IVF deal

I stumbled upon this IVF deal on a message board which I frequent. The poster had said casually that she found a clinic that charged $6,000 for two fresh IVFs cycles and unlimited FETs. And I could not believe that people didn't jump all over her for information, so even though I don't need it right now, I made it my mission to find out more details and post about it here. I have no affiliation with this clinic whatsoever, I did not use them myself, I simply wanted to post what is the best IVF deal I've ever seen and you folks can take it from there.

The clinic is CNY Fertility in with locations in Syracuse, Albany and Rochester, NY (Thanks to Meandbaby for alerting me to the additional locations!). There is a link under "Costs" that reads: 2010 IVF Specials. These are the details of the deals listed there as of when this blog post was written:

$6,000*
• Up to 2 IVF cycles.
• $3,000 deposit at retrieval.
• 12 months interest free financing.
• $250 monthly payment deducted from credit/debit card.
• If a pregnancy is achieved prior to 2nd cycle, contract is completed.

$9,000*
• Up to 4 IVF cycles.
• $4,500 deposit at retrieval.
• 12 months interest free financing.
• $375 monthly payment deducted from credit/debit card.
• If a pregnancy is achieved prior to 4th cycle, contract is completed.

$13,500*
• Up to 6 IVF cycles.
• $6,750 deposit at retrieval.
• 12 months interest free financing.
• $562.50 monthly payment deducted from credit/debit card.
• If a pregnancy is achieved prior to 6th cycle, contract is completed.

*This program includes Anesthesia, ICSI, Assisted Hatching, Retrieval, Embryo Transfer, storage of frozen embryos and FET cycles for one year Patient is responsible for all labs, ultrasounds and medications. We will bill insurance for monitoring and accept what insurance pays minus the co-pays, co-insurances and deductibles. If patient has frozen embryos, they must be used prior to proceeding with the next fresh IVF cycle.

Just focusing on the first deal of $6,000 for two fresh and unlimited FETs, please note the fine print above that it does not include monitoring or meds. If your insurance will not cover this, depending on the doses for your stims, that could add up to another $5,000 per cycle. At my clinic, 4 ultrasounds + b/w would run about $1,400 per cycle. So, this deal could, in reality, be more like $12,500 for the first IVF cycle, but you'd still have another fresh IVF and FETs in pocket, if needed. That it includes ICSI and AH by default is pretty cool too.

The deals for donor cycles also seem to be good but not as drastically good as own-egg IVFs. The details are at the bottom of the same page.

There is information under "About us" regarding accomodations and deals that the clinic has with local hotels for as little as $45/night. Though, if it were me, I might see if I could coordinate doing my monitoring at home and just flying up there for retrieval. But that would be a personal call.

Apparently you can do free phone consults with the doctors but it can take up to two months to schedule the consult, so you'd need to plan way ahead.

Anyway, as I mentioned earlier, I have no personal experience with this clinic, so I won't be able to answer any questions about them. I just wanted to share this for anyone paying out-of-pocket, maybe this would make IVF possible where it wasn't before.

San Fran and low temps

I've been swamped with work and visitors and this is the first chance I've had to post in 5 days! Remember last Wednesday when I said that things with the Win.dows 7 launch had calmed down somewhat, one day before it went live on the web? Well, apparently, I jinxed my entire company. All of our servers went down, completely dead no work possible, at 4pm and didn't come back up until 10pm. Everyone in our hosting company and major players at Or.acle, the database gurus, were frantically working on it and still it took 6 hours to fix. So a busy, but not crazy day that should have ended around 7pm instead became a frantic day that didn't end until 2am. We hadn't had a major crash like that in years and, of course, go figure, it happens on the day before a major launch. We smell espionage from one of our competitors!

During that 6 hour break when the servers were down, NoodleGuy booked our trip to San Francisco, yay!! We're flying out on Saturday morning and back on Tuesday afternoon -- we're flying on Vir.gin America and I am so excited! NG keeps teasing me that I'm more excited about the flight than the trip itself. The flights were only $100 each way from Boston to SF, we're sure they're trying to get us hooked on the airline before they jack up the fares. People liken it to flying instead of a bright, shiny iPod. All seats have private televisions, with TV and On Demand movies at your fingertips. There is free wifi ON THE FLIGHT! There are outlets at each seat, to deal with the inevitable lame laptop batteries. There is seat to seat instant messaging, so I could, potentially, hit on that cute guy in seat 12D (just kidding, NG!). There is on demand waitress service, where you tell them when you want a drink instead of them blocking the aisles for half an hour with that cart. Though, of course, NG have discussed that we'll feel too guilty to make the flight attendants wait on us, so we'll arrive in SF all parched ;).

The impetus for this trip was getting the Hell out of Dodge for Halloween. One of the ironic side effects of IF is not being able to tolerate being around adorable children, at least for me. It's so much more magnified since the miscarriage and I was going to spend the day away from home if it killed me. I'm so happy that we're actually making a fun trip out of it. If anyone has any SF tips (Thanks Heather!), I'm all over them. In addition to being away on Halloween, it's my birthday next week. I'm not at all thrilled about this birthday (39) but I'm trying really hard not to focus on age, as my guru RE advises me against.

Finally, my FF chart is confusing me. I had a fairly normal cycle after the m/c -- about a week longer than normal, but I O'ed and had typical biphasic temps. However, this cycle my temps are so so low and it's CD18 and I still haven't O'ed which is the latest that I've ever tracked. I usually have a coverline at @ 97.9 and my temps fluctuate between 97.2 and 98.4 or so throughout the cycle. I must have estrogen in overdrive with my temps being so low, I don't know if that's good or bad at this point. Thoughts?

I know I still have hormones adjusting (I have my beta-please-finally-be-negative check on Wednesday) but I'm praying I O in the next day or so and then have a shortish LP. If I don't then my IVF cycle in December will run into Christmas. I came up with this calendar math at 3:30am last night and then laid there for an hour stressing about it. Blah, timing, how I hate thee.

Crap.Stupid HCG.

I just heard back from my nurse that my HCG is still positive, at 9.4. It's dropping too slowly for me to be able to squeeze in a sonogram during the window of this cycle, which would have needed to be in the next week. So we're just going to test it again in two weeks, and at that point schedule the sonogram for early November or so.

Instead of IVF in November, it looks like I'll be in December. Of course now I'm going to have scheduling problems near Christmas, when I'm trying to go visit my family in Texas. Even if the timing works out OK and I can do it before I would leave, I'd need to fly during the 2WW. Fuckity fuck fuck. Can't a brother catch a break?

RE appt

I had my STBY appt with Dr. B on Friday and it was a good one. I had actually phoned his nurse the day before to make sure they knew why I was coming in - can you imagine if I got there, having the last they saw of me being a happy 8-week pregnant patient being released to the OBGYN, and I had to explain what happened? No, thanks. So, I left a message, feeling kind of dorky explaining it on the voicemail, but it was good that I did. She called me right back, which is kind of unheard of at my clinic, and was so sweet. I happened to be in the supermarket, so had to have the conversation while standing in the produce aisle, appropriately enough (since I can't seem to RE-produce, get it? Ba dum bum). This nurse and I have a bit of a bond (at least in my mind) because when I was going through the boob scare, it was early in my pregnancy and I was trying to time the surgery for the safest time for the baby. She kindly shared with me that she had gone through the same thing a few years earlier and she knew how scary it was, but everything turned out fine. I appreciated hearing this anecdote and know that it's rare to get a personal glimpse like that into your healthcare worker's lives, so I have a particular fondness for this nurse. Anyhow, she was very sympathetic and sweet and said she'd pass on the info and advised me to have all my records faxed over from the OBGYN to Dr. B, which was a good call.

When I went in on Friday, I got the special post-mc treatment where everyone was a little more soft spoken with me, had me wait in a separate room so I didn't need to see the pg patients, etc. Very thoughtful. When Dr. B was ready for me, it took everything for me not to start crying on the spot. He was so very kind and genuinely sad for us. We sadly said that we thought maybe we'd never see each other again and were happy about it. He was impressed that I was able to be there so soon, but not in a judgmental it's-too-soon way, more in a "you're a strong cookie" way. I've thought about this alot over the weekend, about whether it's too soon to dive back in. And I've come to the conclusion that I'm not going to judge myself, either. You're ready when you're ready. With my last m/c, which was alot less traumatic since the pregnancy was iffy all along (low betas, u/s growth lagged behind), I took 4 months off afterwards. This time I'm ready after 5 weeks, go figure. I think it's mostly that I am so ready to put this chapter of my life behind me, whether successful or not; I just want it to be over.

In the geez-what-else-can-go-wrong category, Dr. B was irate on our behalf that the karyotype of Peanut was inconclusive. He said the mosaicism didn't indicate much of anything - as some of you smart commenters pointed out at my last post, that FISH isn't the greatest analytical tool. He said without good tissue, non-necrotized, they're guessing. He said that after he performs a D&E, he spends alot of time combing through the tissue, trying to find the best sample to send to the lab and that he's never had an inconclusive result, even with 6-week sample. He said with a 10-week sample, which is much larger, obviously, he's never even heard of not getting a good sample for a conclusive result. So, yay me, setting records everywhere I go.

Dr. B thinks there's still reason to believe that I could get a better response with my own eggs and that a few more IVFs are worthwhile, especially since we're fully covered by insurance (yay, Taxachusetts). I'm dubious both about the response and about whether I could produce any chromosomally normal eggs, but I trust him + I feel like I could go into donor eggs in the spring with a better mindset if I truly gave my all to a few last rounds of my own egg IVFs beforehand. He did, however, talk me out of PGD :(. Again, like the smart commenters, he doesn't believe that PGD is the cure-all for chromosomal issues, especially for a poor responder like me. His bottom line is that he wants to get me a healthy pregnancy, and feels like PGD actually jeopardizes that. Yes, we might be able to rule out chromosomal issues. But there's also a 10% chance of a false positive and with someone who will have a few embryos to choose from as me, he doesn't want to risk rejecting a perfectly healthy embryo. He definitely understood my desire not to go through another doomed pregnancy but made a persuasive argument for what is our ultimate goal of a sticky pregnancy. So, no PGD, which is disappointing to a Type A personality like me, but I'll roll with it.

He was ready to slap an estrogen patch on me on the spot and get going in our next cycle, heh. I actually had to put the brakes on a little because I want to get a saline sonogram before starting up to make sure my uterus looks good. It should be fine and clear after a D&E, but last time we thought the same thing and had a routine SS and there were 10 polyps and I needed a hysteroscopy (yes, I'm a disaster). I just want to make sure everything is good in there before starting - the last thing I need is a great looking embie that can't implant due to uterine issues.

We also discussed donor eggs, and while one of the things I like about Dr. B is that he is a very positive thinker and only likes to focus on the cycle at hand, instead of saying "We'll do 3 IVFs and then ship you off to the glue factory", I did tell him our plan of six more months of trying with my own eggs, then a boob check to make sure I didn't screw anything more up, and then DE. He thought it sounded like a good plan, but still insisted he thought we could have a successful IVF (God love ya, Dr. B). However, at my request, he did set up an informational session for us with the coordinator of DEs at our clinic. It's in their main office, so I'll set up a meeting with the woman next time I'm in that neck of the woods. I'd like to get some questions answered and get a feel for what my insurance will cover so that we're armed with that knowledge before the spring and not lose some months if we get to that point.

We did bloodwork on Friday, which showed my HCG is still positive at 18.5. We'll do it again later this week and once it's negative (<5), we can schedule the SS. I hope it works out because I've just finished up with my first post-m/c AF and need to get it in within the next 10 days or so, while my lining is still thin. Ah, the lovely stress of TTC timing, how I haven't missed you.

So, I'm afraid of the meds because of my boob issues and afraid of my own eggs, but here we go again...

Hello embie!

Thawed from carbonite, Han Solo rises again! OK, actually floating in a culture medium, but still. Of the 3 eggs retrieved yesterday, one has fertilized and color me happy! The 2 "surprise" eggs, while I couldn't help but hope for a miracle, were likely immature and I knew they probably wouldn't fertilize. I wish I had gotten a dozen eggs and embies, but I have to say that Han Solo has been a superstar so far. Greedily hogging the FSH buffet, making it through retrieval and now succumbing to one of 75,000 potential boyfriends who attended last night's rave with her. She's a gluttonous tramp, just how I want her right now.

I'll spend the next 43 hours terrified of the phone, worried that the lab might call about arrested development. But at least tomorrow is Friday (hooray!), my in-laws are coming in the afternoon to house hunt on the Cape over the weekend, so I'll be somewhat distracted. I'll go off to the transfer on Saturday at 11 a.m., with pre and post acupuncture appointments while NoodleGuy looks at houses with his parents. House hunting is not his very favorite activity (would be much more up my alley) but considering the weird houses that FIL was liking last time we went looking, some intervention is clearly needed.

NoodleGuy has a hockey game tonight (he plays) so I'm left to my own devices, but that means I can FINALLY watch the Grey's Anatomy finale which I had been saving for while I convalesced after ER, but never got around to it yesterday. I can't watch it with NG because in between getting sucked in by the wily writers, he feels the need to shriek over the girl-rock music and goofy dialogue. Our marriage is much happier when I can watch my shows without the peanut gallery pretending to dry heave in the background.

But back to the main reason for this post. Grow embie grow! For today at least, I'm a mom.

Finally baseline - start the stimming!

Dr. B's nurse finally called me back at 4:45 today, causing me to harass their office twice and ponder the merits of a nervous breakdown. Turns out she was waiting to call because she wanted to talk to the RE about my pathetic antral follicles.

This nurse is new to my case, as the doctor has 2 nurses: one for IUI/Clomid and one for IVF. Since this is my first IVF, I just started working with her. So while I knew I was a deadbeat in the antral follicle realm, she apparently did not. I like her very much, so it was nothing about her specifically, but it was like rubbing salt in the wound when she said that the RE may opt to cancel this cycle and see if the next baseline looked better. I suspected the RE would not be surprised at my scans and poor number of antrals and we would go ahead, but what would a cycle be without a little added trauma due to misunderstandings and turnover of staff?

After waiting another hour for the follow-up phone call, worrying that my already poor prognosis has gotten even worse, she called back and confirmed that my RE was not surprised at what he saw (or, rather, didn't see). So, the plan is still on and off we go!

As I've posted before, the RE will be happy if I can muster 5 good follies. Less than three and we'll convert to IUI. 150IU of Menoupur + 450IU of Gonal-f, ay caramba. If this can't stim me, nothing will. I go in on Friday morning for my next u/s and b/w to check on follie progress. Talk about TGIF!

She's heeere....

So, AF showed up this morning on what was supposedly CD19, which is a good week early for me. Since I've been on injectables, my cycles have zigzagged from a week too short to a week too long. I'm guessing now that the "too long" cycles were an example of what I wrote about below, that I was actually baseline before I had my period, so the cycles are probably, at least hormonally, most consistent than I thought.

I'm going to try not to obsess about a short luteal phase, since that's never been an issue with me before and just start getting excited for my first - FINALLY after 2.5 years of being told I 99% would need IVF to conceive - IVF. I'll be going in for my baseline b/w and u/s tomorrow morning. My antral follicle count is usually a depressing event (most likely due to scarring on my ovaries from stage IV endo), so I'm not thinking at all that I'll hear anything different. But I'm praying they see more than 7 or so, for the hope that we can get at least 5 eggs at retrieval. I can feel myself getting stressed out as I type this, despite my determination to be all zen this cycle, so I'm going to stop typing and go take a shower so I can log on to work by 9am!

IVF#1 - priming has begun!

Pictured above: 1) Vivelle estrogen patches 2) Ganirelix shots 3) Gonal-F pens 4) Menopur boxed 5) Menopur and Q-caps exposed 6) Ovidrel trigger shot 7) Crinone progesterone gel 8) Random supplies - syringes, gauze, alcohol swabs

Things are happening faster than I expected. I was supposed to start this EPP IVF about a week before my next period, mid-luteal phase. I expect(ed) my period on June 5th, so figured I'd start with the priming around May 30th. Well, I went in for bloodwork on Sunday, which was CD14 for me. My progesterone levels disagree that it was early and said on Sunday that I was mid-LP and ready to start on the estrogen patches and ganirelix shots.

So, on Sunday, I slapped on my first estrogen patch (Vivelle dots, to be changed every 3 days, pictured below). On Monday I gave myself the first of three ganirelix shots - I'm unclear what ganirelix is accomplishing at this point in the cycle and also what happens if my period doesn't come for a week and a half, as expected? Because this part of the protocol should lead into CD1 pretty seamlessly and I don't know if that will happen here and if the 10 day gap will be a problem. So, I have a call into the nurse for explanation on this, and will post when I get it! ;)

Cleared for take-off

The nurse finally called me back at 4:30pm this afternoon with the results of my Day 3 b/w - I was beginning to panic that I wouldn't hear from her before the weekend. If I hadn't heard from them by the end of the day, I know I would have invented all sorts of scenarios in my head that they knew the awful, terrible results but couldn't bear to tell me. But thankfully - for NoodleGuy's sake especially - they made it just under the wire.

In order for my insurance to green-light IVF, my FSH needed to be < 15 and my E2 < 100. Praise be, they came back as FSH 11.3 and E2 76. It was actually Day 4 when I had the blood draw yesterday, so they may have even been little falsely elevated. But who cares!?! More than good enough and the FSH in particular was better news than I was expecting. Still in the expected "diminished ovarian reserve" range, but on the low-end rather than the high-end. So, in the relative world of TTC crappiness, this is good news!

Now I bide my time and wait for the RE's financial coordinator to call me and let me know that all the paperwork is completed. I give myself until maybe next Wednesday before I add her to speed dial.

The appeal of IKEA kitchenry

Sometimes over the past few days I feel so excited about tomorrow's IVF consult that I'm almost panting. Truly -- I've apparently turned into a puppy (which isn't so bad). On the other hand, I've been sleeping very restlessly - which is very unusual for me, I'm usually out cold through 6:30am - and waking up intermittently panicking. I'm not sure why I'm so jumpy, I've had 2 years to get used to the idea that this is where I'm headed. I'm certainly not scared of the procedures as I've had 4 surgeries in the past 12 months and countless other procedures. If there's anything resembling a silvery operating table anywhere in sight at this point, I'm hopping up on it, stripping down, spreading my legs and settling in for a nap. This has led to some near-misses in IKEA's kitchen section. Furthermore, I live in mandatory infertility-coverage state and have great insurance coverage, so it's not the money I'm worrying about either.

I think sometimes it just hits me that this is our best shot, but our LAST shot. If this treatment doesn't work, no bambino from NoodleGirl's eggs. I think there was always some comfort in the surgeries or Clomid or FSH injectables or IUI or whatever that there was always the shining beacon of IVF at the end of the road. But if we try IVF and it doesn't work, then we have no last resort any more, we can't cloak ourselves in the magical phrase: "Well, we haven't even tried the big guns yet."

I know about donor eggs, donor embryos and adoption, of course. And maybe one day we will think more seriously about those options, I think they're incredible opportunities and I thank gummi bears that I live in a day where there are these possibilities. This is just me mourning the possibility of not be able to work with my own eggs. But remember that post last week from me about Borrowing Trouble? Yeah, this is me doing it again.

Surly day

Well, I'm out this cycle. Let me get this off my chest: fuck, damn, shit, crap. OK, I feel a little better. I could kick myself for getting my hopes up again. I KNOW damn well that IVF is likely my only real chance at a bean, but since I got pg off my first IUI last October, I thought maybe I was the crazy everything-against-her lady that people who got a 1 on their Ovarian Reserve tests would pray to as their patron saint of beating the odds. But, despite my better instincts, I got my hopes up because I started spotting late yesterday - on our way to meet the in-laws for Mother's Day to put the final dagger in all of our IF backs, stupid Hallmark holiday. The spotting was darker brown than I've ever seen and I thought maybe, maybe it was implantation spotting. It continued light and extremely dark brown all night and I planned to take a HPT first thing in the morning and got all tingly with possible excitement. Well, first thing this morning, I could tell that the flow had gotten heavier before I even got out of bed and I took the HPT and it was the, now expected, BFN. Bah. I should stick with my gut and just assume it'll always be negative. The crash is easier that way. I'll still do my beta, trying to move it up to tomorrow at my local Quest, so I don't have to schlep an hour each way on Wednesday morning just to hear them tell me what I already know.

On to IVF now. I have my first meeting with Dr. B about it on Thursday to discuss my protocol and sign the stack of consent forms. I know I won't be doing BCPs as suppression is not an issue with me (clearly), instead I'll start off with an estrogen patch in week 3 of this cycle. Part of me is excited because I've known all along that IVF is my best chance here, but I need at least a day of being surly and feeling mopey.

Bonkers

Nurse M called and the u/s tech was not dreaming! I have a 20.5mm and 16.6mm follie and my E2 has zagged back up to 257! To recap it was 104 (9 days ago) > 227 (6 days ago) > 109 (3 days ago) and now 257. Whew! That FSH is driving my ovaries bonkers. So... I don't feel 100% optimistic here because my hormones are going haywire but I'm thrilled that I can trigger tonight and do the IUI (#3) on Wednesday a.m. Even if it doesn't result in a BFP, at least I finally had some follie response and have cleared the insurance hurdles to move on to IVF if this cycle doesn't work. Hooray!