Egg retrieval or IUI

[Anonymous]

Hi,

I just had my Stimulation Day 9 bloodwork ultrasound. My current follicle count is 3. My nurse told me that the Dr will be calling to to discuss my options (proceeding with egg retrieval or canceling it for IUI). My insurance does cover the IVF and medication so out of pocket I have spent a lot less. But the medication is already billing at around $20,000 of my $100,000 lifetime IVF max. I just don’t know what makes most sense for me to do. I’ve already had 3 failed IUIs so not sure if that’s even worth trying. But with only 3 follicles, I’m not sure if medical billing of ivf for the 3 follicles are worth it either.

Waiting for the Dr to call but wondering if anyone else has a poor response to stims and what they did.

[Anonymous]

I was a poor responder (and ultimately did better on a low dose cycle), but if you have already tried IUI, I would just move forward with an IVF cycle, subject to the following considerations: (1) will you/your clinic consider a 3 day transfer? I always had to do a three day transfer because I had few embryos, which really lowers your chance of making it to day 5. (2) Does your insurance have a limit on the number of cycles? And if yes, does your dr think you would respond better to a different protocol?

Sending you lots of good thoughts- I’m feeding my 3-day transfer baby right now!

[Anonymous]

Anonymous wrote:I was a poor responder (and ultimately did better on a low dose cycle), but if you have already tried IUI, I would just move forward with an IVF cycle, subject to the following considerations: (1) will you/your clinic consider a 3 day transfer? I always had to do a three day transfer because I had few embryos, which really lowers your chance of making it to day 5. (2) Does your insurance have a limit on the number of cycles? And if yes, does your dr think you would respond better to a different protocol?

Sending you lots of good thoughts- I’m feeding my 3-day transfer baby right now!

1. What is a 3 day transfer? Do you mean not waiting until blastocyst? I can ask but I am also doing PGT-A testing so will see if it’s possible.

2. Insurance limits 3 cycles per live birth. I remember someone (maybe the financial counselor) had told me a cycle is completing a transfer. I think at this rate my medication will get me to the lifetime max before the 3 cycles will.

[Anonymous]

PP - Right, a 3 day transfer is done before the embryo reaches the blastocyst stage. You can’t do PGT-A testing unless you have an embryo that reaches the blastocyst stage. If you truly only get three eggs (sometimes the count is off, of course), my guess is that the chance that you would have an embryo reach the blastocyst stage is fairly low. Which is why some doctors who work with poor responders recommend transferring embryos after 3 days.

Hopefully this cycle works, but if it doesn’t, you should discuss a low-stim protocol with your doctor. For poor responders, you often get the same or better results on fewer meds. Which is of course much cheaper from a medication standpoint. I got three eggs on a high-stim protocol, and then six and eleven eggs on two low-stim protocols.

[Anonymous]

It sounds like you are a poor responder. Another vote, if your doctor thinks it is worth it, to do the retrieval and plan on a three day transfer. If you have had several failed IUIs already, I’m kind of in the mindset of “if it’s not going to work it’s not going to work” and would not waste any more time doing them. IVF is a different situation with much better chances for success. My only success from several rounds of both IUI and IVF is a three day embryo who is going on her kindergarten field trip today. Wishing you luck.

[Anonymous]

If you want more than 1 kid, I would do multiple mini stim IVFs and bank embryos. If you only want 1, do fresh transfers

$20k on meds for 3 eggs is a waste of money

[Anonymous]

is the $20K meds being billed through insurance? I highly recommend paying for meds OOP so you don't burn throguh your $100K lifetime max on meds too. Insurance rates for meds are often 2-4x higher than if you pay for meds OOP; I learned this the hard way (my first round cost $28K in meds billed through insurance; I paid OOP for my second round and it was $9K!). It sucks bearing the financial brunt of the meds, but if it means you can get more rounds in then it's worth it.

[Anonymous]

Anonymous wrote:If you want more than 1 kid, I would do multiple mini stim IVFs and bank embryos. If you only want 1, do fresh transfers

$20k on meds for 3 eggs is a waste of money

I agree with this.

[Anonymous]

Anonymous wrote:is the $20K meds being billed through insurance? I highly recommend paying for meds OOP so you don't burn throguh your $100K lifetime max on meds too. Insurance rates for meds are often 2-4x higher than if you pay for meds OOP; I learned this the hard way (my first round cost $28K in meds billed through insurance; I paid OOP for my second round and it was $9K!). It sucks bearing the financial brunt of the meds, but if it means you can get more rounds in then it's worth it.

I'm wondering if that limit applies to fertility meds or all meds

[Anonymous]

Anonymous wrote:

Anonymous wrote:is the $20K meds being billed through insurance? I highly recommend paying for meds OOP so you don't burn throguh your $100K lifetime max on meds too. Insurance rates for meds are often 2-4x higher than if you pay for meds OOP; I learned this the hard way (my first round cost $28K in meds billed through insurance; I paid OOP for my second round and it was $9K!). It sucks bearing the financial brunt of the meds, but if it means you can get more rounds in then it's worth it.

I'm wondering if that limit applies to fertility meds or all meds

Typically there is a set of billing codes and medications that are included under the fertility coverage clause of your insurance contract (between your HR and the insurance company). Some meds are only covered when billed under fertility (think Gonal-F, etc.) and some can be prescribed for multiple uses (think estrace supplements). Typically it's the fertility-only meds that are the very expensive ones. If you get everything filled through your specialty pharmacy, it may all be billed as fertility. If you take the estrace prescription to Walgreens, you may get away with having it billed under your regular prescription coverage. It depends on your specific insurance provider and the insurance plan.

[Anonymous]

OP here, we decided to go ahead with the egg retrieval. Given our lack of success with IUI, it seemed like we’d be beating a dead horse there. I’ve had 3 miscarriages before and doing PGT-A testing was important to me to reduce the chances of another miscarriage. Only 2 eggs were retrieved, 1 reached blastocyst and it came back normal today!

We decided to do another round of egg retrieval before proceeding with FET. My Dr has decided to put me on “Lupron Stop” protocol. Hoping this protocol will give me better results. I am curious if perhaps improperly stored medication (I had the meds in my mini fridge for 4 months before we started IVF) would of caused my low response before. Maybe the mini fridge wasn’t the right temperature…

Yes, 20k was billed to my insurance while I paid about $500 out of pocket. This next round, I’m going to pay my medication out of pocket instead of going through my insurance. 1 900 Gonal-F pen was billed to insurance at $2675.

[Anonymous]

Anonymous wrote:OP here, we decided to go ahead with the egg retrieval. Given our lack of success with IUI, it seemed like we’d be beating a dead horse there. I’ve had 3 miscarriages before and doing PGT-A testing was important to me to reduce the chances of another miscarriage. Only 2 eggs were retrieved, 1 reached blastocyst and it came back normal today!

We decided to do another round of egg retrieval before proceeding with FET. My Dr has decided to put me on “Lupron Stop” protocol. Hoping this protocol will give me better results. I am curious if perhaps improperly stored medication (I had the meds in my mini fridge for 4 months before we started IVF) would of caused my low response before. Maybe the mini fridge wasn’t the right temperature…

Yes, 20k was billed to my insurance while I paid about $500 out of pocket. This next round, I’m going to pay my medication out of pocket instead of going through my insurance. 1 900 Gonal-F pen was billed to insurance at $2675.

Congrats on the normal blastocyst! Also - so sorry about the minifridge; which one did you use? I got this one but found it needs to be on a very steady counter as the power connection is a little funky: https://www.amazon.com/Cooluli-20L-Mini-Fridge-Bedroom/dp/B07JCBG524/ref=sr_1_16?keywords=mini+fridge+36-46+degrees&qid=1656427456&s=kitchen&sr=1-16

[Anonymous]

Anonymous wrote:OP here, we decided to go ahead with the egg retrieval. Given our lack of success with IUI, it seemed like we’d be beating a dead horse there. I’ve had 3 miscarriages before and doing PGT-A testing was important to me to reduce the chances of another miscarriage. Only 2 eggs were retrieved, 1 reached blastocyst and it came back normal today!

We decided to do another round of egg retrieval before proceeding with FET. My Dr has decided to put me on “Lupron Stop” protocol. Hoping this protocol will give me better results. I am curious if perhaps improperly stored medication (I had the meds in my mini fridge for 4 months before we started IVF) would of caused my low response before. Maybe the mini fridge wasn’t the right temperature…

Yes, 20k was billed to my insurance while I paid about $500 out of pocket. This next round, I’m going to pay my medication out of pocket instead of going through my insurance. 1 900 Gonal-F pen was billed to insurance at $2675.

What is your antral follicle count?