Flip Flopping

We had a consultation for IVF (and other less-intense options if possible) last Tuesday with the doctor I love, at the competing hospital system from my employer (UH). He was very frank with us that there is isn't much different he would do this time to increase the odds and that he was in complete support of moving forward with IVF. We discussed the whole protocol, timing, and asked a million questions. Honestly, he answered most of my questions before I had a chance to ask.

He would have me on birth control starting with my next cycle so that we could have complete control of the timing. I would begin Lupron halfway through this cycle and then start taking stimulation hormones on the first day of my cycle. He recommends all patients give a frozen sperm sample to minimize pressure and timing issues. My egg retrieval could be scheduled any day of the week and then the transfer would be either day 3 or five depending on how the eggs were progressing (he avoided giving any strict criteria). They automatically do ICSI and assisted hatching with all embryos, at not additional cost. He discussed transferring either one or two embryos, per ASRM guidelines, and gave us objective data of pros and cons for both options, essentially leaving it up to us. He recommended freezing extra embryos for a FET cycle as Plan B, or for a second child one day, with a yearly cost for storage not billed until next January. He recommended genetic screening for me and required STD screening for both of us and a hysteroscopy for me, but not other testing was required since it had been less than a year since our HSG and Semen Analysis and other basic labs. He did not have any specific recommendations for other things to do that could be helpful, but did say that many of his patients find acupuncture helpful, and that he does not recommend bed rest after the procedure. Actually, to be clear, he jokingly told us we could head to Cedar Pointe based on all the research, but probably would recommend sticking with normal daily activities.

He was also very honest with the fact that their statistics are not currently on SART. Because of some political issues, which I know all too well from working in a large hospital system, he and a few other doctors left CC hospital a few years ago to re-establish the fertility program at UH. Because of this, the program is relatively new but the doctors are not. He said that their statistics will likely be lower than CC for the first year because they had some issues with the lab, but that these issues were resolved within the first few months and now he suspects that the statistics are comparable. I believe him and am personally not worried about the statistics, although my heart did break a little when I thought about people undergoing IVF during these initial months when their lab was being funky.

At the end of the appointment, we were honest that we may be considering CC hospital from a financial perspective. He was extremely understanding of this position and provided us with several specific doctors that he would personally recommend we see. This is good, because I wouldn't consider returning to my past doctor no matter what the savings and statistics showed!

I had the CC appointment this past Wednesday. (When I get set on something, I am far too impatient for my own good.) This doctor was a She, and she is extremely young, just graduating from her fellowship last year. I actually think of this as a good thing, as a young professional myself. I'd like to think that she's more driven and motivated for success, is more up-to-date on the research, and isn't yet set in her ways or too comfortable. This is clearly my bias, but I'm sticking to it. I also understand that she has less experience, but CC really focuses on the team approach of physicians, so I trust that she can turn to her more experienced colleagues if need be.

We actually began the consultation with me explaining why I left CC for UH in the first place. She very sincerely asked what my issues where and then candidly talked about how she might remedy these in the future. I said that the issues boiled down to two things, 1) that I felt my care and decision was very inconsistent depending on the day I came in and the doctor assigned to my case that day and 2) I felt like decisions were made for me and prescribed rather than allowing me to be a part of the decision making progress. She said that the second issue would be easy to address and proceeded to talk about all the different decisions that I would be a part of. The first issue is a little trickier, because they do have a team model, but she assured me that I could email her anytime and bring up any concerns or discrepancies.

She then told me her proposed plan. I could actually begin birth control pills immediately, given that I'm halfway through my cycle and never get periods on my own, which means could actually move forward quicker than I thought originally (did I mention I'm impatient). She would recommend an Antagonist Protocol given that my very high response to stimulant in the last cycle. Much of the other procedures were the same. She also recommended ICSI be done with all eggs, which is also a part of the package price, but did cite this as a choice that C and I could ultimately make if we chose. She said the embryologist would choose which embryos would freeze, often by letting them develop until day or 5 or even 6 and seeing which ones reach blastyocyt stage. She reported that their FET cycles were as good as their fresh cycles. The same tests were recommended/required and she did not initially mention having a frozen sperm sample but was very open to it when I brought it up. She did say that fresh sperm are considered slightly optimal so they would still want this as well if at all possible.

And then there are the numbers. CC's statistics are very promising. For Day 3 transfers at my age, they had a 56% pregnancy rate and for Day 5 blastocysts it was 80%. The frozen embryos transfers were comparable at 47%. And the other important numbers: price. As an employee at CC, I am given a 60% discount from the IVF package, making it less than $4,000. This includes ICSI, assisted hatching, and up to 5 monitoring appointments. It does not include any medications.

C and I decided, before my CC appointment, that if I felt comfortable with this new doctor and her plan, that we should take advantage of the discount. This would actually mean that we could afford both a fresh and FET cycle (if needed) and maybe still have some leftover for a home. This is something that we feel much more comfortable with.

So this is it. We're moving forward with CC and Dr. F. I'm an impatient flip-flopper. Let's do this!