Friday, November 5, 2010

Laying Down Bets

Beginning infertility treatment is exciting in a way. You are upset that you have to go through this process, but once you have made at least a little peace with that you just want to get going. You might have a highly hypothetical "hmmm, how far are we willing to go?" conversation with your partner, but it's in passing and deep in your heart you know, just know, that you will get pregnant before you seriously have to consider that question.

But then things might not quite work out the way you hoped, and you might not experience a miracle and get pregnant sooner than later. You, like me, might have one IVF under your belt and be looking seriously at the question "When is enough enough?" Because IVF is expensive. It eats away your savings, your future earnings, your financial freedom. For us, a fresh cycle is estimated at about $13,000. Several thousand dollars of that cost is the medication, which is ridiculously expensive. A friend just told me that one medication she needs to go on next cycle will cost her $1,800 out of pocket. Eighteen hundred dollars for maybe a week's worth of meds! If we are were to pay out of pocket with no financial assistance, three fresh cycles of IVF would cost us $39,000. "Fresh" meaning that an egg retrieval is performed and new embryos are created. "Frozen" cycles are where surplus embryos from a fresh cycle have been frozen and can be thawed and transferred with minimal medication and monitoring--those are wicked cheap in comparison. I was not lucky enough to have any surplus embryos to freeze last time, so I am working with "Fresh" numbers.

$39,000 is a crazy amount of money. And if you don't get pregnant after that, adoption is not free. That can also cost tens of thousands of dollars. It is very overwhelming. It begs the question, "How the hell can we afford this???"

It ends up feeling like you are at the high-stakes poker table at a casino. How many cycles can we feasibly afford? Which financing options are the best short-term and long-term? At what point do we say Uncle and throw our energies into the adoption process? (Which, by the way, is not a shortcut to getting pregnant. Lots of people apply for adoption and do NOT then miraculously get pregnant on their own, despite the anecdotes that creep out of the woodwork when you even mention in passing that you are open to adoption at some point.) This is supposed to be a time of great hope for us--we are trying to build our family one cell at a time and have a lot to look forward to. Our doctors are very enthusiastic and positive about our chances this second time. We have a new, juiced-up protocol that will likely make me very uncomfortable but produce more, and higher quality, embryos. But it stinks because before we can move forward we have to seriously entertain "The End" conversation. Which is what we recently did for hours, with T-charts and tears and long silences, as we tried to figure out which financing option that is offered by our clinic is best for us in the long term and will give us the best chance with the least financial strain.

Your first IVF is largely diagnostic, so you can't really go into it 100% thinking that you will get pregnant that first time and just do it once. Some people manage this, and I envy them. Many people need to do 2 or 3 so that the protocol can be tweaked and everyone can see exactly what happens when your genetic material meets so that they can figure out how to get the best numbers. We have been very lucky and so far have not paid full price, and for that we are tremendously grateful to our clinic. We qualified for a grant the first time so it was about half the sticker price, and we qualified for the same grant this next cycle. We were in the running for the refund program as well, but with the grant available and questions over whether we would actually be approved, we decided to go with the grant. This is largely because the cost for the grant for one cycle was less expensive by almost $10,000 if we manage to get pregnant. And if we don't, and we have to pay out of pocket for a second fresh cycle, the cost of the grant versus the refund program is within $600 of each other. So it's not unless we fail after three total cycles that the refund program really kicks in and becomes financially a better choice. It was a really hard choice to make. Mostly because with the refund program I would have the option for 3 more fresh cycles (a total of 4 tries), and with the grant we will have to stop and reevaluate after 2 more. I am not ready to really think about that. I want to believe that the doctors' enthusiasm and belief that this next cycle is IT and we are totally getting pregnant with the second IVF. But it is hard to do that when you have had the same level of enthusiasm for your first IVF only to have it end a failure. And, what if the IVF that will work for us is the fourth one? What if we quit right when we would have gotten pregnant?

This process brings up a lot of difficult questions, difficult circumstances, and no good answers. Did we decide on a definitive stopping point? No. Did we decide on a "reevaluation" point? Yes. Did we choose the option that is best for the short term with the hopes that we'll get pregnant as quickly as we're projected to, instead of the one that offered the better long-term protection if we have multiple failures? Yes. Maybe that's a sign that we are thinking positively about our chances as well. Or maybe it was partially because if we didn't take the grant, there was a chance we could also lose the refund program and end up empty-handed (and really in a pickle to even get two more cycles in). Honestly, I am starting to feel like a racehorse. Everyone--ourselves, the team of doctors--are projecting potential wins and losses and hoping we made the right call. I really, really hope we made the right call.


  1. These are such hard decisions for couples to work through. The conversations are so emotional. My heart is with you both. Whatever you decide will be the right thing.

  2. Thank you, Kelly! It's there now...grant it is. So hard not to be resentful that these hard decisions are part of our babymaking process.