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
• RPR/VDRL
• CMV IGM
• CMV IGG
• 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
• RPR/VDRL
• Type and screen
• CMV IGM
• CMV IGG
• Cystic Fibrosis
• GC / Chlamydia-Urine Aptima
• Rubella Titer
• CBC
• Activated Protein C Resistance
• Protein C Activity
• Protein S Activity
• Prothrombin 20210 Mutation
• MTHFR
• 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!