Friday, April 25, 2008

Medications for IVF

I did some shopping around for my medications, because I learned there is a wide range in pricing. My doctor gave the option of using either GonalF or Follistim, and we went with Follistim because it was cheaper at the pharmacy we chose.

We went with Apothecary Shops, and the total was $1887. Below is a list of medications I was prescribed for the entire cycle:

Follistim 300 (5 vials)
Menopur 75iu (7)
Medrol 4mg (16)
HCG(Novarel) 10,000iu
Leuprolide Acetate 2.8mL (generic)
Lupron 2.8mL multi-vial Kit
Doxycycline 100mg (10)
Progesterone in ethyl oleate oil (2)
Vivelle Dot 0.1mg Patch (8)

My next appointment is Monday morning at 7:45am. We go in to learn how to do the shots, as well as for the trial transfer. The trial transfer is a procedure used to "map out" the shape of my uterus so the doctor knows in advance where he wants to deposit the blastocysts when the time comes.

Integramed Shared Risk

We were accepted into the Integramed Shared Risk plan, which allows 3 frozen and 3 fresh cycles of IVF.

Wednesday, April 16, 2008

How to Make a Girl, Literally

This post is about sex selection. Not whether or not to have it, but how to make a girl or a boy, and the ethical questions.

We were given the option of "selecting" the sex of the embryos they are going to transfer. There are two different ways of achieving this. First, you can fertilize all of the embryos, and then take a cell from each to determine whether it is a girl embryo or boy embryo, and then only transfer the girls back to the uterus. There is a 100% chance of success with this method. Second, they can sort the sperm. Girls over here, boys go over there, see ya boys, you're dismissed for the day. There's a 90% chance of getting what you want that way. I personally think this is the better option of the two. The reason I think it's better, is because then you aren't discarding unused boy embryos, because all of the useable embryos are girls.

We decided not to pick a girl. Our main reason for that is because there is a 50% chance that we are going to have twins anyway, and I'd like to take my chances that we'd get a girl and a boy. Another reason we decided against it involves spirituality and the belief that souls are chosen before birth. What if we were supposed to have a boy, and we stuck it in a girl body? Well I'd be fine with it, but it's just not fair to make a child live their life in the wrong body.

Therefore, we will probably end up with a boy, because that's all that EF's family makes. We'll be happy either way, as long as we get a healthy one.

First IVF Appointment

I started my period on Sunday night, so I called the office Monday morning. My first IVF appointment was set for Tuesday at 7:15am. I had my blood drawn to test my FSH and estradiol levels, and then I had an ultrasound. I was given my prescription for birth control pills, as well as Zithromax 3-day antiobiotic. Both of us have to take the antiobiotic to clear out any minor infections we might have.

The Doctor brought me in to the office to discuss the husband's sperm count. His counts have been fine all along, but when you are planning on IVF they do an additional test called "Strict Morphology", or "Kruger's Test". This test measures the shape of the sperm, but on a more strict basis than what is typically test for the other procedures. Normal range is more than 14%, and the huband's was 3%. The Doctor says this could be one of the main reasons we haven't gotten pregnant yet.

We will have to include ICSI procedures with our IVF. With ICSI, each sperm is hand-selected to be normal, and then injected into the egg directly. Without the assistance, the sperm might not be strong enough to penetrate. You can look at photos of the procedure at:

I would like to advise everyone that is reading this blog before their IVF that they get this particular sperm test completed before spending a lot of money on inseminations. Had we known then that there was a problem with the sperm morphology to that great of an extent, we would have just gone straight to IVF.

Later in the day the Doctor called to tell me my blood test results were normal. My FSH was 8.3 and my estradiol was over 20.

My next appointment is a "trial transfer", where they pretend to put the embryos back in to my uterus, and this allows them to figure out the shape and depth so they know exactly where to put them when the time comes.

Friday, April 11, 2008

Cost of Invitro Fertilization IVF

My doctor offers two different IVF plans: one is "pay as you go", and the other is an insurance program offered through Integramed.

If you choose the first plan, which is called Global Rate, you pay for all your services and medications on a cash basis for a flat rate. If you pay for two fresh cycles and don't get pregnant, they will give you the third cycle for free for the same services. The cost breakdown per fresh cycle is:

$8100 for all services involving the doctor
$500 for anesthesia during the retrieval
$500 for embryo freezing at the end of the cycle
$2000-3000 for medications, per cycle

If you end up with any extra embryos, you can freeze them for the next month, and then you don't have to pay as much. In that situation, the "frozen" cycle is about a total of $3500 including medications. This assumes that the embryos are still alive after thawing, which doesn't always happen. I believe there's a 60% chance that they will be viable after thawing.

In the other option (the Success Program) you have to be 35 years old or less, and qualify medically through the insurance company. If you qualify you can get up to 3 fresh and 3 frozen cycles for a flat rate of $17,000. You have to pay for your medications and thawing separately. At the end of the 6 tries, if you haven't gotten pregnant you get 70% of your money back (70% of the original $17,0000). According to the insurance company there is a 75% success rate at the end of the 6 cycles.

We're going with the Success Program.

I have created a spreadsheet of costs that compares the two options, and if you would like a copy of the excel file you can leave a comment here with your email address and I will send it to you.

Invitro Fertilization IVF Consultation and Process

I went in with my mother-in-law to have a consultation about the next step in our journey to make a girl. Dr. Rosen was very patient with us, and allowed us to ask a lot of questions.

The per-cycle success rate at his practice is 65%. That takes in to account every woman with every issue.

It's a 5-week process, and it starts on the 2nd day after I get my period. I will go in and get a blood test and vaginal ultrasound (yes, while I'm on my period, yuck) and they will start me on birth control pills.

Throughout the 5 weeks I will be on birth control pills as well as 3 (I think?) different injectable hormones, including progesterone. All of these medications work together to create as many eggs as possible.

When the eggs are ripe I will go to their Redondo Beach location to have them removed. They do this surgically, and I will be under general anesthesia. They put my legs in stirrups high in the air, and then use a needle to puncture the vaginal wall and "suck out" the eggs from inside of the follicle sacs they are held in. The number of eggs they remove determines how much pain I'm going to be in. More eggs = more pain.

After they remove my eggs (and while I'm resting) Evan will give a semen sample.

They then take the healthy eggs and put them with the sperm. Hopefully a bunch will fertilize, but there are no guarantees. There is an additional option called ICSI, which is where they make a tiny "nick" in the side of the egg so that the sperm can penetrate easier. This is only necessary if the sperm is too weak to penetrate on its own. We won't really know if this is necessary until after we try the process once.

Hopefully a bunch of eggs have fertilized and turned into embryos. A lot of reproductive endocrinologists will transfer embryos when they are 3 days old, and so they usually transfer more than 2. My doctor transfers 5-day old embryos (referred to as blastocysts) that are already at least 16-cells in size. There is a greater chance that because they have made it to 5 days that they will implant, so they only put in two. If I'm not mistaken, I was told there would be a 50% chance of having twins.

So anyway, after the eggs are fertilized I go back in and the embryos are transferred to my uterus. Hopefully they do their thing, and I go back 11 days later for a blood test.

IUI Intrauterine Insemination

Well, I went through with 4 cycles of inseminations, all with no success. After my very first insemination I felt fine, and then at 5pm that same day my back started hurting. Within an hour I was in bed, in excrutiating pain if I moved my back, and I had a fever of 103. I called the Dr. and he thought it was too soon to have an infection, but he prescribed an antibiotic. I took Tylenol to control the fever, and the next day I was fine. It's a very similar experience to what happened after I had my hsg (hysterosalpingogram), so now I'm thinking it was my body's reaction to being messed with, and not necessarily an infection. That's very good news, because the Dr. thought it was possible that the hsg infection may have done damage to my tubes. Now there's hope that there wasn't any damage.

I was very nervous when I first started the inseminations, but then they became no big deal. The worst part is the cathetar tube that has to be fed into your uterus. My body apparently takes a sharp turn to get to my uterus, so the Dr. asked me to have a full bladder because it "straightens out" my insides.

Now that I have gone through the four inseminations with no success, we are moving on to invitro.