FREEZE! don't move....

that's what embryos 2, 3, 4, 5 and 6 are doing.....freezing!
 If you recall, #7 stopped dividing and #1 went on to the next step 

So after harvesting my mature eggs as a result of grueling hormone therapy with ovulation-inducing drugs, the last thing I wanted to do was let them go to waste.   The goal is to not to have to start over with stimulation of ovaries with injectable medications if we needed to repeat the IVF process.  That's why it was crucial, as painful as it was, to adhere to dosage instructions and injection times (down to the minute)...to give my body the best chance at producing as many mature follicles as possible for a one-time harvest.  It worked!  We ended up with enough remainders for cryopreservation (freezing).  The need for multiple harvests is not only taxing on one's body (and marriage) but can be very expensive, especially since most insurance plans max at 2-3 harvests a lifetime.

Cryopreservation, in this case, is the process of freezing embryos in sub-zero temperatures, which preserves the integrity of the eggs at the division stage and allows them to be thawed at a later time to continue dividing/growing.  It's an advancement in science that has greatly improved the IVF process, in that embryologist can select the highest quality eggs to fertilize, knowing they can be stored for later use.  It also no longer pressures doctors and couples to transfer multiple 'good eggs' into the patient for fear of losing them.  When that used to be the case, couples would end up with multiple births...triplets, quadruplets, quintuplets, etc.  So the solution to infertility was....you either had 'no children' or seven, eight, nine you could barely afford to raise.  Too many extremes.

Sometimes, the first embryo transfer doesn't end up in a pregnancy, or does but ends in a miscarriage.  In this case, there'd be 5 more chances for embryo transfers and increased rate of a birth.  The cryopreserved embryos can be stored for years and thawed for use when needed.  The process is usually not covered by insurance, so it's an out of pocket expense to consider but generally inexpensive -- between $500 - $2000 per year depending on number of embryos.

There's a catch though with cryo.  Unless you're a cancer patient opting to cryopreserve your (unfertilized) eggs before chemotherapy, there are strict rules that govern the freezing of fertilized eggs.  In our institution (and I imagine everywhere else), I had to be with a committed male partner (whose sperm I was using) and he had to express written consent of his desire to have biological children with me in the future.  Of course the consent form was 17,000 pages long, it seemed, and we had to sign off on our desired actions for the frozen embryos should a number of unforeseen life events happen (i.e. divorce, death of patient, death of partner, separation, death of both, change of heart).  In each scenario, I had to decide if I'd discard my eggs, donate to an infertile couple, transfer to ex-husband and his new wife (HAAAA!!!!!)!

no seriously.....HAAAAAAAAAA!!!!!!!!!

The Expense

You're probably wondering why we chose now to move forward with IVF.  How do you know when and if it's right for you, and when to start?  How expensive is the process?

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.

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The Wait

   

For many women, the most agonizing time during any fertility period is the dreaded 'two-week-wait'.  It's the two weeks in between your ovulation date (and hopefully conception date) and the day you're supposed to start menstruating............... or..............miss a period and test positive for pregnancy.

Many of us slow down our activity to give our bodies enough preserved energy to aid in the conception process.  Some of us try to distract ourselves by engaging in as much work/activity as possible, that it leaves no time to think about the inevitable.  Others with very obsessive tendencies practically LIVE on 'two-week-wait' websites and blogs. These sites are usually dumping grounds for women's symptoms during the waiting period ...and how to detect if you're pregnant.  I highly recommend against this....they can drive you crazy!  Instead, focus on eating well and treating your body as if you are pregnant (as you very well could be).  Curtail strenuous activity, cut out alcohol, and stay away from tobacco.

For me, the first two were the hardest.  Curtailing strenuous activity was a mandate from my doctor, and not being able to work out was challenging.  I felt useless and ....fat.  No Yoga, Kickboxing, Zumba and definitely no sex.  Virtually zero calorie-burning! *yawn.    As for wine...I'm still struggling from withdrawal symptoms.  Occasionally, I'd pour a glass of juice in a wine glass and sip slowly with cheese and crackers....to feel whole again.  At a social event recently while out with friends, they all ordered wine and cocktails and I ordered......green tea.  My girlfriend 'tried' her hardest not to laugh at me.  It was quite challenging.

D-DAY!

 

"Drive fasterrrrr....c'monnnn step on it!!!!"
"I'm driving as fast as I legally can on an interstate babe, calm down!"
"Our appointment is at noon....think we'll make it?"
"Relax.  We'll be fine.  Sit back and take a nap....you'll need all the rest you can get!"


I nagged him the entire six-hour drive back home.  It was the big day -- EMBRYO-TRANSFER DAY!  Three days before that, we sneaked out of town for a short vacation while the fertilized eggs were maturing....we were determined to get at least a day on the beach before all hell broke loose. We even left a day earlier than planned, knowing the trip would be cut short as we'd have to depart at the crack of dawn a few days later for the procedure.

The medical team was ecstatic to see us.  We'd been the subject of many round-table discussions amongst well-renowned physicians and medical professionals in the area.  Our case was rather interesting to them and made for great research.

I was giggling so loudly when Dr. ***** walked in to discuss and finalize plans for the number of blastocysts to transfer.
"What's so funny....I want in on the joke?"
"....well, we're at a stalemate here and maybe you can help us out.  What do you think of the name Coral?" I asked.
With a straight face, he adds "I ....like it.  Is that for a boy or a girl?"
My husband falls out of his chair in laughter!  I guess that settles THAT dispute.

Be very leery when a person says "I like it" with ZERO facial expression.  Not a blink, a smile, a twitch...nothing!  He really didn't need to lie.  I have three to five pages full of other names from which to pick. No need to placate me Doc!


"Lie back and spread 'em open"  says the doc.
"hehehe....that's what she said"   blurts out the comedian in the room my husband.
(no one laughs!)
(well actually, the nurse, doctor, and embryologist chuckled, but I didn't find that joke funny at all.  FOCUS PEOPLE!!!!)

"ouchhhh"
"that was just a clamp...you've felt this before.  I need you to relax"
"ok doc"
"see THAT on the monitor?  That's your embryo.  It's in!!!"
"whoa...!  that was quick"
"yep!  lie on your back for a few minutes...we'll return with some post procedure instructions"
"hahaha....that's what she said" blurts out the comedian

He seems to be on a roll today!

A few minutes later, I was discharged and ordered off my feet (bed-rest) for 24 hours to allow the embryo to implant.  I was to exert the least amount of energy in those 24 hours -- only get out of bed to eat and use the bathroom if need be.  For someone who is always on-the-go, this was PURE TORTURE for me.  It was 88 degrees outside, beautiful, sunny, breezy, birds chirping, perfect day for the beach and the sun didn't set until what seemed like well into midnight.  The hours passed soooo slowly.   I wasn't tired at all...yet I laid in bed.  I watched sports and Reality TV and newscast and movies ad nauseam!!!!  I played so much Candy Crush on my phone until it overheated and needed to cool off before it was rechargeable.  It was pure misery!

On the 59th second of the 59th minute of the 23rd hour the next day, I BOLTED OUT OF BED, hopped in the shower, grabbed my keys and headed to the beach.   FINALLY............in my element!