HELP! NEED ADVICE ON UPCOMING IVF AND RE CHOICE

HELP! NEED ADVICE ON UPCOMING IVF AND RE CHOICE

Holly
Holly

July 20th, 2012, 4:40 pm #1

Hi Gals:

I don't post very often but I ALWAYS appreciate feedback. I'll start with my numbers: CC Test FSH = 13.7; Follicle count 9; AMH level .11; 39 years old - 40 end of Oct. TTC for 3 years; PG naturally in January which ended in spontaneous abortion at 20 weeks - Downs. One daughter - 6 years old.

Ok, I live in Wa State. I've been working through Seattle Reproductive. Their cutoff on FSH is around 14/15. I just got the preliminary on my meds for this first cycle in August and its around $5000. I have a $40,000 lifetime benefit through my husband's insurance for IVF. That INCLUDES meds. After I found out how much the meds were going to cost I asked the clinic to give me a breakdown of the rest of the cycle including ICSI. The total cost including the meds was around $18,300 (13,300 for the cycle).

That means I'll most likely only get two cycles out of my benefit (maybe that's normal for a woman my age). Now here's where I'm in a quandry. Don't know if I'm over thinking this or what. I'm not opposed to paying that amount if I know I have the BEST. When I mean the BEST I'm referring to a doctor that sees my numbers day in and day out and still can perform a miracle. My RE at Seattle Reproductive (which I really like) assures me that he's treated lots of woman in the same boat. The clinic has a good success rate for women in my age group (30-35% PG rates). I think my RE told me that I have roughly a 40% chance of becoming pregnant in each cycle and a 25% chance of a live birth. If I committed to 3 cycles he thought I'd have a 80% chance of becoming PG and 50% chance of live birth.

So ladies, do I travel outside the state to see a better RE then what I'm dealing with now keeping in mind the costs? Do you think I should stay where I'm at or go to someone better equipped for my situation? Or, does it really matter? I don't want to blow this gift due to convenience. If any of you out there are dealing with really great RE's that are specialized for our situation (women approaching or over 40) would you let me know.

This is a huge decision and I need a little nudge one way or the other.

Thank as always!

Holly
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jkl
jkl

July 20th, 2012, 5:21 pm #2


and know what protocol you want to do I think you can go anywhere. Also, figure out the meds. There is a lot of data for high fsh that high stims are bad or they don't actually help you get more eggs. Unfortunately, most REs don't seem to know this and always want to do high stims. For you it's even more important because you may be able to do more cycles if you use lower stims (as it will be a lot cheaper).

I debated about clinic but ultimately went to a local convenient clinic (which was also cheap) but after the first high stim cycle I did the protocol I wanted to do (E2 primimg and low stims) I had success (at 39, 40 when I delivered).

So I think if you really inform yourself (but given that it sounds like you haven't done any cycles that may be hard) a local clinic may be fine or you may want to go to REs more experienced with high FSH/older women if you don't feel confident.

Also, there are some veyr cheap clinics that would allow you to do many more cycles with your money--including Coo.per, C.NY.

Also, I informed myself almost entirely off these boards so they were very valuable to me.

I have seen a lot of people doing the wrong protocol to begin with (usually high stims with lupron), having it canceled, and wasting a lot of money.

GL. I am so sorry about the loss of your pregnancy at 20wks, that must have been very hard.

jkl
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Kim
Kim

July 20th, 2012, 5:24 pm #3

Hi Gals:

I don't post very often but I ALWAYS appreciate feedback. I'll start with my numbers: CC Test FSH = 13.7; Follicle count 9; AMH level .11; 39 years old - 40 end of Oct. TTC for 3 years; PG naturally in January which ended in spontaneous abortion at 20 weeks - Downs. One daughter - 6 years old.

Ok, I live in Wa State. I've been working through Seattle Reproductive. Their cutoff on FSH is around 14/15. I just got the preliminary on my meds for this first cycle in August and its around $5000. I have a $40,000 lifetime benefit through my husband's insurance for IVF. That INCLUDES meds. After I found out how much the meds were going to cost I asked the clinic to give me a breakdown of the rest of the cycle including ICSI. The total cost including the meds was around $18,300 (13,300 for the cycle).

That means I'll most likely only get two cycles out of my benefit (maybe that's normal for a woman my age). Now here's where I'm in a quandry. Don't know if I'm over thinking this or what. I'm not opposed to paying that amount if I know I have the BEST. When I mean the BEST I'm referring to a doctor that sees my numbers day in and day out and still can perform a miracle. My RE at Seattle Reproductive (which I really like) assures me that he's treated lots of woman in the same boat. The clinic has a good success rate for women in my age group (30-35% PG rates). I think my RE told me that I have roughly a 40% chance of becoming pregnant in each cycle and a 25% chance of a live birth. If I committed to 3 cycles he thought I'd have a 80% chance of becoming PG and 50% chance of live birth.

So ladies, do I travel outside the state to see a better RE then what I'm dealing with now keeping in mind the costs? Do you think I should stay where I'm at or go to someone better equipped for my situation? Or, does it really matter? I don't want to blow this gift due to convenience. If any of you out there are dealing with really great RE's that are specialized for our situation (women approaching or over 40) would you let me know.

This is a huge decision and I need a little nudge one way or the other.

Thank as always!

Holly
There is a place called Santa Monica Fertility in CA that does Z.I.F.T on a regular basis and has great success with 40+ women and Z.I.F.T. At your age though and responding well enough you could be in for multiples? I know Dr. J there lectured a 45 year old patient, a friend of mine, about putting back 8 zygotes the next day after retrieval in her fallopian tube and mentioned selective reduction to her. I think if you can manage more than 5 embies or zygotes over 45 there have been studies of success. My friend had two sacs originally but only one baby that she is about to deliver. I truly believe it is better to get the fert. eggs back into the mother as soon as possible to improve chances....my friend elected to do CVS testing and amnio at later stages instead to make sure her baby was fine. So if you intend on not doing PGD or genetic testing of the embies, then this procedure could be a good one.

There are plenty of women here on the west coast that may be able to direct you other RE's, but they probably will be in CA. Think MIR is working with a place in CA that she likes and opts for low-stim IVF and freezing embies at blast stage. I'd also look into the low-stim cycle option with vitrification too. These mini-IVF cycle meds are very inexpensive, and some times the RE's give discounts for multiple rounds of mini-IVF so that is like have 3 minis for one full-blown IVF?
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Kim
Kim

July 20th, 2012, 5:25 pm #4

Also like jkl said places that want you to use high stims are probably not the best always. Dr. J at Santa Monica will use moderate stims (300-450iu per day) tops usually I thought.
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jkl
jkl

July 20th, 2012, 5:34 pm #5

and know what protocol you want to do I think you can go anywhere. Also, figure out the meds. There is a lot of data for high fsh that high stims are bad or they don't actually help you get more eggs. Unfortunately, most REs don't seem to know this and always want to do high stims. For you it's even more important because you may be able to do more cycles if you use lower stims (as it will be a lot cheaper).

I debated about clinic but ultimately went to a local convenient clinic (which was also cheap) but after the first high stim cycle I did the protocol I wanted to do (E2 primimg and low stims) I had success (at 39, 40 when I delivered).

So I think if you really inform yourself (but given that it sounds like you haven't done any cycles that may be hard) a local clinic may be fine or you may want to go to REs more experienced with high FSH/older women if you don't feel confident.

Also, there are some veyr cheap clinics that would allow you to do many more cycles with your money--including Coo.per, C.NY.

Also, I informed myself almost entirely off these boards so they were very valuable to me.

I have seen a lot of people doing the wrong protocol to begin with (usually high stims with lupron), having it canceled, and wasting a lot of money.

GL. I am so sorry about the loss of your pregnancy at 20wks, that must have been very hard.

jkl
here is the link for the SART data for your clinic for 2010. You can look at the DOR diagnosis and it's not that impressive (1/12 live birth) but maybe those were some hard cases (which I don't think you are).

https://www.sartcorsonline.com/rptCSR_P ... cPKID=2393

Anyway, you can look up most clinics success rate from this website.

jkl
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Holly
Holly

July 20th, 2012, 5:49 pm #6

How did you figure that? I didn't even think to look at DOR
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jkl
jkl

July 20th, 2012, 5:55 pm #7

it's a drop down menu that you can look at the stats by diagnosis. this can give you the info as to whether your clinic cherry-picks its patients or not. Also, the donor data will tell you how good a lab it is.
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Holly
Holly

July 20th, 2012, 6:39 pm #8

Cooper has a 10.5% live birth after transfer. What do you think is a reasonable % in that dept. He's dealing with 74 cycles in my age group with DOR whilte Seattle Reproductive is dealing with 17 in one year. Just your thoughts.
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Joined: August 6th, 2011, 6:43 am

July 20th, 2012, 7:14 pm #9

Hi Gals:

I don't post very often but I ALWAYS appreciate feedback. I'll start with my numbers: CC Test FSH = 13.7; Follicle count 9; AMH level .11; 39 years old - 40 end of Oct. TTC for 3 years; PG naturally in January which ended in spontaneous abortion at 20 weeks - Downs. One daughter - 6 years old.

Ok, I live in Wa State. I've been working through Seattle Reproductive. Their cutoff on FSH is around 14/15. I just got the preliminary on my meds for this first cycle in August and its around $5000. I have a $40,000 lifetime benefit through my husband's insurance for IVF. That INCLUDES meds. After I found out how much the meds were going to cost I asked the clinic to give me a breakdown of the rest of the cycle including ICSI. The total cost including the meds was around $18,300 (13,300 for the cycle).

That means I'll most likely only get two cycles out of my benefit (maybe that's normal for a woman my age). Now here's where I'm in a quandry. Don't know if I'm over thinking this or what. I'm not opposed to paying that amount if I know I have the BEST. When I mean the BEST I'm referring to a doctor that sees my numbers day in and day out and still can perform a miracle. My RE at Seattle Reproductive (which I really like) assures me that he's treated lots of woman in the same boat. The clinic has a good success rate for women in my age group (30-35% PG rates). I think my RE told me that I have roughly a 40% chance of becoming pregnant in each cycle and a 25% chance of a live birth. If I committed to 3 cycles he thought I'd have a 80% chance of becoming PG and 50% chance of live birth.

So ladies, do I travel outside the state to see a better RE then what I'm dealing with now keeping in mind the costs? Do you think I should stay where I'm at or go to someone better equipped for my situation? Or, does it really matter? I don't want to blow this gift due to convenience. If any of you out there are dealing with really great RE's that are specialized for our situation (women approaching or over 40) would you let me know.

This is a huge decision and I need a little nudge one way or the other.

Thank as always!

Holly
I cycled at SRM twice with my OE at age 43, no insurance coverage. I paid for their two cycle plan and was given a 20% chance of pregnancy with a 10% chance of live birth. Sadly the second cycle ended in a chemical pregnancy and I moved on to DE with them and now have a wonderful baby boy

I think they are a great clinic and if I were you I would just stay there. My OB also highly recommended my RE. I've met four or five of the doctors there with my retrievals, transfers and monitoring. My RE told me they have a great lab. I went to all their new patient meetings and listened to the embryologists. I think they are really a great clinic and I don't see any reason for you to go anywhere else.

I wish you luck!

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Joined: September 16th, 2011, 4:55 am

July 20th, 2012, 7:59 pm #10

Hi Gals:

I don't post very often but I ALWAYS appreciate feedback. I'll start with my numbers: CC Test FSH = 13.7; Follicle count 9; AMH level .11; 39 years old - 40 end of Oct. TTC for 3 years; PG naturally in January which ended in spontaneous abortion at 20 weeks - Downs. One daughter - 6 years old.

Ok, I live in Wa State. I've been working through Seattle Reproductive. Their cutoff on FSH is around 14/15. I just got the preliminary on my meds for this first cycle in August and its around $5000. I have a $40,000 lifetime benefit through my husband's insurance for IVF. That INCLUDES meds. After I found out how much the meds were going to cost I asked the clinic to give me a breakdown of the rest of the cycle including ICSI. The total cost including the meds was around $18,300 (13,300 for the cycle).

That means I'll most likely only get two cycles out of my benefit (maybe that's normal for a woman my age). Now here's where I'm in a quandry. Don't know if I'm over thinking this or what. I'm not opposed to paying that amount if I know I have the BEST. When I mean the BEST I'm referring to a doctor that sees my numbers day in and day out and still can perform a miracle. My RE at Seattle Reproductive (which I really like) assures me that he's treated lots of woman in the same boat. The clinic has a good success rate for women in my age group (30-35% PG rates). I think my RE told me that I have roughly a 40% chance of becoming pregnant in each cycle and a 25% chance of a live birth. If I committed to 3 cycles he thought I'd have a 80% chance of becoming PG and 50% chance of live birth.

So ladies, do I travel outside the state to see a better RE then what I'm dealing with now keeping in mind the costs? Do you think I should stay where I'm at or go to someone better equipped for my situation? Or, does it really matter? I don't want to blow this gift due to convenience. If any of you out there are dealing with really great RE's that are specialized for our situation (women approaching or over 40) would you let me know.

This is a huge decision and I need a little nudge one way or the other.

Thank as always!

Holly
You might want to consider trying a low stim/EZ-IVF cycle first to save money--if the results are encouraging you can do a 3 cycle package somewhere that specializes in that and get more chances at success before you hit the cap on your insurance, without having to put your body and wallet through a high stim cycle... and if it doesn't work then you can move on to a high stim protocol. I tried high stim first and wasted like $7-8,000 on meds for a cycle that was a complete failure before moving on to low stim, which has produced much better results for me. The reasons for my trying high stim first made sense, but now of course I can't help wishing I had tried it the other way around! Hopefully you'll have better luck with whatever you decide.
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