Coming Up For Air

The last two weeks have been a whirlwind as I wrapped up two big projects for two separate clients, planned (and purchased everything for) the babies' birthday and purchased all of their Christmas gifts. I still have to shop for, oh, everyone else. Which is another 10 people, I think?

I have two proposals to write for new client contracts. I still haven't decorated a stitch of my house. I have half-built furniture in my garage that needs to be finished so I can park my car before it starts snowing. And I'm feuding with half of my extended family. I need a vacation. Seriously.

I don't know whether to scratch my watch or wind my ass most days. And just in case this time of year wasn't keeping me busy enough I have yet to stop bleeding since my FET failure on November 3rd. That's right, I got my period on November 10th and never.stopped.bleeding.

For anyone trying to do that math on that - it's 26 days and counting. I had my revisit and consult at my RE's office this morning to discuss IVF #4 and this bleeding nonsense. And just in case today had a chance of going well, I got pulled over on the way to the RE's office for speeding and was written a ticket. The cop was nice enough to write it for failing to obey a traffic sign (namely, the one that had the speed limit posted at 55). He was seriously the nicest police officer I have ever encountered.

So back to my endless bleeding. We basically established that no one knows why I am bleeding, but it's likely a result of the type of progesterone I was on and moving forward I can either switch to PIO or elect to do an unmedicated FET. The latter is what was recommended and is what we are most comfortable with. We also discussed limiting fertilization and doing an sET (and only sETs moving forward) with IVF #3.

I will not cycle again until I am back to normal - which involves getting a period, ovulating and getting a period again. So likely some time in late January. We've agreed to do some cycle monitoring to figure out if my body will reset itself on its own or if I'll need my RE to intervene and restart my cycles. My next clinic appointment is Friday and I will repeat clinic visits every 4-7 days until we establish a normal functioning pattern with my cycle. Overall it was a nice meeting and I like my RE, so I left the conversation feeling happy and ready to move forward.

Following my revisit I met with the financial coordinator to discuss the balance on my account and paying for IVF #3. Halfway through my FET I maxxed out my insurance benefits. Moving forward we are 100% OOP for monitoring, cycle costs and storage. Thankfully I still have meds coverage.

Now before I go any further let me just say, for the record, that I absolutely know how fortunate we are to have had insurance, even for a limited amount of time. While we still paid a coinsurance and lots of fees, copays, etc. over the last three years, it does not even add up to what others have paid in order to conceive.

That said, I found out today that my RE's advertised cost for an IVF cycle ($3500) is just that, the cost for a cycle. They charge an additional $2500 for monitoring, making a total fresh cycle (without meds) $6000. The other clinic in our area charges similar fees, making the cycling costs relatively equal and their cycles may have an edge over my clinic's offering because they freeze eggs and vitrify embros. And now we have some choices to make and I would love the advice of others.

Some things to keep in mind:

* Both clinics offer free FET cycles for up to 1 year if your fresh cycle fails.
* Both clinics have similar success rates for fresh cycles.
* I've done 2 fresh IVFs and 1 FET with my clinic. Both fresh cycles resulted in pregnancies.
* The other clinic has higher success rates for FETs (likely due to vitrification).

Option A: 

Stick with my clinic, pay $6000 OOP for a single fresh cycle. Limit ICSI to 6 eggs, discard any eggs above and beyond those six. Push all fertilized embryos out to day 5 and transfer the single best embryo. Freeze any embryos that remain separately. If the fresh cycle fails, move onto an unmedicated FET.

Option B:

Switch clinics, pay $5762.50 for a single fresh cycle. Limit ICSI to 6 eggs, freeze any eggs above and beyond those six. Push all fertilized embryos out to day 5 and transfer the single best embryo. Freeze any embryos that remain separately. If the fresh cycle fails, move onto an unmedicated FET. If/when I run out of embryos, cycle with my remaining eggs.

Option C: 

Switch clinics, pay $6950 for two fresh cycles. Limit ICSI to 6 eggs, freeze any eggs above and beyond those six. Push all fertilized embryos out to day 5 and transfer the single best embryo. Freeze any embryos that remain separately. If the fresh cycle fails, move onto an unmedicated FET. If/when I run out of embryos, do another fresh cycle before attempting to cycle with my remaining eggs. At this point we would pay an additional $750 for another cycle of monitoring. 

If I get pregnant with the first IVF, we eat the cost of the multiple cycle. So essentially I pay an additional +/- $1200 for the insurance that if we have to do another fresh it is only $1950 (versus $5762.50) for a subsequent fresh cycle. 

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Right now I'm leaning toward Option B, as it gives me the most opportunities for conceiving with one single fresh IVF cycle and at the lowest cost. However, Option B requires me to start all over again at a new clinic, with new doctors and I'm afraid of change. (My Achilles heel.)

Option A, leaves me very little room for error, but allows me to cycle at my current clinic where I've been successful before and I am comfortable. 

Option C, gives me the most options overall. But I wonder if I go through another year (or more) of IVFs if I'll want to do another fresh cycle after who knows how many FETs and BFNs. And the cost is a big gamble, all things considered. 

So ladies, what would you do if this were you?