Thursday, November 5, 2009

The Wheels on the Bus Go Round and Round...

Dr. NiceGuy: The second opinion appointment essentially confirmed what the first RE told me; albeit in a kinder, gentler fashion. I am a poor responder. Dr. NiceGuy agreed that additional testing would be uninformative at this point, since my lack of response is likely independent of any potential autoimmunity, and clotting mutations are primarily associated with early miscarriage. He also recommends the antagonist protocol. He is more flexible with stimulation drugs, though (follistim + menopur is more expensive and requires 2 needles, vs. bravelle + menopur which can be mixed into 1 needle). He uses endometrin and crinone too, so no more horrible PIO shots (suppositories are also cheaper).

All things being equal, I would love to switch clinics to enjoy his more open philosophy and approach to patient- (rather than clinic-) centered medicine, but it would come at a hefty price. Literally. Our insurance does not work with his clinic, so we would pay ~$20K total out-of-pocket to cycle there. Ouch. At the first clinic, the RE's communication style is a little rough around the edges, but our insurance covers all but ~$2K in medical costs (add on $5-6K for drugs). For the exact same cycle. That's a pretty stark difference. How much is kindness worth?

The Plan: Take a break until January. In the meantime, schedule another follow-up with the original RE. Have a heart-to-heart with her about her bedside manner and lay out my expectations for communication going forward. Discuss what I learned from the second opinion and plan for January. We want to try one more antagonist cycle using bravelle + menopur, then endometrin or crinone. If it fails, we will be ready to move on to a donor egg cycle. We have nothing to lose, so it's push-come-to-shove time.

If it reaches this point, we can compare the costs and protocols for a donor egg cycle at both clinics and go from there. We would probably start adoption inquiries then, too, to begin preparing for home-study and placement processes if the donor cycle should fail. I am an all-angles-covered kind of girl.

My head is still spinning, so I am grateful (if a little teeth-grinding-ly anxious) for the 2-month break before the next (and last?) cycle. The IVF cycle is dead. Long live the IVF cycle.

5 comments:

BB said...

I was thinking of you (and your 2nd opinion appointment) this morning. Your plan sounds like what I would have gone with. BTW, have you thought of alternaive medicine? I am not going to try to sell it to you... but there are +ve results with those too... now whether it is totally random or if it "really" works, I don't know... but might be worth trying while you are on a break?

jenicini said...

Wow, I can't believe that your insurance covers that much. Granted it's from the rigid formula, slightly off-putting doctor, but hey! I like your plan and the fact that you're covering all the angles. I'm with you on that note! I can say yay for a break, but in reality, it's annoying to have to wait sometimes. Hopefully it will be nice to not have the stress during the holidays. :)

ASP said...

I think your idea about laying the communication and bedside manner out to your RE is a great idea. I couldn't imagine having to poop (hahahahaha) AND have a failed cycle. I know that there are lots of people that do, and if we were one of them, I don't think we would've moved forward with the 2nd or 3rd cycle. Before our new insurance came into play that covered IVF, we were going to be switching to a clinic that had the refund program available. Cycling is expensive and when it's "real" money being spent, I think that puts even more stress on an already stressful situation...and not to mention the guilt that it's not working. Anyway, the point I was getting at is 20K seems like an awful price tag for kindness. You'll be going into your RE's office with a plan this time and she won't have a choice but to work with you. She doesn't want to lose a patient. I'm sure of that.

So that being said, CHEERS to being on break until January! The holidays will be much much happier when there's wine involved! ;)

kdactyl said...

I am new to following your blog...I found you from a link to another...so I have finally caught up on your story and am ready to comment. I have been in your position....so I understand a lot of your frustration and pain....

You sound so much like me....wanting to explore all options and have future options on the horizon. I admire your pragmatism, but I still know it is hard to travel this fertility journey. I have been in your shoes. I really hope your original RE will work with you. I have done IVF with and without the PIO shots...beware...the crinone gel inserts are gross, gross, gross! AND...they have a tendancy to really fry your cervix so spotting is to be expected (but that just freaked me out..I could not take the spotting)....personally, I prefer the PIO but statistically...they carry the same pregnancy rates so you are safe either way....just be warned.....

As for looking ahead to egg donor and adoption if needed....you may also want to get on some waiting lists for embryo donation. This is a great option for those who have done everything they can to have a biological child but just have too many barriers. You will still be able to have a pregnancy and delivery and the costs are about 1/3 of a normal IVF cycle. Speak to your RE about it and get on a list if your clinic offers it. We are using this option to get a 2nd child due to my age and my husband's severe male factor. I didn't find this option until about a year after exploring others and I wish I would have known about it earlier. There are also national embryo adoption programs but beware of the ones that want to charge a lot of fees...as with anything else...someone is always looking to make a buck!

Enjoy your "break"...we took one just before we had our successful cycle and it was oh so good for us. It was great to connect to each other again and be intimate without an agenda. I will be praying that January is a great month for you with very positive results.

kd

hope4joy said...

It sounds like a good plan. I hope things go well with the follow up with the original RE. Also, as someone who is doing it, the break is both awesome and wicked. As with everything in IF it is confusing. January will be here before you know it and I will be praying for you.