Last week, K (my hubby) and I traveled to the Denver area for our “One Day Work-Up” (ODWU). This work-up is required by CCRM before you can cycle there, and it involves approximately 6-7 hours of tests, instructions, and enough information to make your head spin Exorcist-style. You must be between Cycle Days 5-13 on the day of the test.
I scoured Google before our trip, looking for first-person accounts on blogs, so I thought I would detail our own experiences here.
Warning: The ridiculous length of this post is not for the faint of heart!
In my next few posts, I will talk about where we stayed, where we ate, and what we did while NOT at CCRM. In a future post, I will also talk about two headaches we have already incurred while dealing with CCRM, and suggestions on how you can avoid the same mistakes.
We are just one short nonstop flight from Denver, so we flew in the morning of the ODWU. We woke up at 3am to make a 6:10am flight, and we arrived at Denver International Airport at 7:15am Mountain Time. We took a bus to Budget Rent-a-Car and picked up a Chevy Cobalt. We took the toll road (for a hefty $12.25 fee*).
** BTW, cash is not accepted on the toll road. Instead, a sensor somehow tracks your mileage, and the credit card you provide to Budget is charged with the toll fee many days later.
Anyway, we arrived at CCRM at 8:40am for our 9am appointment, and we breathed a sigh of relief. We checked in with the receptionist and were given the day’s schedule. The order in which the appointments take place may vary, but I believe the ODWU includes all of the “appointments” detailed in the following paragraphs.
Minutes later we were called back by our assigned nurse, Dawn. She spent two hours reviewing general information–the IVF process, CCRM’s business practices, contact information, an explanation of a typical medication protocol, and then demonstrations of how to administer some of the injectable medications that I did not use during my first cycle (Menapur, Cetrotide). We were able to ask her any questions we had, and she did her best to answer.
At 11:00am, I checked in with the front desk again (which you must do after every single appointment throughout the day, annoyingly), and shortly after got called back for my doppler ultrasound. K went to the basement to do his manly duty*.
** Later he informed me that the process has its pros and cons:
Pros: The room has a TV/DVD combo for a man’s viewing pleasure as well as a library of dirty magazines.
Cons: When his manly duty was complete, he had to knock to indicate that he was finished and hand his offering to the tech (the same tech who later drew our blood). : )
The doppler ultrasound (and the room in general) is cool. A TV is mounted on the wall that allows the patient to see everything on the ultrasound machine.
Once she started wanding me, she immediately asked if I suffer from endometriosis. I though, “Oh no.” She then pointed out three (small) endometriomas that have recurred on my right ovary. Great.
Then, she measured my antral follicle count (AFC). These are the resting follicles that sit in the ovaries, one of which will be ovulated each month. This count is used to estimate a woman’s ovarian reserve. A desired AFC would be anywhere between 11-30 resting follicles. Anything less can indicate diminished ovarian reserve (DOR); anything more can indicate polycystic ovarian syndrome (PCOS). The u/s tech eventually measured 19-21 resting follicles in my ovaries!
Next, the u/s tech measured the blood flow to my uterus. She pressed a button on the u/s machine that lit up my blood vessels like a rainbow so that she could find a good, fat one on each side. Then she pressed a button, and the ultrasound machine took a measurement, which sounded like my heartbeat. The threshold for this test is any number below 3; anything higher indicates that not enough blood is getting to the uterus. My levels were, I believe, 2.4 on one side and 2.17 on the other. I was a little worried since I didn’t obey the 72-hour no-caffeine rule (and caffeine supposedly restricts blood flow), but everything was perfect!
(FYI: We were told by our nurse that if this reading would have been too high, then CCRM would require acupuncture for a certain number of weeks.)
Next, the u/s technician studied the shape of my uterus. She drew lines around it on the u/s machine, and pressed a button. The image of my uterus appeared in 3-D, and she tilted the image sideways and looked at it from all angles to spot irregularities. Luckily for me, all was perfect there too.
The tech had a difficult time finding the ovary that had a chunk removed during my 2007 surgery (see the About Us tab on this blog for surgery info), so my wanding lasted for.ev.er. She was nice about it, but finally gave up and told me that I would have to come back later in the day so that someone else could find it.
After checking back in at the desk and meeting up with K, Anna from the Fertility Labs of Colorado (FLC) called us back for our consent review. FLC works hand-in-hand with CCRM, apparently. This portion of the ODWU was basically a review of a bunch of paperwork detailing what we’ll do with any remaining embryos if we divorce, if one of us dies, etc. We were instructed to sign the documentation throughout the day so that some pages could be notarized.
We had a few free minutes, so I was called back again for round 2 with the doppler ultrasound. A different technician found my partial left ovary pretty easily and took lots of pictures. K watched the TV screen and thought it was pretty cool.
After checking in at the front desk AGAIN, it was time for my hysteroscopy. I had heard a lot of horror stories about this test, so I was pretty afraid. I had a bad experience with a hysterosalpingogram (HSG), and I was afraid this would be worse. This test is performed by your chosen RE, so it was my first chance to meet Dr. Surrey. He came in and tried to make me feel more at ease, asking about our trip. The beginning of the test was similar to a pap, and he quickly performed a mock transfer. Then he turned on a machine that expanded my uterus with carbon dioxide. I felt cramps for about 30 seconds that increased in intensity as he used a scope to look around inside my ute. Just as the cramps got pretty bad, he announced that he was finished and turned off the CO2 machine. He said everything looked good and left to prepare for our consultation with him. Overall, this test was not as bad for me as the HSG. It didn’t feel good, but it wasn’t unbearable. I spotted lightly for about two days afterwards (whereas I bled much more after the HSG), and there was no lingering pain. It probably helped that my cervix is easy to work with.
K and I then met Dr. Surrey in his office and barraged him with questions. The summary of our conversation is that he feels like with a better protocol, better monitoring, and a better lab, we will have a great shot at achieving a pregnancy. He didn’t agree with our local RE’s recommendation to move toward donor eggs or her decision to put me on the aggressive Microdose Lupron (MDL) procotol. He does not recommend comprehensive chromosome screening (CCS), since we are young and he anticipates retrieving a lot of eggs. He recommends just watching the endometriomas and only feels like surgery should be an option if any of them start to grow rapidly. He thinks our chances are excellent.
I left his office feeling lighter than air! Locally, we were labeled poor responders, at high-risk of cancellation, victims of a biochemical pregnancy. At CCRM, we are “unexplained” and given excellent odds of success! For the first time ever, I honestly felt (and continue to feel) like we may actually conceive a child of our very own.
I checked in AGAIN, and then we were called back to meet with the genetic counselor. She reviewed the process and some risks of CCS testing and explained that if we were to add this to our cycle fees, we would have to schedule a 90-minute appointment to go over the specifics. Then she annoyed me by asking for payment up-front for this portion of the ODWU. I informed her that we are only going to pay whatever my insurance company denies. By this point in the day, I was tired, hungry, slightly overwhelmed, and just kind of over the ODWU, so I may have been a little snippy.
Our last two appointments were for bloodwork and with the Business Office to have a mini-heart attack over the costs. The phlebotomist used a butterfly needle, which is so much less painful than what my local RE’s office used, and she successfully stuck me on my first try! K had a smooth experience as well. At this point, we had to pay about $1400 for charges from the ODWU that my insurance would not pay.
The appointment with the Business Office was quick and just involved a couple of sheets of paper on which the fees are listed:
Package fees (starting with Lupron consult and ending after first pregnancy test): $12,340 (of which $7480 is paid directly to CCRM and $4860 is paid to FLC)
Medications (paid to pharmacy of your choice): $3500-$6500 (approximately)
Total: $16,270 to $19,270
* The ODWU itself, which can cost upwards of $4K without any insurance coverage
* ICSI $2600
* ICSI w/IMSI: $3100
* Embryo freezing (paid only if you have embies to freeze): $975
* PGS, MESA or Testes Biopsy, Pregnancy Tests: Varies
The paperwork states that you have to pay a $1000 deposit to reserve a place in the current or upcoming session, but we were not asked for any money.
And with that, our ODWU was complete, and we were free! Just in time to walk outside and discover that the battery on our rental car was dead, yay!
To Be Continued…