All,
We received our authorization today (I am not sure how much of this is MD IPA or Brian at GW - he's the bomb).

Just for your info, our cost share at GW for a cycle w/ ICSI is $5,000 and change. Meds TBD based on what MD IPA says and what my antagonist meds are.

How does this compare to your experience elsewhere (or at GW)?

Thanks guys!
Seems like early days of stims it would be OK to work out and then put it back to walking only (treadmill, too cold outside!) until beta?

as for diet, I have switched entirely to decaf and only drink a cup in the AM before work - so I'll cut that out once I start stims. Has anyone been told no hot drinks? like, no tea? no soup?

Sex: nurse told me 3 days of abstaining is what you want for the ER, but I'm sitting here thinking what bloated, drugged out lady wants to have sex? But I could definitely be wrong as I haven't done a cycle before! We're also freezing some juice in case the day-of has any issues.

As a side, does anyone have experience with whether after transfer, getting a facial at the spa is bad? I was trying to think of ways to relax, and this is something I might do even though I definitely have better things to spend my money on! I was wondering if the blood flow stuff was bad (I figured no massage)?

Hi all,
First, thanks again for this great resource - you have all been so helpful and supportive. I hope as I go through this, I can be the same.

Assuming my baseline goes well tomorrow, I'll start stims next week and want to plan accordingly. Once I start stims, at what point do I need to stop my fitness routine as it stands now (step/kickboxing/personal trainer)? Is it ok to walk brickle on the treadmill (like 3.8-4h)?

Food: are there certain dietary considerations I should make? I know "eat healthy" but is there anything anyone can particularly recommend for food stuffs? I am normally an ovo-lacto veg but am ok adding chicken if needed so is it usually recommended to add protein? I've heard no warm drinks but are soups ok?

Sex: is there a point whn sex before ER is a no-no? Our issue is MFI so at what point should I make sure we don't ruin his day of sample? (we are going to try to get GW to take a sample to freeze just in case as a sort of insurance policy).

Thanks in advance!!

MD IPA coverage began Monday, I am close to authorization (they messed up my PCP choice). GW started the auth process last week, I got them my marriage cert and note of us trying/not being sterilized. It is very possible with the right admin folks. Keep on them.

I read up on PICSI - it's a specific process, there's a dish with a protein in it to attract the best sperm, then they use that for the ICSI.

Where are you having this done? I emailed GW and their lab doesn't have it.

That said, I'll be getting my invoice very soon and will post on the costs when I know just to give everyone an FYI

Will your insurance cover the medicine but not the procedures?

If not, what about trying to find donated meds?

Or what about going to a facility with shared risk? It'll cost you more, but there's a semi guarantee (as I understand it).

What is the difference between P-ICSI and ICSI? We are doing ICSI at GW but I don't know the total cost - we have insurance coverage. However, their financial department is fantastic and if you called them (Brian is the financial guy) he will be very up front with you so at least you can get a sense of the cost there to compare.

I don't think I can do shared risk because I am using insurance, right??

Also, last we saw Catherine she was very, very pregnant! I don't think she'll be there when we go. Our nurse is Christine who, so far, has been wonderful and responsive.

I am trying very hard to stay positive...sigh...but the timing will be hard. Everything will likely be in February including my dog's ACL surgery (she needs both knees done). It'll be hard but that is life, sadly.

I am glad for the support here, it really is support even if only virtual

Anonymous wrote:I totally agree with this. (And I was at G W, not Shady Grove, so I think my problem was with the whole IF field in general, actually.) I wanted a more comprehensive, "let's see what your medical problem is," type of approach. I felt (and continue to feel) like the IF field just pushes us all into the lockstep march of "Ok, let's do these tests, get you on clomid, that doesn't work? ok, then we'll up you to IUI, that doesn't work? ok, then we'll move on to IVF," routine. I wish this field were better about looking into WHAT IS THE CAUSE of a particular couples' IF and TREATING THAT and then letting you go, problem solved, to happily procreate on your own.

I didn't feel that - we had a pretty comprehensive Q&A session with Dr G at GW. But, IVF is our only option with the MFI we have, which I gather is much easier to diagnose than unexplained. However, I do with there'd be a bit of "well, for the next three months try this (supplements, put him on clomid, whatever) but our morphology is so poor I doubt it would have done anything. Which is eactly what Dr G said.

I do think that a husband providing a sample that day can save you a lot of heartache and time just in case - you never know. My DH was born with undescended testicles, so we knew there'd be a significant chance of him having issues which is why went in right away when we started TTC - time is precious in fertility IMO so the more you know early on, the better.

Thanks, PP - that first part is how I figured. My girlfriend is a social worker and when I mentioned to her about weight, she said, "if heavy people couldn't get pregnant, I wouldn't have a job!"

I guess my bigger question is, in the DC area, what clinic other than GW is better for "second opinions"? I know shady grove is pretty standard, like they have their few protocols and that's it. Given that GW is really not for profit and all that, it would seem that they'd be willing to take more risks and know more about emerging research than many other places....but, I could be wrong.

I'm not especially worried, per se (I know it takes the average person more than one attempt, I think the average is 2.5 attempts?). Trying not to worry about egg quality because if egg quality is good, fertilization should be pretty good if the lab is decent.

sigh. the worry does never end!

we went to the one at GW and it was only somewhat useful, but not in the "these are the drugs" way. Other people's questions were helpful because many asked what I hadn't thought of asking.

I think you and your partner should attend a class if you can if only to participate in the Q&A with other people, sort of like a brainstorming session. I appreciated that.

That said, ours was almost months ago at this point and I don't remember anythign about the drugs. That part wasn't helpful to me.

Thanks, PPs.

I'm just worried because I keep seeing the whole, "my doctor told me it didn't work likely because I'm overweight" posts. That, and the posts about spending $60k on fertility treatments with no positive outcome.

I want a game plan - this is how many chances we'll use with this place before we move on, and hopefully we won't have to - so I don't end up broke and (like I said) spending my 30s on drugs with nothing to show for it.

I guess it's easier for a guy to say, "don't worry it'll work out!" when they aren't one undergoing any sort of medical procedures or having to take drugs.

I go in for my baseline monitoring next Friday (18th), and from there we [hopefully] start out first fresh cycle ever. I've never been pregnant, no BFP but we didn't try very long before going to an RE because my husband was born with undescended testes.

We suffer from pretty bad MFI and the only thing I have against me that I know of is weight - I'm 31, and all my numbers were fine, HSG was fine, and I ovulate on my own with normal cycles that vary in length from 26-31 days, but I've been told that's normal. I'm very physically active - 5-6 days a week...[I lost 70lbs in about 18 months, but gained about 20 back since husband came back from AFG....been trying to lose it, but decided to just eat as well as I can and stay active in this TTC time to avoid any shocks to my body, if that makes sense]

So as we start this cycle - IVF w/ ICSI at GW, Antagonist protocol - I'm looking for advice so that I don't end up spending my 30s as a human pin cushion. When I try to talk to DH about this, he says that I'm already dooming this cycle to failure, which I'm not at all - Dr. G gave us a 40% chance with a first cycle, which is actually pretty good (though, there are so many viariables...so who really knows).

At what point do you change clinics?
I have told my husband that if, after two fresh attempts, GW can't get us to a live birth, I'd like to give another clinic a shot - probably an out of town one because it seems from here that GW is the most experimental of the lot in the DC area. My reasoning is a new clinic brings a new set of eyes on the case, and the reason I'm giving GW 2 chances is because MD IPA = three lifetime cycles, and if an out of town clinic will take MD IPA, I'd be silly to pass that up (though, an out of town clinic might also take AETNA, but I know CCRM doesn't). DH says this is stupid because everyone has the same information about us and all that, and there's no reason to believe GW can't get us pregnant with ICSI to "cure" his sperm issues.

I feel like he isn't living in the real word - that fertilization and implantation aren't assured with ICSI no matter the clinic, and every clinic does different things - you wouldn't go to the same doctor to cure an actual illness if you continued to not see results, right?

Am I being too freaked out, too early?
I'm starting to worry that if it doesn't work the first time, I could end up on the slippery slope of a ton of money and all of my 30s being a science experiment. I'm trying to set expectations and be realistic...and have a game plan for "this is what's next just in case" vs. fly by the seat of my pants and assume everything will work out. Is my way a bad way to proceed?

you should recommend the "cheat sheet" to them! They might be open to it. I agree that written instructions are helpful for most things, and the information they give you for the IVF class is HUGE. Glad you like them - I'm hearing more great things about them, making me happy they are our clinic for our first cycle!
Good luck and hoping you get your BFP soon!

I will be put on an antagonist protocol when we try our cycle -our first cycle. I have read a bit on here about the protocol, but mostly I have read that it works well for women it's DOR or other issues that could be related to age. I do not have fsh issues or anything that we have found, and as far as we know currently, we are dealing with mfi (count and morph). Could it be weight related? I am overweight, but have lost a good bit of weight in the past 2 years and doc hasn't said anything about it related to IVF. I am 31 (32 in march), so I am wondering if it is odd for this to be my first protocol.

The nurse , when I asked, said it is probably the best way to avoid OHSS.

I am concerned it might cause fewer eggs and make it harder. To do FETs of our first cycle shouldn't work, which hopefully it will work!

Thx! You have all been a great resource to me and I hope to payit forward when we go through it all.

Melissa left the practice so I now have Christine, who is great so far. I have also worked with Catherine, also wonderful