Tuesday, March 13, 2012

We have a plan, I think...

...or at least some stuff to discuss, when we have a moment to ourselves.

We met with our lovely RE today (have I told you how happy I am that we switched REs and that we're not still with this guy?). I've said this before, but my RE reminds me so much of my father's family - my uncle, to be exact. Just a tall and lanky old British dude with a fabulous sense of humour, who is incredibly knowledgeable and very patient.

Today was the first time that Devon had met him, as it's usually just me for the non-IUI procedure visits. Devon has missed as much work as she can for our appointments, and after the first ultrasound, I didn't feel she needed to be there for every one, or for a quick meeting with the RE. But today was important, and I was so thankful she was with me.

We basically told him that we're frustrated and need to make a long-term plan, because IUI after IUI after BFN after BFN is maddening. He went through our options and was very honest about everything.

Because I have no known fertility issues, and that I have age on my side, he was quite surprised that we haven't got pregnant yet - or that we didn't keep the one that we did get pregnant with. From what I understand, although Clomid helps with increasing the odds with more follicles, it is more helpful for people who actually have trouble ovulating, which I don't.

As I have responded very well to Clomid treatment, in the sense of mature follicles, he is discouraging us from going the superovulation and IUI route. I am already producing 2-3 good mature follicles with Clomid, and with superovulation, I imagine they would cancel the insem if there were much more than that anyway. I had no idea that the rate of multiples with superovulation and IUI can get as high as 30%. A superovulation cycle will run us about $2,000.

He mentioned switching to Femera to avoid the thin lining conundrum that comes with Clomid. He wanted us to do our research, as Health Canada (our FDA) has not approved it for anything other than use in breast cancer treatment. He told us that decision was based off a very small clinical trial that showed defects in babies born to mothers who used Femera for ovulation, the results of which have been disproved since. Motherrisk, who I see as the Godfather - or rather Godmother - of all things drug and pregnancy related, does a very good job of giving the facts here. The interesting part is that the drug will probably be covered by my healthcare plan if it is not used (on paper) as a fertility medication. So silly. And, paying $50 is nothing compared to the other costs of this. The most important thing to note, however, is that when it comes to actual pregnancies, Femera and Clomid - for my situation - are essentially the same and Femera won't necessarily be better for us.

So, basically, we found out that there is not a heck of a lot to try between IUIs and moving to IVF... and IVF is what our RE ended up, in a roundabout way, suggesting. He was very understanding of our frustrations around time and money, but suggested we consider IVF after one more failed IUI attempt. At my age, the medications would "only be" around $2,000 and the procedure would be about $5,000. Add another $1,000 for sperm/shipping (just one sample) and we're looking at a total of about $8,000. And that's the absolute minimum. The costs can creep up easily.

With IVF, our pregnancy odds will be about 50%. Here is where I get tripped up: Where the hell do you go after a failed IVF attempt? After you've spent $8,000 on one cycle, where does that leave you if you end up with a BFN except in a ridiculous amount of debt? And yes, I want to feel positive about our chances, but I have to let myself go here as I sort through this stuff in my head. In what other situation can you think of in the entire world would you pay that much money for something that may or may not work out - a 50/50 chance? It's the emotional investment, as well as the financial one.

Somehow I feel better about throwing out our $1,000 a month that we spend on IUIs. But of course, so far we've almost spent the amount of money on IUIs that we would spend on an IVF treatment. It's hard to not go into this process thinking you're going to be that couple that gets pregnant on the first attempt or two. Now we know different.

**Can anyone please educate me on a second round of IVF? Specifically what you wouldn't have to pay for the second time around, using the same embryos from the first time. I imagine you wouldn't have to pay for the medications (?) and obviously some of the lab costs. Is it significantly cheaper with subsequent attempts?**

Devon and I managed to grab a coffee after the appointment and have a quick chat before returning to our respective jobs. This is what we've decided for now: We have two samples left of our donor that are paid for, so if we go ahead with two more IUIs, we would be paying for the procedures only. Two more months of IUIs will cost us $400, which is a relatively low cost. So we will commit to two more months of this. I refilled my Clomid prescription, and if this next one is a BFN, I may switch to Femera for the final month.

By May, we will have a better idea of whether our condo has sold (going on the market tomorrow) and a better idea of where our finances stand as a result of that. Ideally, we will be able to make enough money to pay off our existing debts so that will free up about $700/month that we are paying to our bank loan and the $200/month that we are saving to pay back some other money we had to borrow from other sources. Whether we apply for a line or credit, get another bank loan, or cash out my RRSPs, we haven't decided, but somehow, we will have to find a way to pay for the IVF.

I can't take much more than two more BFN, so it feels like the way to go. However, I am having trouble getting past this sinking feeling in the pit of my gut that we will never be able to get out of debt AND that's it's not a guarantee. Of course, a family is worth the costs, but it is tough to carry around the weight of debt with every step you take.

Another thing that I need to get over with IVF is the fact that our baby will not be conceived inside of my body. I don't know why I have such a mental block over that. Don't get me wrong - there is nothing wrong with it and know that it is necessary in a lot of circumstances, but there's just something warmer about it all happening within.

Then again, there is nothing warm about recurring BFNs.

Here goes...


  1. Sorry Lex that it is turning out this way. I would give it two more tries too and then go to IVF. I know so many people have great debt because of it but they are thrilled with the children it produced. Also, I think it not as much the second time. Might call the RE's office and ask. Also, there might be a payment program. Also, I know people who get their insurance to pay for some of the procedure and meds. Check all the options. Beg or borrow from family so make it happen. You will figure it all out.

  2. Well, you can probably guess where I stand on this, given what we tried and what worked for us, but I think IVF is very worth the financial investment. Aside from the dollars and cents (which, as you've pointed out, aren't actually much more than one spends on a handful of IUIs), there is the time and emotional cost of trying over and over and over again that is saved by bringing in the big guns. I'm pretty sure my blog archives from Spring 2008 contain very little other than processing this leap you're considering, so I understand that it is tough, but I don't regret it for a single moment and I don't think that's just because it worked on the first try for us. It was what we needed to move to at that point. The repeated IUIs and BFNs were killing me.

    To answer your questions: Where you go from a failed IVF is... A different version of IVF. One of the things you pay for in an IVF cycle is for an expert to look at every single step of your cycle under a microscope. If a problem is hiding somewhere, they will find and fix it. There are countless IVF protocols and a million ways they can tweak yours to up your odds if it doesn't work the first time (which I doubt would be needed). IVF isn't a final step, as I thought it was when I was approaching it myself; it's the crossing of the threshold into a whole new world of possibilities. Also, the costs are all different so I can't give you a dollar amount but at our clinic, our frozen embryo transfer cost less than 1/3 the amount of our fresh cycles.

    Wishing you peace and clarity as you decide on next steps!

  3. When we used drugs, we used femera ... It was my doctors drug of choice both because of the lining and for the same reasons your doctor mentioned (my doctor felt it would mostly just help make ovulation a little more precise and clear). Everything I read about the study that was done suggested that it was not a very good study and that while you should not take femera once pregnant, it would be out of your system if you took it early on in the cycle and the rate of birth defects were not really all that different from clomid.

    I am hoping for the best as you move forward!

  4. i totally hear you on the $ issue. we're entering the ivf game shortly and the expenses will mount quickly. for us its the best option. how could you better spend your money than investing it into your family? im glad you had a good talk with the RE, theres certainly nothing easy in this kind of process. just hang in there and keep going!

  5. I'm sorry I don't have any advice. The thing that did it for us when we were doing IUI's was changing how soon we did them after ovulation (if we had listened to the RE and kept doing them 48 hours later, we would've kept missing the egg in time, so we switched to 12-24 hours after ovulation...or rather, the darkest line on the OPK). I'm holding on to hope that one of these next two IUI's will work for you.

  6. The money is a really big issue. When Charlie and I looked into IVF it was totaling up to a minimum of $30,000 for one round. So my first response was $8,000 AWESOME!!!! You don't want to do anything that is going to put more stress on you and Devon. I feel like my response is a little silly in comparison to others. But I just want you to know that you have my support and ear (or should I say eyes)

  7. I had a pretty similar choice to make--we didn't have luck with 3 clomid cycles, and opted not to do the stims-with-IUI because I couldn't handle missing a cycle if there were too many folicles. IVF worked and was cheap (because we finally hit the point where my insurance was covering everything--we'd blown plenty of money on the IUI cycles to get there, though). If it hadn't worked once, we would have tried it again until the money ran out and then we would have switched to my wife. I have zero idea how i would have handled either of those last two scenarios, since I think it would have been so heartbreaking to get to either point (and in our case the money was less of an issue because of the insurance). If you get frozen embryos (we didn't) the next step is a frozen transfer--you do another round or two of birth control to get back on their cycle and when you're ready they thaw them out and then just transfer them in, like a fancy IUI. No stims or retrieval needed, so no need to pay for drugs other than birth control and probably progesterone.
    I will say that for all the baby was conceived outside me (and without my partner's 'help' in any way), it's been in me now for 9 months, and I can't imagine it being any more real or legitimate if it had been magically conceived in bed one night. Once it's in you, and growing, it doesn't matter nearly so much how it got there.

  8. I don't have a lot to add that everyone else hasn't told you, but I can totally sympathize with your situation. I'm not sure if you've kept up on our story, but I'll tell you: we went through six BFNs before meeting with the RE and really it came down to the numbers - cost v. success rate. For us using Clomid and/or Femara was no longer an option with IUI. So we would've been paying for nearly all the same meds as with IVF, but with IUI the chance of success was half as with IVF and also with a lot less control (we have never minded, obviously, having twins but really hoped for no more than two at a time and that route gave us a really high chance of 3+). Two rounds of that would've cost us more than one of IVF. To us, the choice was obvious.

    Yes, you do still have a 50/50 chance of a BFN with IVF ... which is exactly what we got. I won't lie, that was the most devastating BFN. I was nearly ready to give up at that point. Thankfully, the mandatory rest period in between renewed my faith and my determination. We had two frozen embryos and so our next round was FET - we opted for a more natural cycle so almost no meds and we mainly paid for storage of those precious little embryos. That cycle finally gave us the BFP we'd been waiting all that time for ... and gave us these two little boys growing in my belly for the last six and half months. (I'll second Isa - once those embryos are implanted and start to grow, it no longer matters that sperm didn't meet egg inside of you!)

    These choices are hard and they're extremely personal. I would never presume to know your situation or how you and Devon are feeling, but you both will make the decisions that work for you and make the most sense for your (future) family! Just try to stay as positive as you can, even in the lowest moments ... it makes all the difference.