Friday, April 1, 2016

Moving On To IVF - Our Cycle Start Date!

So I can barely believe this myself, but we are officially doing IVF! Spring is here and it's the perfect time for new beginnings. A couple of days ago, we had our appointment with our RE. The appointment was two and a half hours! About an hour and a half was spent with our RE, and the last hour was split between our financial service representative and our IVF nurse. We also found our the start date for our cycle... which will be sooner than we thought!

We discussed a lot of different things with our RE. But the basic plan is that we will be doing the antagonist protocol, ICSI, and hopefully a day 5, elective single embryo transfer. With my AMH level (3.71), the look of my ovaries, my age, and all my test results, I would have qualified to be part of their egg donor program. Meaning that I am expected to be a high responder. Which is excellent news! But it does put me at a higher risk of OHSS, so that will be monitored closely. To counteract that, I may need to do a Lupron trigger, which will prevent any complications from OHSS. But that will only be used if needed. So we will have both a HCG trigger and a Lupron trigger, and will use whichever one we end up needing. The antagonist protocol was recommended for me because it's safer for potential high responders, especially when paired with the lupron trigger (if needed). I definitely trust my RE on this, because out of 1000's of patients, they only see 1-2 a year with severe OHSS and they have never, ever had a critical case of OHSS.

Our RE recommended ICSI, which was something we were interested in doing already. He told us that 30% of the couples that do IVF at our center need ICSI in order to conceive. But a total of 70%+ of their IVFs are done with ICSI, because the technology has a lot of benefits. One of the interesting things he told us is that not doing ICSI is actually more helpful in determining the reason behind the infertility. But that involves potentially wasting eggs that may have been fertilized with ICSI, and realistically, are you more interested in finding out that they don't fertilize on their own, or would you rather have the best chance at fertilization? So ICSI is done in most cases at our center to really maximize your chances. At our center they expect a 75% fertilization rate with ICSI, and even as high as 100% in some cases.

All of our testing was already completed, thankfully! All of our bloodwork was up to date, as well as my pap and physical, my HSG, and our genetic carrier screening was completed. I didn't even need to do a mock transfer because my RE was nice enough to write down all the necessary notes when he did my HSG. A lot of people have a saline ultrasound prior to IVF, also called a SHG. But I didn't need to do that either, because my HSG was absolutely perfect. Our RE said I had an absolutely beautiful uterus, which made us laugh! I hope our little embryo thinks it's nice and cozy! Having all our test results done means that we can start IVF right away.. as in 8-9 days from now when my next period shows up.

One of our concerns was that my husband's morphology was very low, at only 3% normal forms when it was checked last. This alone qualified us for ICSI. With 0-4% morphology, ICSI is always done. And to ensure we have the absolute best sperm sample for our cycle, we will be freezing one ahead of time. It's optional to do this, but I am absolutely terrified my husband will come down with some horrible flu or virus that will affect the sample. So for my peace of mind, we're going to drop off a sample to be frozen. It will most likely never be needed, but I'll feel better knowing it's there.

The medications I will be taking are Gonal-F, Cetrotide, HCG or Lupron Trigger, and Progesterone in Oil. Before sending my prescription, they check all the current med prices and get a quote for us. Our financial service representative, who is so wonderful, checked prices at a bunch of different pharmacies. We ended up getting the best price through Apothecary by Design. Apparently, the med prices fluctuate quite often. Right now, Gonal-F is significantly cheaper than Follistim, and Cetrotide is much cheaper than Ganirelix. Since they are all the same thing, just different brands, they prescribe the cheapest option. We then went through pricing for our IVF cycle. We have no infertility coverage on our insurance, so we qualified for the special cash payment discount. We were able to put it right on our credit card, then and there!

The last person we met with was our IVF Nurse, who was so nice. It was the first time we had met her, since our nurse for the past seven months only does the IUI cycles. She went through our consent forms with us and gave us our instructions for our injection teaching, and monitoring information. It's hard to believe I'll be having my baseline in a little over a week! She gave us a big packet with our cycle information in it, and as our homework, we were to review everything and call her when we were done. Our center really does their best to help out cash paying patients, and our nurse told us that if we need just a little bit more meds at the end of our cycle, to call them first, rather than pay to order an entire new prescription. They receive samples of all the meds that they keep on hand to save people money when they can.

Our RE was extremely positive about our chances. It was especially nice to hear that he expects egg donor quality eggs. But as all of us know, there are no guarantees with IVF. You can never predict what will happen. Maybe I won't respond to the meds how they are expecting, or maybe I have a lot of eggs but they end up being lower quality, or what if there is some other unforeseen issue and the eggs don't all fertilize as they should. We really just need to hope for the best outcome, but realize that things we don't expect may happen as well.

Our center requires you to have three clearances to start your IVF cycle: Clinical, Medication, and Financial. The clinical clearance is all of your testing that must be completed before your cycle (or even before your treatment plan can be drawn up). We had all this done already, so we were able to check that right off. The next clearance was medication, and since we have no insurance coverage and are cash patients, we were all set there. Last is financial clearance, which I assumed we had since we actually paid for the cycle. But when I spoke to my nurse today, she told me that we didn't have our financial clearance yet! My guess is that it's just not put in the computer yet, but I will feel better once we are officially 100% cleared to start! Other than that, we just need to pay for our meds. The pharmacy we are using is trying to get our insurance to cover some of our meds. I'm skeptical, because they wouldn't even cover a $15 Clomid prescription... but it's nice to know that the pharmacy is doing everything they can to keep our price low. Once they've confirmed that insurance will or won't pay for a portion, then we will pay the remainder, and they will be overnighted to us!

All that's left for us to do now... is wait! Wait for the financial clearance to be approved, wait to pay for our meds, wait for our meds to arrive, and wait for our cycle to begin. Did I mention I'm not good at waiting? :)

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