Saturday, January 4, 2014

Second Thoughts

I went to pick up my prescription for the next round of Follistim+Ovidrell on December 31st, concerned that my insurance coverage would change for the new year. It turned out that they had actually billed me inaccurately the three other times I picked up the prescription last cycle! None of these medications are actually covered at all. Instead of the $65 co-copay per Rx (3 total for the cycle), the charge was $1,100 for just one prescription (3x300mg).

I should be extremely grateful that I received such a discount for our first round of injectables. In reality, I felt that this "great deal" was really an as-seen-on-tv piece of crap that looks like a great deal, but it actually a worthless pile of shit that breaks before you can use it.

I left the pharmacy without buying the prescription. At this point, it didn't matter if I waited for the new year. Plus, my ambivalence started to get the best of me. Is this really the right plan? Is this really worth the expense?

In an effort to make sense of this, I find it helps to write down all of my thoughts/arguments and get everything swirling around in my head out in print. Here is a glimpse into my thought process, organized and bullet-pointed:
  • History
    • I do not ovulate by myself.
    • I do not ovulate with the cheaper oral medications, both Clomid or Letrozole.
    • I did ovulate with an injectable regimen, but with 5 mature follicles and perfectly timed intercourse, I did not get pregnant. 
    • The one benefit of PCOS, I produce A LOT of follicles. Too many, even. I've been told this makes me a good candidate for IVF, but also a risk for OHSS and multiples.
  • Costs
    • I estimate the next course of injectables to cost between $ 3,950 - $5,650
      • Follistim prescription: 2 -3 prescriptions x $1,100 each
      • Ovidrell prescription: 1 x ~$100
      • Monitoring appointments: 4 - 6 x ~$300
      • IUI (assuming we still plan on this): 1 x ~$450
    • An extremely rough estimate of IVF costs, including meds and everything involved, is 15K. I haven't looked in to this much, as these wheels just recently started turning. 
  • Outcomes
    • Recent research estimates per cycle success rates of FSH+IUI at ~9%
    • IVF rates in centers around my area range from ~40-55% per cycle, although the RE had given me an estimate of 60% given all our other favorable factors
  • Resources
    • I have a designated medical Flex Spending Account (FSA) for $2,400 for 2014 (essentially, this is coming out of my paychecks, tax free, and I either use it up in the year or lose it)
    • We have approximately 15K in savings, which we have been scrapping for ever since we got married three years ago, intended for a future home down payment. So far, we haven't touched it.
  • Conclusions:
    • Not doing anything (i.e. trying naturally or with minimal intervention) would essentially give us no odds for success
    • FSH+IUI (the original plan) will cost approximately $5,000 for one cycle, using up the entirety of our year's worth of FSA and we will definitely have to begin dipping into the house fund. Adding IUI may add some specificity, but the odds will not be significantly greater than our last cycle, and I am doubtful that I will have 5 mature follicles again, as this wasn't even the goal. 
    • I am concerned that with another one or two cycles of FSH, we will no longer have the option of IVF because our funds will be mostly depleted. 
    • I am terrified that I will fall in the 40+% of IVF probability and be left with no child and no home. I always said I didn't want to do IVF unless we had enough money to do at least two cycles because otherwise the pressure would be too high. 
So what is the right answer? What factors are we missing? What else needs to be considered? The pressure of gambling with our life savings is bigger than I can put into words.

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