Our Initial IVF Consultation

In order to really go over In Vitro Fertilization (IVF) in detail, Dr. Moore had us come in for an IVF consultation a week after our first appointment (July 2013). With my endometriosis diagnosis he estimated that the live birth rate for a fresh IVF cycle (embryo transfer after egg retrieval) would be about 65%. He explained the process beginning to end, including the shots, risks, cost and finally the tests.

The Process and Hormones

I would first contact the nurses to get on the schedule for a transfer week. They would send me a calendar that outlined everything I needed to do. I would start with 6 weeks of continuous birth control pills (active pills only-I would skip the placebo pills and start a new pack). Sounds crazy right? I was surprised that the first step to getting pregnant was to take pills that prevent pregnancy! But the birth control pills quiet everything down which enables the doctors to control my cycle in order to time everything just right.

From there it would be a matter of adding in other medications one at a time...Lupron injections for two weeks, then add in the Follicle Stimulating Hormone (FSH) injections ending with Pregnyl, an HCG (Human Chorionic Gonadotropin) shot 36 hours before the egg retrieval. In the meantime Ryan would have to take antibiotics, just to make sure he wouldn't have any bad bacteria in his semen sample the day of the egg retrieval. (I will get into more detail about each medication/hormone and the side effects I experienced later when I talk about my experience with the egg retrieval and embryo transfer.)

The egg retrieval date would depend on the size of the follicles containing the immature eggs. All of these hormones would trigger my body to release multiple eggs rather than just one like the body does during a normal ovulation. They would have me come in for an ultrasound to check on them every day (starting on a certain date) until all of the eggs were mature enough to collect them. The egg retrieval would be done under sedation. They would use a small catheter guided by ultrasound to basically suck the eggs out (again...I'll go into more detail when I write about my experience with the process.)

After egg retrieval I would start taking antibiotics (a pill-yay!) and progesterone injections. Then we would just wait to see how many eggs fertilize and develop into embryos. On the fifth day of growth they would transfer one or two of the 5-day embryos (blastocysts) into my uterus. We would wait two weeks then come in for a pregnancy test. The doctor estimated that they would get anywhere from 10-20 eggs, with 8-18 fertilizing. Overall he estimated we would end up with anywhere from 3-8 embryos in the end. It all sounded so perfectly planned and simple really. All I had to do is follow directions and the doctors would take care of the rest.

The Risks

• Risk of multiples (which is what EVERYONE thinks when they hear IVF!): 
• If they transferred two embryos then our risk of a twin pregnancy would be 50% and the live birth rate 37% (it is not uncommon to lose one twin before delivery-usually very early in the pregnancy.)
• If they transferred just one embryo the risk of twins would only be up to 11% (slightly higher than the risk of a naturally occurring twin pregnancy, which is just over 3%.)
• Our risk of having triplets or more would be less than 1%.
• I would have a 2 fold increased risk of the baby being Small for Gestational Age (SGA), Preterm Labor and Gestational Hypertension. For this reason IVF pregnancies are considered HIGH RISK pregnancies.
• Birth defects: 2-4% (same incidence as a naturally occurring pregnancy)
• Ovarian Hyper Stimulation Syndrome (OHSS): 1-2%
• Ectopic Pregnancy: 1-2%
• Everything else (bleeding, infection, human error, etc.): 1-2%

 

The Cost

The cost of our first IVF cycle, which would be fresh embryo transfer, without ICSI (Intracytoplasmic Sperm Injection) would be $8900 (ICSI is a process where they inject the sperm into the egg when the sperm cannot penetrate the egg on its own...we did not need that, but if we had it would have cost an extra $1200). Medications were not included in the cost and would be an extra $2000-$3000. Because Utah is not a state with a mandate requiring coverage for infertility treatment, none of these costs would be covered by insurance, even this consultation that cost $165. (Fortunately my doctor was able to put endometriosis instead of infertility as my reason for the rest of my visits so they could all be covered.) Each frozen embryo transfer would be $2720 with under $500 in medications. To cryopreserve (freeze) our extra embryos it would be $1000 with a storage fee of $435 for each year after the first one.

By the time Ryan and I made this appointment, we had already done a significant amount of research about the costs and options. Like many infertility clinics, UCRM also has a money back guarantee program. We went in for this appointment with our minds made up that we wanted to do the guarantee program. The doctor explained that with the money back guarantee program they place you in one of three tiers based on history and age. We would have to transfer two embryos on the first try and if it didn't take we would do one frozen embryo transfer. If that did not take either, then we would be refunded about 80% of the cost (which still would not include medications). If we got pregnant on the first or second try (and that pregnancy resulted in a live birth past a certain week) then we would not get any money back. <After talking to the manager (who I actually went to high school with) later that week we found out that it would cost $17,900 to do the guarantee program. They had some finance options he gave us information on and emailed us all the terms. We still wanted to do it. We thought it was our best bet because if it didn't work we would get back enough of our money to try a few more frozen embryo transfers.>

The Tests 

The tests were an interesting part...there were so many different ones that I think that could be an entry all on its own! Here is a list for now, but I will go into more detail (including definitions) about all of them and my (and Ryan's) results later.

• Anti-Mullerian Hormone
• Thyroid Stimulating Hormone
• Prolactin Levels
• Blood Type
• RBC Antibody Screen
• Rubella Antibody Screen
• Counsyl Genetic Screening
• Sperm Assessment
• Sperm Penetration Test
• Ultrasound (more specifically, a sonohysterogram)

These would all need to be done before we even started the IVF process! It seemed overwhelming, but we still left this appointment feeling SO hopeful and excited! Talking about the babies we would have someday finally seemed like a more realistic conversation than what we would do with all the money if we won the lottery. We couldn't wait to tell our families about the new path we were about to take.
 

This appointment happened on July 16, 2013...we went through so much more before we even got to our first IVF cycle in February 2014! Keep checking back to find out about the tests, the procedures, the emotions and the medications and side effects!