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 régime 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.

Latest Update

We have decided not to do a 4th round of IUI.  I would have had the scan this past Monday with intrauterine insemination on Wednesday, but we have weighed the pros and cons and decided against it.  Our RE said that she has seen many successful pregnancies happen with the 4th round, but there were just too many cons to consider.  My thought process was that I did not want to be pregnant in Ghana in case I -

• have severe nausea
• have an ectopic
• have a SAB (spontaneous abortion/miscarriage)
• need a D&C

I also was concerned because I will have to take anti-malarial tablets and of the 3 kinds that are recommended for Ghana - Malarone, Mefloquine or Doxycycline - none are safe during the 1st trimester.  I definitely do not want to contract malaria whilst I am there, but I also do not want to cause undue harm to my unborn child.  Which, I guess in theory, could happen with not taking anti-malarials and contracting malaria AND with taking anti-malarials.  According to the WHO, pregnant women are more vulnerable to malaria as pregnancy reduces the immunity to malaria (an immunity of which I have none of) and increases ones attractiveness to mosquitos due to hormones and pheromones.  Contracting malaria in pregnancy increases risk of illness, severe anaemia and death.  Maternal malaria also increases the risk of a SAB, stillbirth, premature delivery and low birth weight, which is the leading cause of infant mortality in Ghana.

All these thoughts culminated in us skipping our last round of IUI.  

We met with our RE this past week, and told her our decision.  We discussed doing a 4th round when I return from Ghana, but we are already booked for an IVF start date of 27 October, so there was not a way to squeeze in both the IUI and IVF start in October, especially with having to take anti-malarials for 2 weeks post-return.

So, we now are set for the following schedule, some of which has been completed:

1. Husband do pre-IVF infectious disease blood work 
2. Re-apply for Springstone IVF financing at end of August
3. Leave for Ghana beginning of September
4. Husband donate sperm for freezing on 2-3 separate occasions during September
5. Return from Ghana early October
6. IVF counseling 3 October
7. Husband leave for 6 months
8. Begin IVF cycle 27 October

I know there are many more steps between 3 October and 27 October, but I do not know what they are yet.  We will find out on the 3rd!  I know I do need to let Attain know that we are beginning our treatment on the 27th.  They are providing us four rounds - 2 fresh and 2 frozen - for $16,000 USD.  I also need to work out our financing.  Our clinic wants the money up front, so we are going to go through an IVF financing company called Springstone.  We applied earlier with them and were approved for the IVF amount with monthly payments of $300 for 60 months, $335.97 for 48 months, $412.44 for 36 months or $573.50 for 24 months.  It IS quite expensive, like a monthly car payment (which thank goodness, we do not have), but we are going to have to use the financing route as we do not have $16,000 in cash to pay up front by October.  Unfortunately, our application was only good for only 60 days, so we will now have to re-apply.  I hope we are able to secure as good of a rate and financing for the whole amount when we reapply at the end of this month.  

It's nerve-wracking thinking about all that needs to be done and the possibility of not having a successful outcome whilst being out $16,000.  I am trying to be positive, of course, but the fear is still there.  I had a dear friend who just went through her 4th failed IVF attempt.  It is heart breaking.  I am truly hoping and praying for success on the first go-round.  I'd like to get our money's worth, but really, I'd much prefer early success.

Missing

I have not blogged since March, so for about 3 months now. Where have I been? Well, no where really, but I have not had anything new to blog about and I have been a bit unmotivated as well. If I'm honest, I have been feeling a bit down and depressed in these past 3 months trying to sort out what I want to do now.

We met with our reproductive endocrinologist (RE) in May and have sorted out a plan. We are going to do two more rounds of IUI in June and July and then take a break until after September if neither of them take. I will be gone for the month of September to Ghana to do midwifery work, and upon returning, we will try IVF. Since my husband will be leaving for work for half a year in the fall, he will probably have to make several deposits before he goes and I will undergo IVF alone.

These are the things I have been dealing with. Going through IVF alone, spending the holidays along, possibly being pregnant for a large chunk of time alone and my husband missing out on all of this.

On a good note, we have been approved for the Attain IVF program where we will receive 4 rounds of IVF (2 fresh and 2 frozen) for $16,000 USD. If I were under 35, I could have qualified for having a percentage of my fees refunded if our IVF attempts were unsuccessful. But due to being 38, this is not an option because of the reduced chances of having a successful pregnancy via IVF after 35. Luckily my chances do not go down drastically until I reach 40, so I do have a good chance left still and that is why it is important to go ahead with the IVF even if my husband is not here. Every 6 months I wait, my chances decrease as my eggs get older and fewer.

The last bit of news is that I received my anti-Müllerian hormone (AMH) results. This hormone is suppose to be able to tell how much of an ovarian reserve one has and is a serum blood assay that can be drawn on any day of the cycle, unlike FSH, estrogen or progesterone. The results are as follows:

Interpretation	AMH Blood Level
High (often PCOS)	Over 3.0 ng/ml
Normal	Over 1.0 ng/ml
Low Normal Range	0.7 - 0.9 ng/ml
Low	0.3 - 0.6 ng/ml
Very Low	Less than 0.3 ng/ml

My result was 1.1. JUST above the normal cut off range. I have been researching this in journals and have found that IVF is most successful with a value of 1.24 or greater. The articles recommend taking DHEA. A good blog post about this is by Kylie Hughes: DHEA for low ovarian reserve. Her blog research and linked articles show that IVF success was significantly increased with DHEA supplementation for those with low AMH results. Right now my RE is saying my chances with no intervention is only 1.8% per month of conceiving on my own, 8.6% chance with IUI + clomid and around 50% for IVF. I am not sure if my AMH result now will affect that 50% chance for a successful IVF. These are the things I plan to ask her this Saturday when I go for my scan to see how many eggs have developed for this cycle. If there are enough eggs, as there have been in the past, we will do round 3 this week.