday to make sure.
Jane: So what are the chances it's really positive?
RE: Oh, it is positive. Anything above 5 is positive.
Jane: Okay, well, what are the chances it's going to be a viable pregnancy?
RE: Well, there's no way to know really.
Jane: Well, do most women in your experience with a number that low go on to have a viable pregnancy?
RE: It's just too early to tell.
Jane: Okay, well, I guess I'll come in on Monday, then.

9? Seriously? And she's telling me it's positive?

But, okay, it's only 9dpo. If it were 14dpo, then 9 would obviously be super low, but maybe at 9dpo an hcg of 9 is okay? But no, she said it was low. But I did do a trigger shot, so maybe it was leftover from that? Probably. But they also tested my progesterone and it was over 40. That is pretty high. Like, maybe I was pregnant high. And when I went back on Monday and they retested my hcg it was at 2. One other time when I had my hcg tested at 12dpo (several months later) it was at 0 at 12dpo, so if it really was leftover from the trigger, wouldn't it have also registered the other time I had my hcg tested at 12dpo?

Can you tell that I'm still thinking about this? I mean, way over thinking about this?

Was I or was I not pregnant?

Okay, I was not pregnant pregnant. If an embryo implanted enough to produce hcg but not enough to delay my period (okay, I think it was delayed by 2 days, but clomid always seemed to lengthen my luteal phase), then that's not really pregnant. But could an embryo have implanted? In my uterus? Is it possible?

Going into IVF... I guess it would be nice to know that it's possible.

So, in closing, stupid not-even-enough-to-be-called-a-chemical-pregnancy pregnancies can SUCK IT.

And get out of my head stupid not-really-a-BFP BFP!

Wednesday, May 19, 2010

My Long and Winding Road to IVF Or: Doctors and Finances and Testing, Oh My!

As you may know, we are on the road to IVF. The long and winding road. We have seen 3 IVF doctors over the last 2 months, and although we're leaning toward one in particular, we haven't made any final decisions yet. I don't want to name these doctors/clinics here (because I wouldn't want them to find out that they're being blogged about), but if anyone wants to know names, feel free to email me. (And anyone in NYC that's familiar with its REs can probably make a good guess who they are based on the descriptions below.)

RE#1: With a respected fertility clinic associated with a major university. Definitely top 5 for IVF success rates in the city (top 1 or 2 depending on the age group). I'll call him Dr. University

RE#2: With a large and respected fertility clinic NOT associated with a university. Also top 5, or top 1 or 2 depending on the age group. We'll call him Dr. Big Time

RE#3: A fairly new NY clinic that is associated with a well-known clinic not in NY. In top 5 depending on the age group, but also not in top 5 in some age groups. They are known for testing for and treating immunity issues. We'll call him Dr. Immunity.

Let's start with Dr. University. Nice guy. Really obsessed with his clinic's awesome success rates. And why not? They're top notch. Two big drawbacks: First, really far from the subway (I know, I know, this seems like a silly thing, but since I'm going to have to be going there A LOT, and this is going to mean it will take me about an hour and a half to get there with that long walk tacked onto the subway ride, which is of course 3 hours round trip, plus the time actually spent at the clinic, I just don't know if I can find almost 4 hours to go there every time...), and, second, they don't offer an IVF refund plan (more on that below).

Okay, Dr. Big Time. Another nice guy, although a fast talker, but also very optimistic, which I liked. He advises us when we tell him that we also have an appointment with Dr. Immunity that Dr. Immunity is not in the same league as they are. Describes how their lab is a "clean room" just like where they make microchips, and that they had to close down a major avenue in Manhattan and use a crane to deliver and install their lab's air system. This impresses me, but probably impresses hubby even more. Hubby says "Well, we'll probably cancel that appointment" (but we didn't). Plus: they have a refund plan. Plus: they are close to the subway. They also have us speak to an IVF coordinator and a financial coordinator, who both are very professional and helpful. Drawbacks: none, really. Their success rates are not quite as phenomenal as Dr. University's, but really the difference is minor.

Finally, Dr. Immunity. Nice, soft spoken, maybe a little too soft spoken. They also have a refund plan, and are close to the subway. Big drawback: IVF success rates are all over the place. Also, as stated above, Dr. Big Time doesn't have much respect for them. But big "plus": immunity testing.

So, about immunity testing. As you may or may not know, so far no one has found ANYTHING wrong with either me or hubs. We have both passed all our tests with flying colors. The only thing is that I have had some symptoms of endometriosis (more on that here, if you care to know). But I asked all 3 IVF docs about this and every one of them said that if they can't see it on an ultrasound or HSG, then it's probably not a problem. So why the F can't we get pregnant? I'd love to have an answer (although I'm also afraid of an answer), and so immunity testing sounds good.

Also, about the refund plans. Hubs and I are leaning toward doing a 3 cycle refund plan. Basically, you pay for 3 cycles (at a discounted rate) up front and get a (fairly large) portion of your money returned if you are not successful. Hubs is way behind this, for some reason. I'm going back and forth over it. Part of me thinks it's rather pessimistic of me to think that I might not get pregnant after 3 IVF cycles (I've heard that 85-95% are pregnant and deliver a baby after 3 IVF cycles), but at the same time, if we'd already shelled out the money, and the first cycle fails, I'm thinking it won't be as big of a letdown if I know that I can try 2 more times (plus up to 3 FET cycles, too). Also, statistics are such that I know the majority of women do NOT get pregnant after the first cycle (the clinics I've been to have about a 42-44% success rate for my age group, meaning that 66-68% of women DON'T get pregnant each cycle, thus most women will require more than one cycle of IVF). Anyway, we haven't decided yet, so I'll probably write a longer post on this subject later.

We are leaning towards Dr. Big Time. If we go with him, I would start my BCP cycle in early/mid June and my IVF cycle in early/mid July.

But first we are going to do all the tests recommended by Dr. Immunity. Just to see. So, I had my first test today, which was not an immunity test, but a fluid ultrasound to look for fibroids/polyps, etc. in my uterus (which, if present, I understand could cause implantation problems). Results: all clear!

Next are blood tests.

Here is what they are testing the hubs for:
  • HLA phenotype panel
  • Hepatitis B surface ag
  • Hepatitis B total core antibody
  • Hepatitis C Ab
  • HIV I and II
  • HTLV I and II
  • GC / Chlamydia-Urine Aptima
Here is what they are testing me for:
  • HLA phenotype panel
  • NK Activation with IVIg
  • Hepatitis B surface antigen
  • Hepatitis B total core antibody
  • Hepatitis C Ab
  • HIV I and II
  • HTLV I and II
  • Type and screen
  • Cystic Fibrosis
  • GC / Chlamydia-Urine Aptima
  • Rubella Titer
  • CBC
  • Activated Protein C Resistance
  • Protein C Activity
  • Protein S Activity
  • Prothrombin 20210 Mutation
  • Fasting plasma Homocysteine level (Cardiac)
  • Factor V Leiden (DNA)
  • Anti-thrombin III activity
  • Lupus Anticoagulant
  • Plaminogen Activator Inhibitor - 1 (Activity)
  • Anti-Cardiolipin IgG, IgM, IgA
  • Beta-2 Glycoprotein IgG, IgM
  • Phosphatidylserine IgG, IgM
Phew! Geez!

Sunday, May 9, 2010

Dear Movie Theater Ticket Taker

Dear Movie Theater Ticket Taker -

You wished me a happy Mother's Day when you tore my ticket today. All I could think of to say was "thank you." But afterwards I thought, "Does he assume that I'm a mother because I look past the age that I should have popped out a few by now?" and it made me feel old. Then I thought, "Does he say that to all women on Mother's Day?" and it made me feel not so special anymore. Then I thought, "Does he know something that I don't know?" and it gave me a little thrill. And then I thought, "Don't go reading into every little thing, missy," and I tried not to think about it anymore. Then I thought, "That's what it sounds like to hear someone wish me a happy Mother's Day," and I wondered if I would ever hear those words spoken to me again.

If that turns out to be the only time, then, once again, thank you, Movie Theater Ticket Taker. I will always remember you.


P.S. We really liked Iron Man 2.

Saturday, May 8, 2010

Previously on TTC Hopeful

Okay, to catch you up on where I was in March. Our last IUI (#4) went pretty awesomely. A nice 9mm lining, 4 decent sized follies, some good swimmers. I was so hopeful. And I knew it was our last chance at IUI - our next step was IVF and tens of thousands of dollars.

So, anyway, yeah, went awesome. Until that stupid beta.

And, like I said in my last post before my break, that kinda put me in a bad place. Now, I'm usually not a crier. Before starting TTC I cried maybe once a year. If that. And when I do cry, it's very dignified. A single tear, maybe two. A muted inhalation, perhaps, but never a sob. But after that last BFN? Sobbing so hard that I began to hyperventilate, get lightheaded, and consciously tell myself to calm the f down before DH called 911. Like I said, bad place.

So after that I didn't want to talk about TTC, read about TTC, or even think about TTC. Like ever again. Okay... for at least a month. So that's what I did. Or, um, didn't do.

Luckily, I have hobbies. Very time consuming hobbies, actually (I'm considering writing some blog posts about my hobbies at some point... so make sure you're all on the edges of your seats!). So, I dove head first into those and started to wonder how I had ever had time to go to the RE 2 or 3 times a week. Sheesh!

And, I'm not going to guarantee that everyone will have the same break results that I did... but... it went back to the way it used to be. Yes, you heard that right. Don't we all say that we wish things could be the way they were before we started TTC? Back when it was just us and our hubbies and we were content that way?


I remember before we saw the RE for the first time how much I was looking forward to a doctor taking over my care so I could stop the temping and the OPKing and the running the show all by myself. But it turned out to be so much more stressful, with the wanding and the blood draws and the injections... and I have to say that it is such a relief to be back temping and OPKing. A relief, I tell you! I feel like I could do this forever. But, we don't have forever, and so it looks like we'll have 3 cycles of trying naturally before we start down the IVF path (we're getting towards the end of cycle #2 right now), and I'm happy that we'll have those 3 shots at doing this on our own, but, honestly, I don't have a lot of hope. And since I don't have a lot of hope, I'm not getting my hopes up.

And so instead, I'm just relaxing.


That's right. I'm terribly relaxed about the whole thing right now.

So, it's like the way it used to be, before we started TTC. But we're still, technically, TTC.

It's brilliant.

Except that there is, like, a 99% chance that we'll still have to do IVF.

Oh, well.

So, in summary: breaks are good, and you CAN have it back.

Take that, infertility!

Thursday, May 6, 2010

My Vacation Story: Part 2

Once we decided on Key West everything else fell into place pretty easily. Hotel? Check. Flight? Check. Ummm... okay, that's it!

The island is only a mile and a half wide and about 4 miles long, so we really didn't need to plan anything ahead of time. We figured we'd stumble upon the interesting stuff just by walking around.

We came in on an evening flight and grabbed a bite to eat at the beachfront restaurant next to our hotel. They were closing up at 10, so we just ordered appetizers and a couple beers. We then decided to take a walk up Duval Street to relax and stretch our legs. A block or two up we saw a crowded open-air restaurant/bar. Oh! If we'd known we could've come here for dinner and drinks! Then, a half block later, another one. And another one. And ten more. And, ummm... I thought this was a sleepy little beach town?

Okay, don't laugh all those who have been to Key West before. We didn't know!

All those who don't know anything about Key West: it is a party town. A loud drunken party town.

And just like any respectable touristy party town it had tacky T-shirt shops galore all up and down Duval. My favorites: "I got Duval faced on Shit Street" (does it get more poignant than that?) and "I'm not drunk, I'm just naturally a loud, clumsy, friendly person" (Oh! The insight!). I am easily amused.

Anyway, we proceeded to avoid this aspect of Key West as much as possible, which was kinda easy since we got up early and went to bed early like old people.

Instead, we concentrated on Key West's historical sites, and enjoying a wonderful little thing we like to call "physical exercise"! We visited Hemingway's house, the Customs House, the Lighthouse, and we took a trolley tour. We went kayaking, snorkeling, swimming, and did the glass bottom boat tour (word of warning: glass bottom boat=horribly sea sick). We also rented bikes for a day.

And, we visited the Key West farmers market! Which... was just one table. But it was a table filled with an abundance of tomatoes, zucchini, and all sorts of stuff we won't be seeing here until July or August. And they told us that this would be the last farmers market of the season: their growing season ends in April! I love finding out about the odd little regional differences in farmers markets around the country (for example, they sell snow cones at the Reno farmers market. Which would so not fly in NYC).

All in all we had an amazing time. We found that most activities were very affordable, but that ALL of the "guides" would ask very humbly for tips at the end. But only after giving AMAZING service, of course. An example: on our kayaking tour, our guide at one point spotted something in the water, DOVE in head first, came up with a conch shell in hand, and passed it around so we could all admire the cute little conch creature inside. Wow! Every guide had an endless stream of warm and witty banter. Every tour they gave seemed like it was given just for us. They were all knowledgeable, friendly, and funny! That said, we tended to tip generously and I began to see what their angle was. Low prices up front, knock-your-socks-off service, and humble requests for tips that probably produced windfalls for them at the end. Brilliant. Hats off.

One last thing. Apparently, there ain't no party like the Key West party 'cause the Key West party don't stop. I counted about 5 visibly drunk people on our flight out. Visibly because they were stumbling and slurring but also because they, separately, had to each be told that no, they couldn't bring their drinks from the airport bar onto the plane, and so I watched as each one chugged said drink and then deposited it in the trash before being allowed to board the plane. Oh, and one of them was wearing a T-shirt that said "I'm not drunk, I'm just naturally a loud, clumsy, friendly person."

Key West out.