My CCRM IVF Journey

Our successful journey through IVF #2 at one of the world's top fertility clinics

Archive for the ‘Money’ Category

T-Minus 13

Posted by auntiem10 on August 2, 2010

It was a crazy weekend, but all of our plans kept me from obsessing too much about our upcoming IVF cycle. Some of my family was in town, and the minute they left, we headed over to my in-laws’ to celebrate DH’s grandma’s 73rd birthday.

My pregnant SIL was at my in-laws’, of course. She has a very thin frame, and I’m pretty sure her belly was looking a bit rounder already. It may have just been her shirt, though. Surprisingly, I didn’t feel devastated about being around her this time. I winced a bit when they referred to my MIL as “Grandma” once or twice, and when they happily discussed who will change diapers, but for the most part, I was okay. I guess the fact that I plunged the Lupron needle in my belly in their bathroom helped me get through it–I know that we’re moving forward, making progress, in our own quest to have a baby. We’re doing everything we can, and that has to be good enough right now.

Regarding my last post, I found out this morning that ICSI is NOT included in the costs of CCS testing. Thanks to everyone who provided feedback. The business office only told me our remaining balance today. I should have asked for the breakdown, but I was in a hurry to get to my next meeting. However, the letter we were originally sent (for a freeze-all cycle) included all of the costs related to the retrieval process–monitoring, bloodwork, nurses’ coordination time, ER costs, ICSI, etc. We just had to add $6850 onto that amount to figure out our final total. My panicked post yesterday was the result of thinking ICSI was not included in the letter we originally received from CCRM. We are definitely near the very tail-end of our budget, so I was glad that I was wrong!

Breakthrough bleeding stopped all day yesterday and then picked up again in the evening. I thought it had stopped completely and stupidly went to my in-laws’ house without an emergency liner. I went into the bathroom to inject the Lupron and realized that I had bled through my khaki shorts. Ugh. I made an excuse and had DH take me to the store, where I bought liners. The stain wasn’t visible to anyone else, thankfully. Crisis avoided–but lesson learned! So far today there has been zero spotting. Hopefully it’s gone for the rest of this week!

The Lupron injection went off without a hitch last night. I nonchalantly walked over to my purse and stuck the syringe (which I had pre-filled right before we left) in my pocket along with an alcohol pad, and then went into the bathroom. I’m not squeamish about sticking my belly, so I was in and out of there in under a minute. I’m due for the next one in 50 minutes!

 This morning I made all of our appointments at CCRM while we’re in Denver, assuming the dates on my calendar stick:

Monday: IVF physical, u/s + b/w, cycle review
Tuesday: u/s + b/w
Wednesday: u/s + b/w
Thursday: u/s + b/w, DH’s back-up freeze
Friday: u/s + b/w, genetic counseling
Saturday: u/s + b/w

Time is moving right along!

Posted in Cancelled IVF Cycle, Chromosome Testing (CCS), Money, Struggles | 4 Comments »

CCS Question

Posted by auntiem10 on August 1, 2010

Does anyone know if the cost of CCS ($6850) includes the cost of ICSI ($2600)? We are trying to figure out how the costs work out now that we’re adding chromosome screening to our plans. Is it just adding the $6850 to the package price ($12k)? I’m planning to call the business office tomorrow, but I’d appreciate your input!

Posted in Chromosome Testing (CCS), Money | 5 Comments »

Logistics, Mad Men, and Lupron

Posted by auntiem10 on July 27, 2010

I’m glad to read that I’m in the company of other “Mad Men” fans! Don Draper is yummy! : ) We’re only on episode 10 of season one, so I’m sure we haven’t even gotten to the “meat” of the story yet. I’m pretty sure that soon, my hubby will be pouring himself an old-fashioned and wearing a skinny tie to work. : )

Over the past few days, I have:

  • booked a hotel room for the first part of my stay (when DH arrives on the 20th, we’ll probably move somewhere with a bigger suite)
  • partially paid our cycle fees (I’ll pay the rest when we’re given the all-clear with the suppression check)
  • booked a pet-sitter to stay with our two doggies during the time that my DH is with me in Colorado
  • ordered new food bowls for our doggies that will force them to eat slower (they both eat too fast and inhale their food and then choke on it, which is a constant worry to me and something that was going to cause me stress while a pet-sitter was with them)
  • Figured out from which pharmacy to order my Lupron

Speaking of Lupron, I learned from my nurse that name-brand Lupron is apparently no longer being manufactured. CCRM just orders the generic now, Leuprolide Acetate, which is excellent news for me. Generics are more likely to be covered by insurance companies, and in my case I’ll save over $100 by ordering generically. It’s not much of a financial break with all things considered, but it’s something!

Posted in About Me, Cancelled IVF Cycle, Money | 2 Comments »

Happy Independence Day!

Posted by auntiem10 on July 4, 2010

Whew, so far this weekend has been a whirlwind of cooking, entertaining, cleaning, and running errands. Today will be more of the same!

Yesterday we received a letter from CCRM stating our financial obligations for our upcoming cycle. That just made everything all the more “real.” The fees for an IVF Freeze-All w/ICSI cycle include $4910 made payable to CCRM and $8060 made payable to Fertility Laboratories of Colorado (FLC). Anesthesia is an extra $430. We also already paid a $1000 deposit that is not part of the fees listed here. I’m including this info because when I began researching CCRM, I searched endlessly for cycling costs.

Edited to Clarify: The costs listed above represent the charges involved with doing an IVF cycle and freezing all embryos. The amounts listed do not include the transfer fees, chromosome testing (CCS), or medications. I just wanted to make that clear!

I’m still testing negative on OPKs, so I’m wondering if my calendar might need to be readjusted a little bit. We will see. Today is Cycle Day 21, and we had based my calendar on this current cycle lasting 33 days. Usually once I test + on an OPK, AF arrives 14 days later. Since today is CD 21 and I haven’t even tested + on an OPK yet, I’m guessing this cycle will be at least 36 days, if not longer. I’m just trying not to stress about it, since that will probably further postpone AF. The dates on our current calendar meant that my hubby would have to miss his first week of graduate classes, so maybe everything will work out for the best. Maybe my ER will even get pushed closer to Labor Day weekend, in which case I won’t have to take as many vacation days!

Posted in Cancelled IVF Cycle, Money | 3 Comments »

Plunked Down $1K

Posted by auntiem10 on May 25, 2010

This morning I called CCRM’s business office and plunked down the $1,000 deposit that CCRM requires before they will put you on their schedule. Since we aren’t cycling until October, I really didn’t need to pay up for another month or two, but what can I say–I like crossing tasks off my list. : )

My primary nurse called yesterday to follow up with me after last week’s regroup with Dr. Surrey. She’s planning to fax an order to my local RE’s office for an ultrasound next cycle to measure the endometriomas that were visualized at my ODWU. Dr. Surrey recommends that the ultrasound be performed on Cycle Day 4 or 5, and then hopefully my local RE will agree to save the images on a CD and ship it to CCRM. Hopefully the endometriomas have not grown significantly, because that could mean surgery before starting the IVF process.

We talked about my timeline and Dr. Surrey’s recommended treatment protocol. I estimate that AF will arrive sometime around September 16th. On Cycle Day 21 (October 6), my progesterone will be tested locally. If the test result is >5, I’ll start Lupron for five days (I think? Nurse was talking really fast!). Once AF shows up, I’ll head into my local RE office for the suppression check. Assuming all goes well, I’ll start stims (150iu Follistim + Menopur). I’ll have the first ultrasound performed locally after three days of stims, and then travel to Denver on the fourth day.

This schedule will likely result in my husband and I celebrating our second wedding anniversary (10/18) one state apart, which is kinda sad. We talked about this last night on our dog walk and just decided that even though we would rather be together that day, we’ll have plenty of future anniversaries to celebrate!

Posted in Money, Testing | 8 Comments »

Waived Fees and Credits

Posted by auntiem10 on May 12, 2010

I’ll be honest and say that I haven’t been impressed at all with CCRM’s business office, with the exception of one person: the account manager. I do not want to publish this person’s name on a public forum, but I have been very impressed with the way this person has handled two recent headache-inducing billing mistakes made by the business office.

Recent Billing Situation #1: Remember this post? We had received a $150 bill in the mail from FLC a few weeks ago for the genetic counseling session we had attended as part of our one-day work-up. The business office told me I would have to wait until my regroup with Dr. Surrey and then ask him to waive the fee. I feel that the regroup should be utilized for treatment-related questions, not billing issues, so I was unhappy with this suggestion.

Last week I called the business office to ask about FET costs, and I was (fortunately) transferred to the account manager. I mentioned the FLC billing situation casually, and this person immediately talked to Dr. Surrey. Ten minutes later, Dr. Surrey had agreed to waive the fee!

Recent Billing Situation #2: Last Friday, we received a receipt in the mail, indicating that CCRM had charged $100 to our credit card. I researched the claim online and found that my patient responsibility was $0. My insurance company confirmed that I shouldn’t have been charged.

Basically, the business office had submitted a global billing code for the hysteroscopy + consultation with Dr Surrey, for charges totaling $750. My explanation of benefits showed a network discount applied of $250, reducing the total charges to $500. My insurance company paid CCRM $475, and I had paid a $25 co-pay before the hysteroscopy. These payments = $500, which was the total charges after the network discount.

CCRM’s business office claimed that the network discount should have been only $150 (20%), and that my insurance company had actually denied the office visit portion of the claim ($100). The CCRM account manager was out of the office yesterday, so I spoke with another business office employee when I called to discuss this matter. Although our conversation started out nice and calm, it quickly got heated. I explained to this employee that since the billing code was for a “global” procedure, CCRM could not charge me for only a portion of the claim (information given to me by my insurance company representative). Instead, they needed to issue a refund to me and write off the $100. My request for a refund was unequivocally refused, and I hung up. Last night, I spoke to my insurance company yet again, and this conversation led to them issuing a letter to the CCRM business office demanding that they refund the money and appeal the claim if they are unhappy with the way it was processed. Bottom line: they NEVER should have charged us.

Today CCRM’s account manager returned to work, and the whole debacle was quickly resolved. It turns out that my insurance company was correct all along, and I now have a $100 credit (which I asked the account manager to send me in writing). The mean girl inside of me wants to call the rude business office employee from yesterday and say HA! However, I will refrain. : )

Today I am faxing a letter instructing the business office to REMOVE our credit card information from their records. We want to be billed for everything from now on, effective immediately. I think most of the claims from our ODWU are processed by now, and we are OOP for all treatments, so I don’t think they have much else to charge on our card. But still! In my opinion, their business office leaves something to be desired.

Moral of the story: If you encounter issues with the personnel in the business office, you might want to ask to be transferred to the account manager. This person is extremely kind and wasted no time in getting both situations resolved for us! Also, any time you are billed by the business office, I highly recommend calling your insurance company to verify that you were charged appropriately. As you can see from our situation, they do make mistakes (sometimes to the tune of $250!).

Posted in Money | 3 Comments »

FET $$$ Matters

Posted by auntiem10 on May 7, 2010

At the end of my post detailing our CCRM One-Day Work-Up, I listed out many of the fees charged by CCRM during an IVF cycle (non-FET, non-CCS). The breakdown is as follows:

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)
Anesthesia: $430
Medications (paid to pharmacy of your choice): $3500-$6500 (approximately)
Total: $16,270 to $19,270

Not included:
* 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

I scoured blogs for these details when budgeting for our upcoming cycle, so I wanted to add additional information regarding FET costs when the patient is not doing chromosomal testing on embryos.

The 2010 cost of a routine FET: $4470
Medication estimates: $800-2000

The business office confirmed that before starting stimulating medications in October, we will be expected to pay the full package fees, including the portion that pays for an embryo transfer during a fresh cycle. A credit will be applied to our account at that time, to be used for our future FET cycle. After applying the credit, we will be expected to pay a little less than $3000 before the FET (not including the medications). We can wait until early 2011 to pay the FET-related charges.

I asked about whether the costs will increase in 2011. The costs increased in 2010, so I was worried that 2011 might follow suit. The contact in the business office told me that since we’re completing the bulk of our cycle in 2010, she could likely get Dr. Surrey to honor the 2010 prices regardless of any possible increase.

It’s expensive, yes, but I guess it’s to be expected when you’re paying for top-of-the-line care!

Posted in Money | 1 Comment »

Altering the Plan

Posted by auntiem10 on May 4, 2010

After Dr. Surrey agreed to allow me to do the Depot Lupron treatment yesterday, K and I put on our thinking caps and really talked about our upcoming cycle. I was feeling pulled in every which way, and I needed a sensible person to help me sort out my feelings.

I just have a bad feeling about doing the Depot Lupron treatment before a fresh cycle. It seems that many of you out there are doing the treatment while your embryos are being CCS tested. In our case, chromosome screening testing was not recommended, so Dr. Surrey’s plan for us was to do the Depot Lupron treatment, take 28 days’ worth of BCPs, and then immediately start stimulating my ovaries. I was not comfortable with the idea of shutting down my ovaries so completely, and then expecting them to be rock stars and churn out a decent number of eggs. At our ODWU, Dr. Surrey told us that he didn’t see a difference between those who do the DL treatment and then go into a fresh cycle, and those who do not. Still, I could not get comfortable with this plan. My worries were driven home by a comment on my blog entry yesterday (thank you so much to this person; it really helped to solidify what I was already thinking).

We made a decision to alter our timeline (again, ha). I know it seems as though we can’t make up our minds, but any IVFers out there likely know how easily things can change based on test results or recommended treatments.

Our ultimate motto going into this cycle is “No Regrets.” We want to be able to reflect on the cycle and know that we gave our bodies every opportunity to succeed. And even though Dr. Surrey was not concerned about me going straight from Depot Lupron treatment to a fresh cycle, I feel as though I may later regret this decision if I just decided to go with the flow. Our intuition is telling us both that “Plan B” is the right one for us.

I already called the Business Office and learned about the added expenses involved in our new plan. I just sent an e-mail detailing our new timeline to my CCRM nurse and asked for approval. This new plan is going to add a couple of months to our original plan, but as my blog friend Mo recently wrote, 30 days of waiting is a drop in the bucket at this point. We’ve already waited about a year to cycle at CCRM; what is 45 more days?

Here is our plan:

May 11–See endocrinologist, hopefully start Synthroid
May, June, July, August–Send CD3 bloodwork, regulate my thyroid levels, live life!
September–Start BCPs for IVF
October–Travel to Denver, Egg Retrieval
November, December–Depot Lupron treatment
January–Start medications for FET
February–FET

No, it doesn’t thrill me to endure more waiting … to go through another holiday season with a hole in our hearts … to incur extra expenses with medications, travel costs, repeating communicable testing, and the cost of the FET itself. Every adorable child I see dressed up for Halloween and every baby picture we receive in a Christmas card will hurt. I won’t lie about that.

But honestly, for the first time since we started planning our second cycle, we have etched out a plan that doesn’t make my pulse race. With this plan, I know that the Depot Lupron won’t be affecting my egg quality, and I know that the lapse will allow the stimming meds to leave my system. I think that peace of mind can only help me when it comes to stimming.

For the first time, I feel 100% comfortable with our plan. Now I only hope Dr. Surrey and the nurse agree!

Posted in Dr Surrey, Money, Struggles | 6 Comments »

Endo Biopsy Scheduling Timeline

Posted by auntiem10 on April 28, 2010

On to happier topics today … like my upcoming endometrial biopsy, yay! You know, that diagnostic test during which a local RE is going to scrape the heck out of my endometrium (uterine lining) in order to obtain a tissue sample. Sounds like fun, right? Don’t you wish you could have one too? : )

The endometrial biopsy is performed to detect beta-3 integrins in the endometrium, a glue-like protein produced by the uterus. Research indicates that without this protein, embryos sometimes don’t fully implant during an IVF cycle. The doctors at CCRM only require this test for some of their patients. Some reasons for which your RE may recommend this test are:

  • History of endometriosis
  • Biochemical pregnancy or miscarriage
  • Multiple BFNs after IVF with a diagnosis of “Unexplained”

With my history of stage IV endo and one biochemical pregnancy after IVF #1, Dr. Surrey felt like this test was necessary for me. On May 3rd at 2:30, I’ll be in stirrups, having this test performed by a local RE. It is apparently a pretty painful test, causing cramping and an uncomfortable sensation when the RE has to scrape the tissue. I’ve been told that the pain is a little worse than a hysterosalpingogram (HSG) test.

My Timeline for Scheduling an Endometrial Biopsy:

The following steps were my timeline for scheduling the endometrial biopsy. My hope is that if you are planning to have this test performed, it may help serve as a guideline for you!

1) Obtain orders for the endo biopsy from your nurse at the ODWU, along with instructions on ordering the specimen kit from Sepal Reproductive Devices.

2) Detect your LH surge by using OPKs, starting on Cycle Day 10.

3) Schedule your endometrial biopsy 9-11 days after your LH surge.
FYI… My CCRM nurse said that the first day of the LH surge doesn’t count. For example, because I detected my LH surge on April 22nd, my “window” for the biopsy is from May 1-3.

4) Order the specimen kit by calling Sepal Reproductive Devices. My kit arrived after about five days, and there is no fee for the kit itself. The specimen is shipped to West Coast Pathology Lab in Hercules, CA.

5) Write a check to West Coast Pathology Lab for $475, and include it in your kit.
FYI… there are two procedure codes that Sepal Reproductive Devices can give you so that you can file a claim with your insurance company for reimbursement.

6) Bring the orders CCRM gave you to your appointment, along with the specimen kit. In my case, the lab will ship off the collected specimen for me.

Within the next few weeks, I will post my results and explain CCRM’s recommended treatment for patients lacking beta-3 integrins. Fingers crossed that I will have the protein!

Posted in Money, Testing | 10 Comments »

Another Insurance Headache

Posted by auntiem10 on April 26, 2010

I promise to stop complaining about being nickel-and-dimed by CCRM, but I do want to add this post for folks who may not have traveled yet to Colorado for their One Day Work-Up (ODWU). I don’t want my recent negativity to set the tone for this blog (I’m usually much more positive!), but I do want to help others prepare for the costs involved.

We received a bill last week from the Fertility Laboratories of Colorado (FLC) for the genetic counseling session we attended at the ODWU. The bill was for $150, and we could see that it had not been submitted to my insurance. FLC is in-network, so we immediately called and verified that the procedure code was eligible for coverage.

This morning I called CCRM’s business office and found out that the genetic counselors are independent contractors, and they do NOT accept ANY insurance. This is despite the fact that the bill appears to actually originate from FLC. Therefore, we are expected to pay for this 20-minute counseling session.

Our genetic counseling session was the second-to-last appointment of the ODWU. By this point, we had already waived all ancestry-based genetic testing (like Fragile X). We had also already met with Dr. Surrey, who does not recommend chromosome testing for this cycle. Therefore, we only attended this genetic counseling session because we did not know we had a choice. If we had known, we would have waived the appointment, had our blood drawn, and left the building.

Our options:
#1) Pay the $150 fee and forget about it.
#2) Talk to Surrey at the regroup about waiving the fee. If I try to establish contact with him before then, I will be charged for the appointment.

I am really upset by the way CCRM handles the ODWU. Some claims are submitted by CCRM, some claims are submitted by FLC. Some labwork was sent out to another laboratory that may or may not accept our insurance. Now we are expected to pay $150 for a genetic counseling session that we did not want to attend in the first place. I think they should review all of this information with the potential patient BEFORE the patient travels to CCRM. The money involved in the ODWU is small potatoes compared to the cost of an actual IVF cycle there, but every penny counts when trying to save that amount of money.

I’m struggling to adjust to being a tiny fish in a big pond! Someone tell me it gets easier!

To anyone planning to attend the ODWU: If you are not interested in genetic testing, ask to WAIVE the genetic counseling session. Just tell them you are not interested in attending. They do not take ANY insurance, so you will be expected to pay $150 if you attend.

Posted in Money | 7 Comments »

Insurance Woes

Posted by auntiem10 on April 24, 2010

We are fortunate to have insurance coverage for some diagnostic testing associated with infertility. Before the ODWU, we called both of our insurance companies and made sure CCRM is in-network. Although we have no coverage at all for IVF or associated medications, we were happy that a large portion of our ODWU testing would be covered.

CCRM’s business office told us that my husband K’s insurance company is not contracted with CCRM’s lab, so we had to pay his fees up-front and then submit claims for reimbursement. Okay, this was no problem. We received completed forms in the mail the week after our ODWU, and promptly mailed them to the insurance company. Based on the coverage, we anticipated receiving a refund of about $1K.

For the past week, we’ve been monitoring the claims online. Yesterday we realized that although some of the claims were being processed, no money was designated to be sent to us. K has been swamped with work this week, so I called the insurance company to find out what was going on.

As it turns out, even though CCRM is an in-network provider, their lab (Fertility Laboratories of Colorado or FLC) is out-of-network. This particular insurance company’s policy is that if you visit an out-of-network provider, they will cover some of the claim, but any leftover monies are only applied to your deductible. In other words, they do not refund any money when you go out-of-network.

Honestly, I am kind of upset. I don’t feel like CCRM’s business office thoroughly explained to us that FLC is a separate entity that may or may not be in-network. We thought we were doing our homework by checking to see if CCRM was an in-network clinic. It never even occurred to us that an in-house lab might be out-of-network. We had never even heard of FLC before we arrived for our ODWU; we thought all testing was done through CCRM. I know that regardless, CCRM would have required us to do this testing at FLC, but it would have been nice to know so that we wouldn’t have been pinning our hopes on a refund.

And just like that, we will have to postpone our IVF one extra month. We had built that refund into our IVF budget. We needed to wait until August anyway (so that K can accrue more vacation time), but now we will have to wait until September to pay the cycle fees. So our desired plan will be to start BCPs in August, and schedule the stimming/egg retrieval, egg transfer in September. This isn’t a huge postponement, and we might have had to wait this long anyway if I lack the beta-3 integrin and need two months of Depot Lupron, but it is still disappointing!

Moral of the Story
To anyone with diagnostic coverage who is planning your ODWU: I suggest that if you have coverage for diagnostic testing, make sure that BOTH CCRM and the Fertility Laboratories of Colorado are in-network providers! Learn from our mistake!

Posted in Money | 4 Comments »

One-Day Workup

Posted by auntiem10 on April 14, 2010

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)
Anesthesia: $430
Medications (paid to pharmacy of your choice): $3500-$6500 (approximately)
Total: $16,270 to $19,270

Not included:
* 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…

Posted in Dr Surrey, Money, Testing | 9 Comments »