Sunday, November 27, 2011

Financial Costs of Infertility Treatment

Outlined below are our costs that we have paid so far for infertility treatment.

  • 3 rounds of IUI at $500/ea = $1500
  • Infectious disease testing $75 per person = $150
  • IVF via the Attain Program (4 rounds - 2 fresh/2 frozen) = $16,500
  • IVF sperm workup = $300
  • Cryopreservation of sperm (done prior to my husband deploying) = $100
  • Daily injectables for 1st round = $3500
  • Anesthesia for egg retrieval = $500

Grand total for thus far: $22,550, and for 1st round of IVF:  $21,050.

NB:  Our insurance, Tricare, did not pay for any of the treatment.  The only meds they paid for were Clomid, Lupron and progesterone - all the inexpensive ones.  So much for supporting the troops, especially since it is male infertility factor for us!

We drained our savings of all we had - $9,000 - and the other $7,500 came from a Springstone Fertility Loan.  We had no idea the injectables would be $3500 and so when we received that call from the pharmacy, I almost fainted.  We had to take out another loan for the $3500 as it had to be paid immediately to start the round.  So in total, we took out $11,000 in loans.  The rest of the charges we paid in cash.  In cash total, it was $9,000 from savings and $2550 over time from our checking for a total of $11,550.  It looks like it works out to 1/2 in cash and 1/2 in loans.

I wish we did not have to take out any loans, but I also wish we did not have to drain our savings.  This kind of expense puts a lot of pressure on the process of having a baby.  No longer is a just a nice dinner and a bottle of wine.  Now, it is tens of thousands of dollars.  

Needless to say, even though my RE has said it is fine to go back to regular daily activities, I am still taking it easy.  I have not returned to my daily exercise rĂ©gime or Ashtanga yoga practise.  I do still walk my dogs daily and go to work, but I am still careful in both of those.  I am holding out for the 6.5 week US on 12 December to see a heartbeat, so I can know for sure I am actually pregnant.  I know many people do many things during the first four weeks, including jumping on trampolines, and still remain pregnant, but with this much money at stake, I'm playing it safe and hoping not to be sorry.

Wednesday, November 23, 2011

Beta Site

A great site that collects Beta results - now from over 61,000 women - and shows median levels for singleton and multiple pregnancies.

http://betabase.info/index.php

BFP!!!

For those not in the fertility acronym know, BFP = Big Fat Positive!

Monday morning before work I decided to do an early home pregnancy test (HPT) since I had 2 sticks.  I figured I would test Monday and Tuesday and then have my blood drawn on Wednesday.  I had no expectation of being positive at this point.  I had already had so many negative HPTs, that I did not hold much hope for a positive one.  I urinated on the stick (First Response) and then hopped in the shower.  As I was showering I even told myself, "Don't be disappointed when it is negative.  It is still very early."  After my shower, I decided to have a quick peek.  And then a double look.  Then a close up squinty inspection.  I could not believe it.  There were actually 2 lines - one dark, one light.  How could that possibly be???


I quickly readied for the day, and then called my RE office.  I really thought they would tell me to still keep my Wednesday appointment, but instead they squealed with glee and told me to come in right away.  On my way to work I swung by and had my blood drawn for my quantitative B-hCG and progesterone levels.  As I was coming out of the room after blood draw, all the nurses were lined up to say congratulations and give me big hugs.  It was so incredibly sweet!

I received a call from one of the RNs later that day saying my quant level was at 165 and my progesterone was good at over 40.  

At this point, I was still trying to fetter my joy.  I was extremely happy, but I still knew that my quant could go down, I could have a spontaneous abortion (SAB),  and any number of things could go wrong.  I have seen 2 patients in the last week who had a loss between 4-6 weeks, and so I did not want to let myself become too excited or committed to thinking I was indeed pregnant.

It is hard for my husband and I to talk since he is 9.5 hours ahead of me and working a variety of shifts, but I shared the news with my husband in Afghanistan that night via Skype.  I just held up the HPT stick to the camera.  He was shocked and happy and then a bit sad that he was missing it all thousands of miles away.

This was 10 dpt (days post-transfer).  

Now today, on 12 dpt, my quant is 362 (more than doubled!) and my progesterone is still really good (thanks to all those self-inflicted IM injections!).  

Next up is an ultrasound at 6 weeks and 5 days on 12 December.  I am hoping for twins (although my husband is definitely not!), but I will be happy for a singleton.  I just want a very healthy, happy baby that makes it to term.  That is all that really matters.

Sunday, November 13, 2011

ET

No, not extraterrestrial (although it all feels very sci-fi), but rather embryo transfer.

I had my only 2 embryos (1-8 cell B with clean margins and 1-4 cell B with fragmented edges) transferred on Friday - day 2 and a very auspicious day - 11/11/11.

Here are my little embies on day 2 - I call them Violet & Poppy.  I am hoping with all hope that at least one of them (although I would love to have twins!) stick and stay, and develop into a lovely little baby.


The embryos are too small to see with the naked eye, but in this short clip of my ET, you can see little white dots (air bubbles and fluid surrounding the embyros) on US.

video

I am feeling a bit crampy (hoping that is implantation!) but overall doing well.  Still a tiny sore from my egg retrieval (where my RE punctured the vaginal wall bilatterally in order to retrieve eggs from both ovaries), but I am feeling better each day.  I have Friday-Monday off, so that has been a blessing.  I have been doing lots of lounging, resting and relaxing along with trying to work out my landmarks for the IM (intramuscular) self-injection of 1 mL of progesterone in oil (PIO) every night.  This sounds easier than it is.  I am still trying to master it!  So easy to do on another person, a painful quagmire to do on myself.

Ay!  Now, there is nothing to do but wait.  The dreaded 2 week wait (2ww).  I am hoping this 2ww goes by quickly and yields a positive hCG.  My beta hCG will be on the 23rd of November (the day before Thanksgiving, how apropos!), and I can do a home test 1-2 days before although it can give a false-negative.  Not sure yet what I will do.  I do not want to get disappointed early, but I also want to know as soon as possible.  Hoping I can stay sane and positive throughout the duration of this 2ww!

Thursday, November 10, 2011

Eggs and Embryos

Received news today regarding my eggs and it is not good.

7 eggs were retrieved.  Only 3 (!) were mature.  All were injected with a sperm but only 2 fertilised.

Ah bless.  So disappointing.  I just do not know what went wrong.  My RE thinks she should have waited until day 11, but sadly, it is too late for hindsight.

I know that I only need one beautiful embryo to implant to make a baby, but I really had hoped that we would have more than 2 in order to make a choice regarding quality and to freeze one or more of them so that if this transfer did not take, I would not have to start injectables again.  I really, really, really wanted to do a FET (frozen embryo transfer) cycle next!  I just am devastated that I may have to start a full fresh round all over again.  I also only have 2 fresh rounds covered by Attain, so if this next round does not work either nor produce embryos for freezing, my IVF rounds will be finished.  It's so scary to think about that!

My RE recommends I transfer on day 2 now since there will not be any opportunity to "wait and see" and make a selection on which embryos are the best.  Both will be transferred regardless.

So, I am returning again to my RE's office tomorrow to have 2 embryos transferred at 1400.  I will know at that time how they have graded our embryos.  Gosh, I hope they are at least decent embryos.  My RE seems to think these two have a good chance as they look really good at this point.  Only time will tell.

All prayers and positive thoughts are well coveted.  I need all the help I can get!

The End is Near!

Monday, I finished my last day of injectables.  Yay!  I was quite happy to finish my injectables as I was starting to have heaps of side effects - excessive vaginal discharge (so much that I had to wear a panty liner because I soaked through 2 pairs of scrubs!), really tender skin where it was beginning to hurt to give subq injections, bruising on my stomach after injections, extremely tender and sore breasts, constipation and an irritable mood.  At first the injectables just made me happy with no symptoms.  In the end, they were really starting to wear on me.

Monday at 2230, I took my hCG trigger shot (35 hours prior to retrieval).

Tuesday, I began my antibiotics.

Wednesday was egg retrieval day.  My sister took me to my appointment at 0830 for a retrieval by 0930.  My blood pressure was sky high for me (140/85) at admission because I was so nervous about being put under anesthesia and waking up in pain.  Luckily, I had my sister there to make me laugh and comfort me.  My anesthesiologist was phenomenal as well.  He put me at ease right away with his good nature and humor, and he really listened to me regarding my anesthesia fears.  I was under anesthesia previously for a tonsillectomy and had the worst time coming out of anesthesia - difficulty waking up and staying awake for over 24 hours.  I have the same issue when I take any prescription narcotics or other meds that say "may cause drowsiness".  In me, they ALWAYS cause drowsiness and it is typically a drowsiness I cannot easily shake.  I will often sleep for 12-18 hours straight after taking those types of medications.  So, it was wonderful to actually have him take me seriously and listen to my concerns instead of blowing me off.  He then gave me only 1/2 of the versed and fentanyl right before the procedure instead of the whole dose.

Before the procedure started, I asked my RE to look and make sure my eggs were still there prior to going under anesthesia.  I did not want to go under if I had already ovulated!  Thankfully, the IVF round was not a loss and I had not ovulated.

I was given versed in the pre-op room in order to calm my fears, and then I was given fentanyl when we were back in the procedure room.  After that, I do not remember a thing.  I was given propofol (yes, the Michael Jackson drug) and I went off to sedation land.

I woke up in my pre-op room, now a recovery room dimly lit with my RN sitting at my bedside charting my vitals.  She asked the usual questions - how did I feel?  was I in any pain?  did I feel nauseous?  I felt fine, actually.  Just a bit foggy in the brain, but otherwise, no pain and I woke directly after the procedure with no hangover.  That was the best thing!  I drank some apple juice and ate some pretzels and then they brought back in my sister.  The RN monitored my vitals for some time until all was good (BP now 114/72), gave me my post-op instructions and gave me my first progesterone injection - 0.25 ml with instructions to give myself another 0.25 ml that evening.

My RE popped in with the news that there were 7 eggs.  I was disappointed in hearing that as we had hoped that there would be at least 10-12.  It was disheartening, but I tried to think positively and hope for the best.

Going home, I was to continue with my antibiotics for 5 days and give myself 1 mL of progesterone every evening. They said they would then call me the following day with news of my eggs.

My sister then took me to Whole Foods for lunch, which was lovely.  I had a nice pretzel sandwich with field roast and a white bean and kale soup.  Yum!  It was nice to spend time with my sister and have someone with me who really cares about me with my husband being gone. She took really good care of me too!  My sister then drove me home, and I spent the rest of the day sleeping and resting - hoping that I would receive good news the following day.

Saturday, November 5, 2011

Progress

Friday I had another US and more blood work (having every other day appointments now) and it looks like my follicles are maturing faster than expected.  My RE said we are on track for retrieving 8-12 eggs, but she is not sure if they will all be mature enough.  I am going to have a follow up US and blood work done on Sunday. If the follicles are plentiful and the sizes are good (indicating proper maturity), then I will have my egg retrieval on Tuesday.  My RE says it is a fine balance between retrieving prior to ovulation and ensuring maximum number of follicles possible and that the eggs are mature.

My estrogen is also doubling and increasing nicely.  So far, so good!

I've stayed at 375 IU for Gonal-F each p.m., 1 vial of Menopur each p.m., and 10 units of Lupron BID (twice daily).  Sadly, no decreases in the Gonal-F for me.  This means that I have gone through 3 pens of Gonal-F, and had no more pens after last night.  We never knew the meds would be so incredibly expensive, and when we drained our savings for our 4 rounds of IVF (2 fresh and 2 frozen with Attain), we had no money left.  When the pharmacy called and said our meds would be $3500 and that our insurance would not cover it, I almost had a heart attack.  Literally, I ended up in the ER with PVCs (pre-ventricular contractions).  We ended up having to take a personal loan to pay for our medications.  Our insurance only covered the progesterone and Lupron, so the $3500 was for the Gonal-F ($900 a pen x 3) and Menopur ($80 a vial x 10) alone.  With the RE office not ordering enough pens for me in the beginning (since they are so expensive, they are cautious not to order too many), I was in a panic when I realised I would run out of the Gonal-F on Friday with no way to buy another pen at $900 a pop.  Thankfully my doctor's office donated a pen to me.  Wow - what a blessing and such a relief!  One less thing to worry about.

On the midwifery front, I have made progress in my clincals as well.  I caught another sweet baby boy yesterday increasing my count to 12.  (This count is only my US births and does not count the babies I caught in Ghana.)  My program only requires 20(!) births, which I think is far too low to call myself experienced/ready to practise on my own, so I am setting a goal for myself of at least 60.  I would ultimately like to make it to 100 (they say you feel comfortable with births after your 100th catch), but anywhere between 60 and 100 would be sublime for me.  I also sutured my first patient yesterday with bilateral labial lacs, and a wonderful MD taught me how to tie one handed with my left hand (non-dominant hand).  Now, I can hold my instrument in my right hand and tie with my left without ever having to switch hands or put down the needle.  Woo hoo!  So exciting!

I needed a day like yesterday.  It was such a moral booster.  I made wonderful progress in both my IVF course and my studies this past week.  Excited to see what this next week brings!

Thursday, November 3, 2011

November - Good Karma Mandatory!

Since my husband left in early October for his 6 months of working abroad, something has gone wrong every single day.
  • My car battery died on 2 separate days and I had to sort out how to jump my car from a instructional pamphlet.
  • I got a stress fracture in my right foot from running.
  • I re-injured my right SI joint while running.
  • I had a chiro appointment to help my back and it some how made it worse!  I ended up not being able to walk for 2 days.
  • After thinking we had all our IVF costs covered, the pharmacy called and told me my meds would be $3500!  I about had a heart attack.  I had no idea they would be so much, nor did we have that kind of money lying around after draining our savings of $9000 to pay for the IVF.
  • I became so stressed and overwhelmed over the IVF costs, that I ended up in the ER with PVCs!
  • Our pool pump broke.
  • 2 windows in our house broke and would no longer shut.
  • My washer machine flooded the laundry room.
  • I came home to diarrhea all over 2 of bathroom floors from one of my dogs who became sick while I was at work.
  • I came home one day to find a policeman in my house saying my alarm was going off and ADT could not reach me - they thought I was injured or incapacitated in the house.  Oh great!
  • I tried twice to insert an IUD and failed - very humiliating.
  • I was told by a patient that my Leopold's were too strong and that I was hurting her.  She told me normally my midwife preceptor touched her gently like a feather.  I just wanted to tell her that there was no way she could possibly feel her baby if she just barely touched her.  Instead I apologised and tried to touch her like a freaking butterfly.
  • There was one full day of clinic where it seemed like I did everything wrong and my midwife made sure I knew it.
  • I scored a 70% on 2 separate quizzes - the lowest grades I have made in nurse midwifery school thus far.
  • My mac book flipped out and my keyboard would not work for a day.  Unfortunately I have no time to take it in for a repair.
  • A new gas line was ran in order to install a gas cooktop replacing our electric glass cooktop.  The line was ran wrong and so a drawer was pulling against the line - I ended up with a lovely gas leak and another 4 hour repair.
All this in the month of October.  

This mandates that from here on out, from November on, nothing but good shall happen.  All good karma, all good luck.  Nothing but fairy dust and fairy tales coming true.  I am believing on it.