Infertiles' Math

Just a little project I had brewing in my head for a while now (click to see it larger)...

Ramblings

Things I'm thinking about....

Will freezing my embryos - twice - hurt them?
Love this official study that proves the answer is NO!   "Although it is unconventional to thaw/warm, biopsy, revitrify and rewarm blastocysts for cryopreserved embryo transfer, the results indicate that outcomes are not compromised."

What can I do to overcome my autoimmune issues for the next transfer?
I read this interesting article about wobenzym N.    "Wobenzym N was shown in this study to greatly reduce the incidence of miscarriage in women with immunological response to pregnancy resulting in miscarriage."   So I'll do that and add back in baby aspirin.  I also got my RE to agree to allow me to use lovenox but she's being dodgy about writing me a script for it.  I need to her to get on that since it needs prior auth with my insurance (gag me).  I wonder if I can get my endocrinologist to write an Rx for it since most of what I read it's because of my hashimoto's and/or MTHFR that I would need it anyways.

I keep googling to see the percentage of normal embryos for a 33 year old (age I was when they were conceived).
It seems like 60-70% of my embryos are normal.   That is 2.4 to 2.8 normal embryos of the 4.  Though, the 4 to be tested were my "worst" 4 of the 8 blasts I originally had.  I pray at least 2 are normal.

PGS & FET #6 Plan

So my RE could never get a hold of my insurance nurse case manager to see if she could persuade them to let me do IVF even with frozen embryos.

So the plan is (because I'm not getting any younger):

• Cleveland Clinic will thaw, biopsy, and ship my embryos - roughly 1/27
• Genesis Genetics will receive them and PGS NGS (pre genetic screening with next generation sequencing) them - roughly 1/28
• I'll get my period - roughly 2/1
• PGS results should be in - roughly 2/10
• Lining check - roughly 2/12
• Transfer - roughly 2/20

Totally guesstimated those dates.   Just hoping my embryos make the thaw, are biopsiable, and are at least 50% normal.

I also had a hysteroscopy today to see how my uterus fared from the D&C last fall.  It went well.  The RE did a endometrial scratch while she had the camera up there as well.

My view just before the hysteroscopy:

Decisions Decisions

Man, more bad news.   Dr. Flyckt informed me that we can't do PGS and a transfer close enough that the embryos could avoid another freeze. AKA, our embryos, if we want them tested, will have to be thawed, biopsied, tested, and REFROZEN.   Ugh.  Luckily, both freezings are done using the vitrification method which barely damages the embryo.  But those poor little 100 cell guys (or gals) might not be able to handle being thawed twice over!   

Dr. Flyckt was super nice though and she is going to contact my nurse case manager to see if they will wave the restriction in my case for another fresh cycle even with frozens in storage.  We'll see what happens.  If that's the case, should I do supplements for 90 days beforehand (like I did last time and got my best hall to date)?   Will my RE like that if she pushed to let me do IVF just for me to say "hold on, I need time for supplements".   

You may be thinking, 'why hasn't she been on supplements just in case this whole time?'  Well, first and foremost, they do a number on my body.  My face practically falls off (it's truly gross..think snake) from the DHEA.   Second, they are $$$$$.  I've been on about 1/3 of the supplements this whole time so hopefully my eggs are at least decent?   Also, now I sound like a spoiled brat, but IVF is now covered so I could do it more than once should I get a craptastic haul.   

I'm so torn.  Should we even do IVF if they okay it?  Or should we just attempt to use those poor 4 frosties that would need to be frozen again and potentially damage the crap out of them?   I'm actually leaning toward just using them and no IVF.  But I'll be 35 this year.  My eggs are basically 50% crap at this age.  So out of every 2 embryos made, 1 will be useless.  That number gets exponentially worse with age.  See the chart:

Update (kinda)

So I hooked up with my nurse case manager from United Healthcare on Friday.  Surprisingly, she was actually an awesome person and very knowledgable.  I was super fearful she wouldn't understand my lingo (IVF, PGD, PGS, ICSI, etc), but she understood it all!   So good news and bad news.  Good news is they will, indeed, pay for an IVF.  Double bad news though..... they won't let me do another IVF until the 4 frozens we have are used AND, the more bad of the two, they won't pay to test our embryos to see if they are chromosomally normal (PGS).   They will only pay for PGD (the same test but also tests for a genetic disorder) - but Mike and I don't have any genetic disorders that we are trying to prevent from passing down.   So no paid testing for us.  So, we will pay out of pocket.  The transfer itself WILL be covered at least.   So I emailed my RE the following and I am still waiting to hear back:

Hi!  It's finally 2016!  I was able to speak with my  'insurance nurse case manager' and she answered all of my questions.  Unfortunately, I cannot do a fresh retrieval until all frozen embryos are used.  I want to PGS them using Genesis as well before transfer.  Unfortunately, my insurance won't cover PGS.  They will only cover PGD if we had a genetic disorder we were trying to prevent from passing down.  I don't suppose my scoliosis or anything could be used as a reason for PGD?   If not, we are fine with paying for PGS out of pocket.   So, next steps:  

1.  I'd like to still combine a hysteroscopy with a uterine scratch (in the luteal phase) the preceding cycle.  I am on cycle day 6 currently.

2.  PGS test my 4 frozen embryos.  Can we thaw them, test them, and transfer them all in the say 24-36 hours (so we don't have to refreeze them)?

3.  Transfer 1 to 2 normal embryos cycle following uterine scratch.  

I need your guidance on how to time #2 with #1 and #3.  :)   Again, I am on cycle day 6 currently if there was any way to do the scratch this luteal cycle and transfer next cycle?

A New Hope

Okay, so the post title was/is a Star Wars nod.... but it's also how I feel about 2016.   This year is our LAST year attempting to TTC.  Hopefully.  I hope we either end our story with another baby in our arms, or at peace that we never gave Victor a sibling.

A look up until now:

52   Eggs retrieved
32   Mature eggs
25   Fertilized eggs turned embryos
17   Made it to a transferable state
13   Have been transferred so far
7     Embryos transfers
4     Untransferred embryos

4     Pregnancies
3     Miscarriages (including 1 after a heartbeat was detected)
1     Baby - the absolute light of my life.

We made life 25 times and only have 1 baby to show for it.  Thank GOD we have him.  Don't get me wrong, I'd be nothing without him.  He's the light of my life.  I just want to give him a sibling so badly.  Especially after almost giving him a sister (who would be due in less than 2 months now if she didn't leave us on 8/18/2015 at 9.5 weeks).

I called the insurance company tomorrow to ask my list of questions.   I'll find out if I can proceed with an IVF, but more likely than not, they'll make me use the 4 embryos we have left.  To recap, we wanted to do another fresh IVF to make new embryos, and PGD those embryos as well as our 4 frozen embryos.   But there is an exclussion clause on our insurance that we can't do any egg retrievals until we use all embryos.  So, looks like we are going to try and get the insurance company to pay the $5,000 to PGD test our 4 lone embryos.  I pray 1 or 2 are normal.  I made them when I was 33 so chances are 2 are normal.  Maaaaaaaybe 3.  My heart would break if it was 1 or 0.  Anyways, the questions I'll hopefully get answers to tomorrow are:

1. Are you a senior member of RRS?      I have a lengthy history including numerous IVF cycles, and 7 embryo transfers.  I need someone who knows their stuff.   (Basically, I'm going to be a douche and ask this up front because I don't want to waste my time with someone who doesn't know the difference between IUI, IVF, ICSI, PGD, etc.)

2. What is the deductible we need to hit before we can tap into the 10k-20k family planning limit?

3. Already have been a patient of the Cleveland Clinic for 6+ years, I’d like to stay there.  Is Cleveland Clinic a COE?  (60 miles?)

4. My RE (reproductive endocrinologist) recommends doing IVF, creating embryos and testing those using PGD.   I do, however, currently have 4 UNTESTED frozen embryos.  Do those embryos exclude me from being able to do an egg retrieval because of the stated exclusion (even though I paid to get those embryos out of pocket): “Embryo or oocyte accumulation defined as fresh oocyte retrieval prior to the depletion of previously banked frozen embryos or oocytes.”  

5. Can my RE submit any documentation to allow me to proceed with IVF?

6. The next plan would be to thaw those 4 embryos and do PGD on only those four.   What does my RE need / “what forms are required” to do have PGD covered by insurance?

7. Could the PGD be covered on my husband’s insurance since the embryos are half his? (and not eat into my 20k)?

8. What does my RE need to do, what forms need to be filled out, to have IVF covered under my insurance?

9. I used to use Walgreens Specialty pharmacy for all of my specialty/fertility drugs, UHC no longer covers them in network.  Who will fill my fertility drugs now?

Regrouping / Plan

So last weekend Mike and I decided to PGS (pre-genetic screen) test our remaining four embryos, use any normal embryos, and if they worked, they worked.  If they didn't, they didn't.  We WERE going to be done.......

Then.....

My company announces as of 2016 they will give their employees $20,000 (lifetime cap) to use towards............ I - V - F !!!!!!!!!

We were shocked.  I cried.  I couldn't believe it.   After seven long years of TTC (literally since 2008), we were FINALLY going to be DONE.   Now......... we AREN'T.  

I'm happy and sad at the same time.  I am more than happy to have $20,000 at my fingertips to use towards the things we have ALWAYS paid out of pocket for.  We have probably sunk $30,000 - $40,000 in TTC since 2008.   Thank GOD we got our miracle Victor out of it in 2012.  He is my life.  He is my prince.  I'd be.....well, let's just say thank God he is here.

I am just tired of this roller coaster.  A seven year rollercoaster.  We were pregnant just 2 months ago.  Today marks exactly 2 months since I couldn't hear my baby's heartbeat.  2 months and 1 day ago we were living in bliss.  We were pregnant.  Our baby was alive.  THE END OF THIS JOURNEY WAS IN SITE!!!!!!!!!!!!!   Then that was ripped away.   So, just a month or so later the end of our journey was in site again when Mike and I decided to be DONE after these four embryos.

So you can imagine my head is spinning with the $20,000 2016 coverage announcement!

So, we coincidentally had a meeting (that we scheduled when I miscarried) with our reproductive endocrinologist this week.   We told her of our old plan and of the new coverage.  This is what the three of us decided:

Since it costs roughly $5,000 to $6,000 to PGS test a batch of embryos (that covers 8 embryos), why spend that to test only four embryos?  Now that we have coverage to do IVF (for a fourth time mind you), we will do that in February of 2016 and whatever embryos are made from that send cells from them as well as cells from our original four and send them all to be tested together.   PGS also reveals gender - if we want to know - and we do...... well, I do.

We will do IVF in February of 2016 instead of January because I am now going to go back on my PLETHORA of egg quality supplements that I was on prior to our 2015 IVF that yielded our best haul yet of 8 blastocysts.   I need 90 days of supplements for it to have an effect on the eggs inside me.   Mike is also going to go on supplements.  That way, come IVF #4 our parts are the best they can be.   February is good too because I'm sure I'll need all of January to figure out stuff and jump through hoops with the insurance company.  I already tried calling them and they could give me NO answers to my questions and told me to call back on the 2nd of January.  Unbelievable!

Did I mention my head is spinning?!?!?!?