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.