33, unexplained: Shared risk vs. multi-cycle?

[Anonymous]

Wanted to take a poll here since everyone seems to have a wealth of information and experience. We're on a "break" before starting IVF with Shady Grove in Jan. 2013, and trying to plan ahead financially since we're entirely self-pay. I am 33 (34 next April), DH is 39; TTC for a year with three failed IUIs; and we've been classified as unexplained (super helpful label, btw) since all our tests look fine. Great numbers with IUI, regular ovulation, all that.

My question is: Should we go whole hog with the 6 cycle shared risk plan (potentially $20-$23K plus meds), or just do the 2 fresh/unlimited FET multi-cycle plan ($16K-$21K plus meds)? My RE feels we have a good shot for first or second cycle success because of my age and "normal" tests/hormone levels. But I've also read numerous posts on here from women who felt much less anxious doing shared risk, or had unseen problems that led to needing additional cycles. If we budgeted and scrimped (and delayed buying major purchases for oh, another five years) we could make shared risk work, but is it excessive? More cost-effective to do the multi-cycle given the circumstances?

Thanks in advance your poll vote (and advice, of course)!

[Anonymous]

I don't know about the Shared Risk because I did Multi-cycle, as we weren't qualified for SR.

Count on the first cycle possibly not being successful. I say this because I know with myself and a lot of friends who did IVF, the first cycle they are playing with meds to see how you respond. By 2nd cycle, they can fine tune it more. This isn't a hard and fast rule and of course 100 people will comment after me that they were effective on cycle #1 and that's great, but they are the exception.

Shared Risk I believe you can get kicked out at any point in time and converted to Multi-cycle but I could be wrong about that.

What I can tell you is they have very very strict requirements for freezing embryos, so few people at SG end up with a ton of frozen blasts. I had "almost blasts" and they wouldn't freeze them. So this means you ramp up and cycle again faster. I never ended up with frozens and they retrieved a dozen eggs from me, twice.

[Anonymous]

We had the same debate and decided on shared risk. Got pregnant first time and were upset we blew so much money on the program. Then I miscarried at 12 weeks and was so grateful I had done it. We also had 5 embryos left to freeze so it takes the pressure off future cycles

[Anonymous]

Thank you. Hmm, I hadn't really thought about the standards for freezing, nor the point about miscarriages (was focused more on just failed cycles.) Very good points.

[Anonymous]

I vote for shared risk having done it the other way. They didn't have the multi-cycle option when we did it so we opted to pay by the cycle. I was also 33 with unexplained and a few failed IUI/clomid cycles. I agree with PP's that SG is VERY strict on freezing. Although we retrieved 9 eggs the first cycle and had 6 embryos, they implanted one and didn't freeze any others. Next time we had 12 eggs, 8 embryos and they only froze 1. The main benefit of SR as I see it is just not having to stress so much and feeling a *little* less pressure. Without it, we felt like EVERYTHING was riding on the first cycle so when it didn't work, we were really devastated. I also agree with PP's that SG uses the first cycle to see your response. In our case, they started with lower doses of everything and then ramped up the second time, which worked. I guess a lot of it depends on your own risk tolerance and whether you'd be willing/able to keep going if for some reason the first 2 cycles didn't work. Good luck to you! SG knows what they're doing so hopefully you'll be starting the new year off with good news before too long.

[Anonymous]

7:13 back. I should add that this is a tough choice. Our finances took a beating this year and the payment each month is terrible and stressful. However, all i could say after that terrible miscarriage was thank god we did shared risk. The idea of having to start over again and sink in another 15k (or whatever it is) was just devastating.

[Anonymous]

I am one of the lucky ones who did shared risk that worked the first time, but we have no regrets. Having the option to recoup the majority of the expense if ivf didn't work was something we considered when making our decision. In the end, we thought it would allow us to keep our options open since I wasn't sure how many cycles of ivf I would be able to handle and was worried about miscarriage. I also didn't want to have to revisit the financial decision if we had multiple failures (ie if that were the case I could focus on whether I could handle more cycles from an emotional standpoint since the financial aspect woul have already been decided). I should add that we had been able to save the full amount before treatment, otherwise the choice would have been much more difficult. It's definitely a tough decision. I was 35, unexplained, with three failed IUIs (and one miscarriage prior to starting treatment).

[Anonymous]

OP here; many thanks 9:50, 10:37, and 11:27 for your sharing your experiences and insight. And I hope you all wound up with happy & healthy results. Seems like if we can hold our nose and make it work, shared risk might be the best/least stressful choice (at least in the long run.) I suppose I haven't yet seen anyone who said they regretted the $$ after getting that BFP!

[Anonymous]

I too did multi-cycle (too old for shared risk) for two reasons: emotional sanity and also because of the chance that the first cycle would not work and I would at least get to a FET (expensive in its own right) or a whole new IVF.

Reality: First cycle worked for this 41 year old. However, I am still pregnant (5 months in) and still not feeling assured that I will get out of this with a live birth for several reasons. TBD.

Reason I felt I might get to a FET was that I had a few medicated IUI cycles and new I was a great responder and there was a chance I'd have eggs to freeze. Turns out, yes, 2 wonderful blasts implanted and 4 wonderful blasts frozen. So that was lucky.

If I end up with a happy ending here and have my baby, then I will have paid $17,500 for the multi-cycle (2 cycles and unlimited FETs and cryopreservation; plus add ons of assisted hatching etc.) but only had 1 cycle which could have cost me about $9,000 or so. So I will have paid almost double. It's like I took out insurance on the situation (of course my age was a big factor though I had been an excellent responder and great numbers including AFC all the way) but may not need to use it (hopefully!).

Honestly, emotional sanity was a factor I was very aware of that influenced me some. I did not want to feel like it was over at a negative or that everything was riding on that one cycle, even though my savings account still had plenty of money for a new 2nd cycle payment. Sometimes you just know yourself and need to protect your mental health! Only you can decide if that (and the stats applied to your specifics) is worth a potential overpayment of like $10,000.

All in all, I'm ok with my choice though I feel sick that the darn fertility clinic made bank on me! But it didn't start with the multi-cycle.

[Anonymous]

PP here again. Also, because I was having trouble (the luxury, I know) of decided when I had spent too much and to walk away, doing the multi-cycle kind of gave me a way to say ok here's my "all in" and when that is done it is a clear place and time to move on. I felt had I done a cycle at a time, I might be less clear on that and keep going and going.

My RE explained to me that fertility treatments and the cost are sort of like sitting at a slot machine. It's so easy to keep putting in money and hoping that the next time is the time. And the more you put in the more you want to try again that last time to make it all worth it. But when do you walk away? Anyway, that analogy really resonated with me and stuck with me.

[Anonymous]

15:48, I just wanted to thank you all for your comments. They are extremely helpful. Sending you very best wishes for the rest of your wait to go smoothly and happily.

[Anonymous]

Anonymous wrote:15:48, I just wanted to thank you all for your comments. They are extremely helpful. Sending you very best wishes for the rest of your wait to go smoothly and happily.

Oh good, I'm glad!

[Anonymous]

We opted to go with the shared risk, got pregnant on the first try and have no regrets. I'm due next week, and while we joke about our "30K baby" (between meds, sperm retrieval, ICSI, it adds up). We felt like the stress of multi-cycle would be emotionally harder than shared risk, for what is already a difficult journey. But even better, we ended up with 4 frozen embryos after our first IVF cycle, so if we choose to have another child after this one, we've got 2-4 FET chances (which are much cheaper when you're paying out of pocket like us). So it's possible that our 30K investment, will end up being something like $35K for two kids.
But that said, we'll be "paying off" this baby for years. Worth it, but also worth thinking about.

[Anonymous]

I am a shared risk patient - pregnant after 1 fresh, a frozen and then a second full fresh. The other thing to consider is that maybe you'd like to pay for your plan, whichever you choose, in December instead of January. You may be able to get a tax benefit if your medical bills exceed a certain percentage of your income. With having paid for the Shared Risk plan in November, my husband and I qualified and were able to get a good amount back from it when our taxes were due.

[Anonymous]

People have talked about adjusting the meds after IVF #1, however since you already did a bunch of IUIs they should have some idea of how you will respond to the meds for the IVF. They're not going in cold, they'll know how your ovaries react to certain doses.

Also, some REs are more willing to up the doses to produce more eggs, which theoretically should give you a better chance at some more embryos/blasts.

Good luck!