Help with weighing IVF packages

By Amorini Jul 11, 2015

IVF grads and anyone else with number-crunching insight...

Due to severe MFI and my age (39), our RE (and our second opinion) recommend IVF/ICSI ... and pronto, as my FSH is borderline high (9.8) and the age cliff is imminent. :silly: Seriously, though, we have been NTNP for 7 years and had pretty perfect (however futile!) TI for 7+ months so we are ready to be parents ... but with his extremely low count, our chances are super slim to ever conceive naturally. Despite the ridiculous price tag, we have agreed to go all in and have no regrets in trying to have a biological LO (or LOs).

DH is ready to go for option 2 below, but I have concerns and would like to hear from you. All costs are out-of-pocket. Here are the financial options offered to us by our RE:

1) One IVF/ICSI cycle, includes all monitoring: $12,272

This does NOT include ET anesthesia ($400), SSHSG/TT ($815) meds ($2-5K), embryo freezing ($500), yearly freezing fee ($360), FET ($3,500) or medication instruction visits ($50 each).

2) Multiple Cycle Discount Program - two fresh and two FET included, plus all monitoring: $20,500. Option 2 is completed "once pregnancy is determined at 9-week OB us with fetal heartbeat." Note that this is not a refund or guarantee program.

This does NOT include ET anesthesia ($400), SSHSG/TT ($815), meds ($2-5K or more for multiple cycles), embryo freezing ($500), yearly freezing fee ($360), or medication instruction visits ($50 each).

I realize that processing this is part the emotional roller coaster of IVF and my thinking may be completely irrational. I would probably opt for Option 3 of guaranteed LO and little disappointment at twice the highest price, if it were offered. Ha. That's why I'm turning to some voices of reason and seasoned perspectives. Thanks to all for helping me see straight and evaluate this one!

ETA: I'll add my own pros and cons list in the response, in case it helps to add on to those.

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26 comments

Amorini
persimmon / 1132 posts

Jul 11, 2015

Option 1 Pros and Cons:

Pro: If we are successful the first time or even with adding FET a la carte, we are spending about the same as option 2. According to my RE, she gives us a 40% success rate (doesn’t that seem high, in general?).

Pro: My RE says she expects me to produce lots of mature follicles (good AMH) just not high-quality ones (borderline high FSH), so to not to expect having much to freeze.

Con: No back-up plan if this cycle is a bust.

Con: Because of my good AMH, my first cycle would be a luteal lupron protocol (after bcp month), which I understand wouldn't normally be the case with my high-ish FSH. Because it's unusual to have the AMH high when the FSH is high at my age, I'm concerned the first cycle will be a "learning cycle" for my RE since she will mostly concerned with not overstimulating me (and rightly so). With my LH at normal, apparently I'm considered PCOS-like in terms of what it takes to stimulate (not a lot, she thinks, but I have not had IUIs to test this theory).

Option 2 Pros and Cons:

Pro: We have back-up plan if cycle 1 is a bust and accounts for my concern that cycle 1 may be a "learning cycle."

Pro: I strangely consider it a pro that they even offered this to me given my age. As another post on IVF packages said, they are looking out for their best interest so they hope that it all works out for me on cycle 1.

Con: Fear of ending up pregnant with cycle 1 or even 2 and then miscarrying after 9 weeks. (And why isn't the cutoff at 12 weeks / 1st T?) At that point, we would have sunk about $30K into IVF, having had it work and then have no LO. My fear is that DH would abandon ship with IVF and not try again.

Con: No chance to change clinics if we turn out hating the RE after cycle 1. I doubt this would happen actually, but you never know.
Mrs. Pickle
blogger / wonderful cherry / 21628 posts

Jul 11, 2015

I think in your situation I would go with option 2. I say this because it sounds like your RE doesn't expect you to get many high quality eggs so it might take a couple of retrievals to get to get a handful of embryos.

I know it's a hard decision to make, and a lot of money to spend. I hope you feel confident with whatever you choose.
BSB
hostess / wonderful apple seed / 16729 posts

Jul 11, 2015

We had the same similar decision to make. I don't know if I can be of any help. We definitely took a gamble by doing only one complete cycle. I seen other IVFers have success and some who did not. You have all the pros and cons I would think of.

My clinic had a guaranteed plan but they considered it a success if you made it to 12 weeks. It might be possible that they say 9 weeks because that's when they graduate people to their OB. I thought I would see my RE until 12 weeks but around 6 weeks they said I could call my OB to get something schedule. Last time I saw my RE was 9w6d and saw my OB the week before. My RE did say if I had any issues they could still treat me uptil 12 weeks. I saw my RE at 7 weeks for an IV because they wanted to give me fluids after being nausea. Around the 11 week mark, I felt sick again and was hoping my RE could give me another IV. My OB said they don't do just IVs so I would have to go to the hospital. Guess I didn't want to go to the hospital if I had the ability to do a quick 1-2 hr IV at my RE. Anyway, at that point my RE said he felt better if the OB treated me. It was probably better that I waited, I ended up being admitted for 4 days to the hospital at 12 weeks for HG. The hospital was able to personalize and adjust my meds.

Oh, my guaranteed plan that was offered was within 1 calendar year. So if I got to 11 weeks and m/c and then had to wait until my body recovered then had another transfer... Would I be up against time of the guarantee plan running out? Unfortunately, I forgot to ask my RE about what would happen in that scenario.
FliegepilzHut
pomegranate / 3533 posts

Jul 11, 2015

That's a really tough decision. My reasoning would follow @Mrs. Pickle's-- it might take more than 1 retrieval to get a good number of quality embryos and even if you should have to pay OOP for another FET, they are cheaper and physically much easier. Wishing you lots of luck!
Caly
nectarine / 2765 posts

Jul 11, 2015

It's such a tough decision, I feel for you! I agree with Mrs. Pickle regarding option 2. I also used a similar plan when undergoing IVF (however, they guaranteed a pregnancy til approx 36 weeks) which resulted in my twins. One of the main reasons for me personally was the peace of mind knowing if it was unsuccessful I could easily continue and try again. It really helped put me at ease and gave me some comfort knowing we had options. Obviously, theres a lot to consider and it's tough...I wish you lots of luck!
Amorini
persimmon / 1132 posts

Jul 12, 2015

Thanks so much for these responses! It really helps to not look at this hard question on our own, but instead feel the support of a community. I especially feel so grateful that you as IVF grads continue to post in the threads and share your knowledge and experiences. Virtual hugs all around!

@Mrs. Pickle: Thank you so much. After reading your comment, I recalled that these were some of my RE's exact words. She actually gave me some numbers to put it in perspective because she expects "low attrition," like 30 eggs retrieved, 15 fertilized, 2 making it to day 5. I appreciated her painting a realistic picture for me, especially because I feel in such denial about my own fertility creating any issues for us. Haha. So thanks for your comment as it helped me remember my RE's key perspectives on what our journey might look like... And therefore, what we need to consider when weighing these packages.

@bluestriped bee: Thank you for sharing your own past dilemma and also why the 9-week mark might be in play. It really just helps to hear more and more IVF stories with all of the details because it helps me prepare for the possible outcomes. It also helps to hear about other difficult decisions that IVF grads have had to make, even if they are different than my own. I'm so excited for your twins and so glad you are feeling less crappy. PS. I will definitely be calling WinFertility after I get my list of prescriptions, thanks to your great success with them!

@FliegepilzHut: Thank you for your comment and helping to remind me that it might take more than one ET. I loved yours and all the responses in the other current thread about "what would you go back and tell yourself...." The the overwhelming responses were about being realistic which is what is needed when evaluating these kinds of costs! So excited your LO is almost here!

@ Caly: Thanks for sharing! I'm glad to hear that going with the similar plan truly gave you peace of mind. While there is probably no panacea for the IVF emotional roller coaster, having some built-in comfort in the process definitely seems worthwhile. And congrats on your twins! I love every success story.
brownie
grapefruit / 4110 posts

Jul 12, 2015

There may be tax implications. In order to qualify for the tax credit you must itemize and spend more than 20% of your income on eligible expenses. The higher package may get you to that level and you may get some money back. Also for tax purposes you can count mileage to appointments and hotel stays if they are directly related (we spent two weeks in a hotel and a few hotel stays for early appts). With all of that we spent $20k on just one cycle (which worked).
Thenetexan
apricot / 355 posts

Jul 12, 2015

You should ask your RE about PGD (pre genetic testing). They are able to determine if the embryo has all the right chromosomes before implanting, allowing you to only move forward with healthy embryos that are more likely to be successful. It comes with a cost, but could save you some cycles, stress, and emotion.
BSB
hostess / wonderful apple seed / 16729 posts

Jul 12, 2015

@brownie: A bit of a correction on what you wrote. You are able to deduct medical expenses that exceed 10% of your income. So you have to hit that 10% mark and any expenses beyond that can be deducted.

http://www.irs.gov/uac/Claiming-a-Tax-Deduction-for-Medical-and-Dental-Expenses

I did that last year, but what is not mentioned is that there is a salary cap. I took out money through stock & investments to pay for IVF. In the end, I was no able to use the deduction. If anyone is creating income to pay for IVF, wall me and I'll tell you what the salary cap is.
Amorini
persimmon / 1132 posts

Jul 12, 2015

@brownie: Thanks for reminding me about this very important point. Getting over the % of income has always kept us from itemizing in the past. (I recall naively saying to our accountant a few years ago that I can't imagine ever having enough medical expenses to qualify!) Like @bluestriped bee said, I have read that we need to have at least 10% of our income. And I do plan to keep every itemizable receipt. We are traveling 2 hours each way to our RE (except for monitoring) so it will include overnight stays for sure. This will all add up for sure!

@bluestriped bee: I'm sorry to hear that your expenses weren't deductible in the end, but sounds like twins will more than make up for that (not to mention getting to claim them on next year's return!). I am curious what you mean by "creating income to pay for IVF." I can wall you for more details once I upgrade, but I'm a little confused what that means.

@Thenetexan: Thanks for bringing up PGD. I actually did ask our RE already about PGD for cycle 1 due to her mentioning the egg quality issue. Her response was that thought it might be something to consider if we run into major quality issues, but that my labs alone don't indicate PGD as a necessity at this point. Also she had DH's DNA karyotyped for abnormalities to see if that was the root cause of his MFI -- those results came back all normal. Despite the added cost, I was ready to have PGD recommended from the get-go and but based on my RE's evaluation, it isn't worth the cost .... At least not yet. I have done some reading, but haven't pressed the issue. Certainly if you have any further recommendations or experience, please let me know!
Amorini
persimmon / 1132 posts

Jul 12, 2015

@bluestriped bee: just to clarify, I know what you mean about "walling you for details" just not about "creating income." I re read my sentence and it could have been read either way!

This question has brought up so many interesting angles. Thanks to all!
BSB
hostess / wonderful apple seed / 16729 posts

Jul 12, 2015

@Amorini: We 'created' (maybe generated is a better term? Sorry, not an accountant.) income by selling stock and investments so I made a lot more money on paper last year. It bumped us into a higher tax bracket and then we couldn't deduct our medical expenses which came out to be 32% of our income. Yeah, that sucked. I can't complain because I'm lucky to have the option to sell stocks to pay for IVF.
agold
grapefruit / 4045 posts

Jul 12, 2015

I'm so sorry you have to even be considering all of this. Its such a tough decision. Under your circumstances, I would probably go for option 2. $20,000 is the price I will be for one round of IVF, a fresh transfer, a mock cycle and a FET. So if I could pay $20K and get two IVF egg retreivals, I would strongly consider that if I had any ability at all to pay for that. Have you considered the option of just paying for all of this a la carte style? Is that an option? If I need another IVF egg retreival cycle, a second one costs $6,500.00 but has to be purchased within 6 months from the 1st cycle. Then a third cycle goes down to $5,000 but has to be purhcased within 6 months of the second cycle. Sorry if you already stated this above, but do you know when you would have to go through the second IVF if you picked option 2? Hopefully it gives you enough time to reasonable go through with it should you need it. But if you think you would want to try two IVFs, and its cheaper to get option 2 in that regad, I would go with it.
momazon
kiwi / 613 posts

Jul 12, 2015

@Amorini: Do any clinics around you have shared risk or guarantee programs that you could use? I did a shared risk refund program and it saved us, allowing us to have the money to move on to donor eggs, once all my own egg IVF cycles failed. In any case, the peace of mind that paying for extra cycles in advance brought me was very reassuring.
Amorini
persimmon / 1132 posts

Jul 12, 2015

@bluestriped bee: Gotcha. That is a bummer. I share the same feeling of "feeling lucky" we happen to afford IVF at this point in our lives. We sold our condo for a profit last year and have been renting in preparation to figure out where to buy again. Suddenly what we were going to mostly pour into a new home will partly go to IVF. Totally sucks (not to mention renting again!) but I still feel grateful we can do this.

@agold: Thanks for your comment and other angles to consider! I'm sorry that you are also in this boat! By the way, I rechecked some of my IVF quoted costs from what I shared in your fresh cycle thread, so they a tad different from what I said yesterday. In the end, though, I think you are right -- they seem pretty much in the same neighborhood of costs. In terms of just paying a la carte, yes it would be an option, but we would exceed Option 2's price if we need a second cycle (egg retrieval) since that's the expensive part with all the monitoring. That's interesting that your clinic offers a scaled price for subsequent retrievals. Mine doesn't so that's what makes the Option 2 appealing (well, in context ... nothing about this is appealing!). You raise a good point about timing for a potential second cycle. I'm trying to take this one step a time, but given my situation, I guess I have a 60% chance of a second cycle (if I only have a 40% chance of success on the first round). Given the age cliff, I probably will be encouraged to move to cycle 2 as soon as I am physically ready. Not sure if it's advised, but that's all the further I can really think in the future for now! I agree, though, that the Option 2 is looking like a clearer choice now.

@momazon: Thanks so much for your thoughts on this. Unfortunately, we don't have too many clinics nearby to choose from. The nearby RE (who we didn't choose) had a reputation for being difficult to work with, so we went to the one that is 2 hours away. (My OBGYN and DH's urologist concurred with the RE -- they were our second opinions.) With our RE, we weren't offered any other plans, but it's interesting that yours rolled in the embryo donation route. Embryo donation is something I am open to, but my DH is not yet so that would have been a hurdle in itself, if we had been offered a plan like that. (We are headed to counseling as IF has brought up so much that we never knew we strongly disagreed about!). At any rate, I really appreciate your thoughts and I'm further encouraged to hear that your plan brought peace of mind. I have been following the IF thread and haven't officially joined so big congrats on your pregnancy and best wishes for a healthy LO!
momazon
kiwi / 613 posts

Jul 12, 2015

@Amorini: My clinic has separate shared risk refund programs for own eggs and donor eggs. Once I "failed out" of the own egg program, I got a refund of the money I'd paid in (meds and some pre-testing costs were paid separately). With that money I got back, I purchased into the donor egg program (which was more expensive), as I felt I had given my eggs more than enough chances (and at 38 with over five full years of trying behind me, I was ready to move on.)

Good luck with your decision making!
agold
grapefruit / 4045 posts

Jul 12, 2015

@Amorini: Yep, its too bad we are both in this boat. But at least we have this option available to us, right? (Even if we are gouging our eyes out trying to figure out how to pay for it. ) When do you think you will be proceeding with your IVF cycle?
agold
grapefruit / 4045 posts

Jul 12, 2015

@bluestriped bee: I've tried to google the income limitations for tax deductions and I can't find them anywhere.
Amorini
persimmon / 1132 posts

Jul 12, 2015

@momazon: Wow, that's an amazing plan. You've inspired me to ask my RE about how they work with those that fail out and opt for egg donation. Even though it wasn't originally offered it, a similar plan might exist in another fashion at my current RE. I found that in our RE follow-up, she waited until I brought up egg or embryo donation before elaborating on that as a possible route if my own eggs aren't as viable as she thinks. Anyway, it doesn't hurt for me to ask and have a back-up to our back-up plan (albeit, after some things are worked out in counseling!) While I haven't been though all that you have been through, in terms of giving your own eggs a chance, I can understand that there comes a time to face facts and move on. Most days since we learned of DH's MFI, I feel that way. Let's do this! Thanks so much for sharing and adding this facet to the conversation!
BSB
hostess / wonderful apple seed / 16729 posts

Jul 12, 2015

@agold: I looked, too. I couldn't find anything. I did use a tax software for our taxes because I was told it could do deductions but I couldn't deduct it because of my income. I used H&R block software so I have the ability to see a person to check my taxes.
agold
grapefruit / 4045 posts

Jul 12, 2015

@bluestriped bee: Well thanks for this heads up. You've had some great info.
Amorini
persimmon / 1132 posts

Jul 12, 2015

@agold: I could start my next CD 1 on bcp's but I starting a new position tomorrow which requires some intensive training later this month. So naturally I'll wait until my next CD1. How about you?

Regarding the income limitations, I vaguely know what it might be for us based on a previous year's return. Sadly, my dad also went through this to pay for my brother's uncovered medical bills. What he told me was that he was able to deduct $30K but, in the end it was ended up deducting about $3500 due to his income (retirement pension of roughly $100K). That's just some rough figures, but I agree with bluestriped bee that having an expert look over the figures would be the thing to do.
agold
grapefruit / 4045 posts

Jul 12, 2015

@Amorini: I'm going to skip my next cycle also for work reasons and then start at that time. I'm currently CD18, but my cycles have been a little wonky after doing the IUIs so I'm not sure when to expect my next CD1. It really looks like we might be going through this together!
NorthStar
pear / 1881 posts

Jul 13, 2015

@Amorini: Thank you SO much for posting this! I was thinking about doing the same as it's very hard to determine what makes the most sense. We are trying our 2nd IUI currently, but if this cycle and the next doesn't work, we will be moving onto IVF. I've been putting thoughts into my husband's head regarding these things we need to consider.

Good luck in making your decision!
FliegepilzHut
pomegranate / 3533 posts

Jul 13, 2015

@Amorini: Thanks! It's kind of alarming how quickly things move at the end!
Amorini
persimmon / 1132 posts

Jul 14, 2015

@agold: Glad we won't be facing this alone! See you on the IVF cycling thread when we get there!

@NorthStar: Good luck with your IUI. Hoping this is it for you! We will be here for you regardless!

Thanks to all for helping me look at this with eyes wide open. I still have a few more questions for my RE, but I think I feel more comfortable with Option 2 / the multiple cycle plan now. I have been lurking on the IVF cycling thread but I haven't introduced myself yet there -- see some of you there soon! Thanks again and best of luck to all, no matter where you are in your family-making!