Well, I've always known I'd have to address the unknown questions of fertility as a result of my aggressive chemotherapy years ago. Its impact on my unharvested eggs was a huge question mark.
The general rule of thumb is that if you're married and have engaged in sexual activity (with no form of contraception) for over a year and have had no pregnancies, then make an appointment for a consultation with a fertility doctor. A consultation with a fertility doctor could be the first step to either ruling out or discovering any issues in the woman's reproductive system that could hinder a successful pregnancy down the line (i.e. fibroids, endometriosis, blocked Fallopian Tubes, cancer, etc), or ruling out a potential male factor (i.e. injury, chronic health issues, lifestyle choice, genetics). One of the most important aspects of your fertility consultation should be that your doctor is as equally vested in your partner's reproductive health as s/he is yours, since about 40% of infertility issues are due to a male factor of some sort. Do not make the mistake I once made of seeing a doctor who isn't interested in your partner's health....it's a waste of money and time. If the application/form you complete on/before your first visit does not ask about your partner's health, family history, etc....tear it up and cancel the appointment! They won't have enough information to be fully equipped to diagnose infertility issues, if any.
Our first experience with a fertility doctor was self-funded. Our health insurance plan had a provision for the 'diagnosis of infertility' but not 'treatment'. Basically, our health insurance covered the first visit or so, in which the doctor concluded 'yes, I believe there is a fertility issue'. The expense from any lab work, medication and treatment (IUIs) thereafter was on a cash basis. It was not ideal but we hadn't done much research at that point and didn't know of any other options. I would not recommend this route unless you have no other choice and a healthy savings account. We probably wasted about $5k - 7k in blood work, ultra sounds, IUI cycles, and eventually male factor diagnosis and countless hours from work...until I had enough. They also offered us a chance to receive free or subsidized fertility treatments in exchange for donating some of my eggs....I was the least bit interested. The entire experience was nothing short of a nightmare....from feelings of inadequacy from the medical staff to disorganization and lack of comfort, I was convinced that if 'this' is what was required to conceive, I wasn't interested! They somehow managed to remove all aspects of humanity from this very intimate, sensitive and delicate process and turned what was once a renowned and bustling fertility institution into a baby factory. No, thank you!
A few years and a number of life events later, we had opportunities to change insurance plans and this time were very selective. We selected a health insurance plan that had a provision not only for infertility diagnoses but for treatments. Ours provided for two Invitro Fertilization cycles in a lifetime. This meant that we could visit a fertility institution, begin fertility treatments, have my eggs retrieved then fertilized and receive embryo transfer....twice in a lifetime. I've also seen insurance coverages make provisions for '2 egg retrievals in a lifetime', etc. For those people, it could mean begin fertility treatments, have surgery to harvest as many mature eggs as possible -- two times in a lifetime, but have multiple opportunities to transfer as many frozen embryos into the womb as needed without insurance restrictions (3, 4, 5, 6 children just from one/two cycles of IVF). It's all in the details of your insurance benefits. Depending on the contract between the insurance provider and the employer, the patient is responsible for some or no portion of the treatment (i.e. copay, deductible, percentage of procedure). This is a big deal and a big financial break for many couples.........but........there's a catch!
Fertility treatments haven't always been included in insurance benefits...it's a relatively new phenomenon and came as a result of the adoption of the Affordable Health Care Act. With this, insurance companies often require you to jump through a few hoops before qualifying for IVF treatments. They use a formula called 'lesser before the greater' meaning, you'd have to exhaust a list (predetermined number) of lesser effective means of fertility treatments and only after having been unsuccessful will they then approve an IVF cycle. I've heard of some couples being required to complete 6 IUI (artificial insemination) cycles before qualifying for IVF. We're talking at least 6 months of hormone therapy (less intense than that of IVF...mainly pills, but nevertheless mood-altering and undesirable effects)....it's kind of crazy. Luckily for us, the threshold was 3 IUI cycles, and credit was given for previous cycles. Coverage for each IVF cycle (about $25k) was sufficient for us and our out-of-pocket expense was manageable. Expect to pay about 30% of expenses between office visit co-pays, medication/prescription co-pays, travel, and cryopreservation of embryos (if you choose as this is not covered by most insurance plans).
It's perfectly normal to ask within your first few visits, how much an IVF cycle costs with that particular institution and if there are any included (special) services you'd otherwise be expected to cover (i.e. ICSI, video embryonic development, preimplantation genetic diagnosis). Each institution's IVF cycle will differ in cost based on their technology, methods, expertise of their staff, whether they're an extension of a research or teaching hospital or a university. We deliberately chose a research hospital within an Ivy League institution as we felt we'd benefit from the best technology, cutting edge methodology that may not yet be ready for commercial use, and handled by some of the best trained fertility specialists in the nation.
Lastly, ask if they devote time for a detailed info-session for IVF patients. This is very crucial to your success rate and for us, led to desirable outcomes. Knowing exactly what IVF is, what happens with each process, what role your medical team plays versus the roles you/your partner play is the key to a successful IVF process. It'll help with decision-making at each juncture, and help you understand why some medical recommendations unique to your situation may be for the best (or not). Also understand 'who' makes the final call....patient/partner, or doctor. The info-session, if done correctly, should last a number of hours and provide adequate time for a Q&A session. Ours was 5+ hours long, facilitated by the Chief of Staff of their Reproductive Endocrinology and Infertility division, and I raised my hand about 17 times in 5 hours ......a distant but fond memory of my 4th grade teacher reminding me there was no such thing as a stupid question. Hey....it's my body, and I needed to feel very comfortable before moving forward.
No comments:
Post a Comment