Monday, 7 April 2014

My IVF Pro Tips

I'm not quite a veteran, but after a fresh cycle and two transfers, I feel I've gathered enough experience to list some of the useful information I learned along the way.
  • We did some price comparisons with other REIs in the area, and my clinic was slightly less, but I now appreciate that the fees quoted on their website is sort of the base model price. ICSI and assisted hatching contribute to some of the hidden costs. Also the office bumped their expenses up a bit from when we first did our research, just to give us another reason to wish we started IVF earlier.   
  • Husband carefully reviewed both of our insurance policies and noted that his offered better coverage for IUI procedures by paying 75% (mine just paid for half). However, my employer pays my insurance premiums in full, so we would have ended up spending more than any potential savings. Recently, we received a bill for $834 from the lab as my insurance did not cover my karyotyping. Apparently, they will cover any genetic testing on a fetus from NIPT to amniocentesis and they did remit for the chromosomal analysis on the products from miscarriage #2, but no testing for me. Husband's insurance did fund his testing completely. You win some, you lose some.
  • When IVF was seeming inevitable, we starting holding on to those many credit card offers that come through the mail. We found one through Citi-bank that was offering 0% interest for 22 months. So, we charged our first cycle. Sadly, the balance hasn't changed too much, after paying off a bit, we charged our FETs. The ultimate goal is to have a baby and have the debt cleared by the time interest charges start to apply. 
  • We both maxed out our Flexible Spending Accounts (FSA) which not only translated to almost $2,000 in tax related savings, but also we saved all our receipts and sumbitted at the end of the year so that we could have $5,000 coming our way in the new year. 
  • I wish we had looked into Attain a bit more. Through a naive set of eyes, we feared that if we became a first time IVF success, we could have paid twice as much as our clinic's cost for one cycle. I felt that Attain made more sense for couple who want more than one chid, or for couples with longer odds who anticipate doing multiple cycles (again, very naive). I'm a bit envious as it seems that Attain couples don't have quite the same 'OMG how are we going to afford another fresh cycle?' stress with each failed cycle, but it also seems that Attain has some strict rules that must be followed. We would still have the additional costs of PGD testing and I know that costs aside, I don't want to do any more treatments beyond what we could yield from a second fresh cycle. At least with Attain, you don't have the feeling of spending an obscene amount of money and having nothing to show for it.
  • It pays to double check. I requested a printout of my entire account as we had paid $2,000 toward our balance when my insurance was delaying payment and I wanted to make sure we were receiving appropriate credit. Not only was it really interesting to see the breakdown and distribution of the charges for one IVF cycle, I noted that they had charged for a superfluous ultrasound during one of my IUI cycles. Recently, I discovered that they billed for a saline sonogram when I had just a regular ultrasound done. I also queried a $55 material/supplies charge, which was for the PIO syringes and needles. I actually never received a new supply with my FET, so this was a fraudulent charge, but as I have access to supplies from my office, I will continue to refuse. It sucks as we have these stupid safety covers on our 3 ml syringes that makes them harder to use, but every time I struggle, I remind myself that I'm saving us money. 
  • My RE insisted that I needed to have my estrogen levels drawn at his office and processed through their lab as not all outside labs can process a stat estradiol level and he's uncertain of their validity. However as checking my CD#9 progesterone level was not as time sensitive and produces a clear cut result, I did this at my regular lab. We used a diagnosis code of 'anovulaory cycle' (completely accurate) and billed my insurance for a savings of nearly $200.     
  • When I was ordering the meds for my IVF cycle, I only used Freedom Pharmacy for the injectable stims, antagonists and trigger. I had Misery call the dexamethasone and oral estradiol to CVS and made my insurance pick up the tab. I went to a compounding pharmacy (which is in walking distance of my office) with Freedom's price list for the PIO and micronised progesterone. I played the "I'd rather support a local business" card and asked if he could beat Freedom's fees. I wasn't planning to reveal who I was, but when asked, I admitted "Yes, I'm that Jane Allen." I probably speak to the pharmacists on a weekly basis, so we commented that it was nice to have a face to go with the names. Not only did the pharmacist offer me his employee discount, he revealed his own infertility struggles. 
  • As I know my insurance will only pay (minus my $10 copay) for one month's worth of medication at a time, (Actually it's a 30 day supply, as I recently thought I could outsmart them by picking up one box of 4 patches at the end of March and then getting one more in early April) I should have started stock-piling them each month when the idea for transdermal estrogen first occurred to me in December. Interestingly, my insurance did pay for all the patches for my first FET at 50% on a one time only basis (I think they may have felt guilty for trying to enroll me in their maternity program again).  I considered asking some of my colleagues in other offices if they have any estrogen patches in their sample closets, but as the compounding pharmacist offered to order stimming meds (if I need them for a second cycle) and sell them to me at cost, it's worth it to keep getting my patches from him.         
  • If a fellow infertile offers you any leftover meds, take them! Remember the episode of Friends where Chandler gets stuck in an ATM vestibule with Jill Goodacre during a city wide black out? He politely refuses when she offers him a stick of gum, but then reconsiders, if Jill Goodacre offers you gum, you take it. If Jill Goodacre offers you a dead animal carcass, you take it! before declaring that gum would be perfection. I didn't immediately jump on Jen S's offer for Ganerelix, and I should have as I was nearly stranded at the end, but she came though big time with an overnight delivery. I recently passed on an opportunity for some stimming meds prior to starting my FETs, as we might not need a second fresh cycle, but if I didn't end up needing them, I could always pay it forward to someone else.
  • I use the applicators that come with Pre-Seed lubricant to insert my vaginal progesterone.  The box claims that their product can help you get pregnant, but this is probably not the way that they intended. A daily serving of dried fruit (apricots or pears) helps counteract the GI effects from the PIO injections. 
  • Travel tip: an empty shampoo bottle works for a functional and discreet sharps container. 
This list is not necessarily meant to provide any suggestions or recommendations, but to reflect what I've learned by questioning and getting creative. I also acknowledge that I have a few insider advantages and access to various resources. I think the ultimate lesson I've learned is that it is necessary to be an advocate for yourself. No one else is looking out for your best interest.


  1. It's totally necessary to be your own advocate. That's probably my biggest lesson in all of this too after 6 years of infertility.

    I learned a lot when I requested a copy of my medical records from my clinics. I had to pay for them, but it's interesting to see the nurses and doctor's notes. I also requested to talk with the embryologist about their reports (because seeing them gave me questions), I'm glad I did.

    1. My RE's nurse gave me a copy of his notes about my protocol and I took a look though my chart when no one was looking (I know, totally illegal) His notes were pretty prefunctory but I supposed I was just realived not to see anything to the effect of "poor prognosis, doubful treatments will be successful.."

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  3. Jane, honestly, the lessons-learnt is probably what I'm missing most in my google and fellow-infertility-bloggers' searches to help out in my struggle. I'm European living in US and health insurance works totally different over there, I found it absolutely exhausting trying to educate myself on how it all works, how much it costs and how/where to save money. One of the most frustrating part is - to me - not really knowing how big of a bill I get at the end of a cycle, as in theory my insurance covers most costs, but in practice the bills I get from the clinic state otherwise.

    I'll dig into the tax write-off option, I wasn't aware of that..

    Any tips, any advice is - in my case at least - more than welcome. And so thank you for that post. :)

    (sorry for the accidental deleted comment, I'm such a scatterbrain..)

    1. Kas,
      To anyone living in Europe, where there is a single payer universal health care coverage, the US system is beyond confusing! The simplest advice I can give is to first know your plan and to know what will be covered.

      Know what your RE will bill to your insurance. I recently saw a patient who had her transfer done with XYZ fertility center, but she asked us to order her HCGs and I did her initial scan and follow up in two weeks. At first I thought this was poor of XYZ, that they kick them out to OBs faster than a one-night stand, but they won't bill her insurance. They charge $150 for each blood draw and $350 for each ultrasound. After their first successful transfer, they were so happy about being pregnant, they were almost happy to be paying that extra cost. For baby #2, the realised they could save a grand by coming to our office and we billed her insurance just like we would for any other pregnant woman. Ask what can be done by your regular OB/GYN and can be billed to your insurance

      Most companies will offer FSA as part of your benefits package and you have to enroll during a certain time period (usually at the end of the year, but it may run according to the time of your hire) You designate a certain amount of money (maximum is $2,500 per person per year) and that money is not subjected to taxation, so it's a way to stretch your dollar further. It's accumulates per paycheck, so you can either pay as you go (as long as you have enough to cover the expenses) or we like to gain it in a lump sum at the end of the year. The catch is that is operates as a 'use it or lose it' principle, so you really have to estimate your health care expenses and know how much you will need to set aside. Otherwise at the end of the year you end up stocking up on band-aids, Tylenol and anything health care related just so you don't lose your money.

      Also, if your health care expenses account for a certain percentage of your income (I'm not sure what that percentage is) you can use it as a tax-write off.

      If you have any specific questions, just email me and I can try to help

    2. Thank you Jane for understanding! I do know a little bit about FSA, as my friend from work enrolls every year. I never, however, really thought of using it, as our annual health costs were minimal in the past. I'd sure be able to use it this year, if I were able to anticipate the expenses. We're now getting close to the FSA limit, and with one failed IVF- we will most likely spend beyond that amount by the end of the year.

      The lesson I've learnt recently is something I'm really quite mad with my clinic at - they didn't let me know in advance that their anesthesiologist is (my assumption) out of network for my insurance and we now have an extra $400 that we owe to the clinic, as the insurance only covered part of the overall cost. Sometimes it's really hard to know what questions to ask in advance of any treatment..

      I will also be looking into my clinic's financing options, as my insurance doesn't cover embryo cryopreservation and PGD testing, which is something I'd like to do with my next IVF.
      I don't dare to think of putting any of that on our credit cards, as they're already pretty burdened.

  4. I couldn't agree more - you definitely have to advocate for yourself!

  5. That being said, I have 7 or 9 Vivelle Dot patches that I don't need. My RE does Estrace for FETs. Are you interested.

  6. This is great, Jane. If I've learned anything, it's that this online community is a fountain of helpful knowledge. A few comments: 1) We totally did the credit card 0% offer thing too. It's going to be brutal when our no interest period ends, but for now it makes IVF manageable. 2) We had/have similar fears about Attain and paying double if it works the first time. It would stink (and yet be awesome), but based on our situation it seemed like the right approach for us. But you are right, ICSI is separate, testing is separate, and you still have all the meds and office visits that aren't included. It never ends. 3) I will now pay closer attention to my bills. :) 4) YES, advocate for yourself. There's no hand-holding guidance through all of this, or a guarantee that our best interest is their #1 priority.

  7. I say "Gum would be perfection" anytime anyone offers me gum. Most people give me the same look Jill Goodacre gives Chandler.

    I should bookmark this post. Of course, I'm still claiming that I won't do IVF...but I know you once made that same statement.

  8. I am so humbled by your list of tips, knowing that I have insurance coverage and so many couples out there do not. In fact, I cannot imagine going through IVF, as I am now and having to pay out of pocket. Your post will remind me to keep things in perspective and to be grateful. By the way, shampoo bottle for sharps is a great tip! Thanks for the GI tip too. I've been drinking 1 tbsp of aloe vera juice from Whole Foods. It also helps. I drink it before bed.

  9. I think this is a great resource for people just getting started...and yet I'm sad that there's so many of us (yourself included) that can now consider ourselves "IVF Pros". We should get team t-shirts and have a softball tournament against the amateurs. Of course, they'd probably all get pregnant and we could win by default. ;)

  10. I remember getting the price list from my RE and thinking "this isn't going to be nearly as expensive as I thought". Then I got the pharmacy bill and added ICSI and assisted hatching and suddenly it was exactly as expensive as I thought. I wish I had thought of getting a 0% credit card for all this stuff. I am paying the interest on the ridiculous amount of credit card debt I racked up. Live and learn, I guess.

  11. I wish I had been more knowledgable when we started the process. I didn't even know to look into differen pharmacies for the meds! I'm also so incredibly envious of anyone that has any sort of insurance coverage as we did not have a dime of help. We are suffering for that now, although fully believe it was 100% worth it. This is a great list, Jane. If anything, it helps others to understand that they need to look deeper into the process and do some research on their options.