In a few hours I am going to hop on a plane for part two of my holiday vacation, which is a very good thing because I just need the distraction.
My appointment yesterday went well. But it was just a lot. A whole lot.
My nurse was very nice and I can tell she really cares about her patients. She took her time going though things and stopped often to ask if I had questions. She made me feel comfortable and she was very approachable which I am sure will be very valuable through all of this.
First we discussed the consent forms we need to sign. She took her time going through each one and what it meant.
We also went over my outline, which is basically a tentative schedule of events over the next two months. If felt like a check list. You have to check the box to move forward. Basically step one: Start Period and call the nurse. Oh and send in a hefty check to the clinic. At that time they will schedule my hysteroscopy, another appointment with the nurse for injection training, and I will start BC on day 3 and she will let me know how many days to take it.
After the hysteroscopy is complete if it goes well and I am cleared to proceed she will order my medication.
When my next cycle starts I will call her again and be scheduled for a baseline ultrasound appointment. I will meet with her again and get the ok to start meds.
Starting on Day 7 of my cycle I will be in the clinic every day doing ultrasounds and bloodwork. Meds will be adjusted based on the results each day. Hopefully around Day 13 my retrieval will be scheduled.
Transfer will be on day 3 or day 5. She said that patients with 5 embryos or less usually are scheduled for day 3, which based on my follicle count I will likely fall into the day 3 transfer category.
Next we went over my protocol (Lupron Microdose). Because of my low AMH my protocol was adjusted to have more stimulation and less suppression. In patients with a low AMH the largest concern is poor response to stimulation, therefore the amount of suppression is decreased. I will be taking significantly less Lupron and for a shorter period of time that what was previously planned because they do not want the Lupron to over suppress my ovaries so they don’t respond to the stims.
My nurse and I had a good conversation about my AMH and what it means. Previously I had emailed Dr. S about the results and she referred to them as “a little low”, however the nurse reaffirmed my feelings that they are actually VERY LOW. She said that she personally would highly recommend we move forward with IVF as soon as possible due to my AMH. Obviously you can’t go back in time, but I wished I had had this test a year or two ago. First I would like to know if there had been a significant decline over the past two years or if my AMH has always been low. With my decrease in follicle count from 2014 to 2015 from 16 to 10 I would be interested to know if the two numbers both have dropped that significantly. If this number has always been low would it have changed how we moved forward? I would imagine we would not have waited the year to move forward with IVF and just found a way to make it work. She stressed that quality is much more important than quantity, which I appreciate, but most of what I have researched shows that a low AMH drastically increases the risk of the cycle to be cancelled due to non-response. This is the largest concern sitting in the back of my mind at the moment. Interestingly the doctor and the nurse did not use the words Diminished Ovarian Reserve but I feel like the writing is on the wall. One study I read said that my AMH is typically found in someone over 41 and I am 33.
Because I know that many people are very interested in the cost of all of this I will be completely transparent to what we will be paying.
Cycle Fees to the clinic: $9,850 (includes all blood work, ultrasounds, egg retrieval, transfer, embryology, two betas
Cryopreservation of embryos: $800 (if required and includes one year of storage)
Estimated medication cost based on Freedom Fertility’s website: $5,300.
I believe there is also a fee for the hysteroscopy however I do not know what that is yet. I also do not know what my pre-cycle bloodwork cost is yet.
So far known cost is: $16,950 (not including unknown cost stated above, acupuncture on transfer, and cryopreservation).
I will also be transparent in sharing that to date we have spent $12,135 on our fertility journey which includes office visits, ultrasounds, 4 IUIs, medication, supplements, acupuncture, an HSG, blood work, semen analysis, and my laparoscopy/hysteroscopy to remove my cyst (partially covered by insurance).
So now I wait for AF to arrive sometime next week. Hopefully a few days in Portland with my family will be a good distraction. I hope everyone has a wonderful New Year and may 2016 bring babes for all of my TTC sisters!