A lot has been developing during the last couple weeks. Our consult with SIRM was bumped up and we spoke with the doctor there via Skype. He gave us his thoughts that a large part of egg quality lies with the protocol. We really thought what he had to say was interesting. Plus, after speaking with the nurse and financial coordinator and considering that the doctor is renowned globally, it seemed like SIRM was the way to go. They do all their cycles in batches. The next 2 dates were 2/22 and 4/2. We were going to shoot for April.
But alas, the day hubby and I were gonna sit down and discuss it, I got a letter from our insurance company saying that as of 12/31/15, we must choose a "center of excellence" in order for future cycles to be covered. I immediately called the insurance company and discovered that not only is SIRM not a center of excellence, but our current clinic is not either! Granted, we were leaning toward switching clinics but still...talk about frustrating!! I set up an appointment to talk to a nurse coordinator to discuss it in further detail last Tuesday. During that call, she did confirm that the only clinic we were considering that was a center of excellence was CCRM. I pled our case, but she said that the only way to be covered would be if we were going to start cycling before the end of the year - which at this point is impossible. So thankful that we do have coverage but so frustrated and dumbfounded as to why we were only given a couple weeks to be notified of this change. What if we had already put down a deposit (non refundable I might add)? We lost money spent on consults with clinics we can't even cycle with, spent hours researching, and hours filling out endless paperwork, getting records sent, etc. Grrrrr!!!
So now we are starting back at square one. I have to choose only the clinics that are on the "list". This list is not able to be sent to me as well. I have to send possible clinics to my nurse coordinator and she will tell me if they are covered. She only works during normal business hours so research I do has to take that in to account. I did get 2 candidates to call after our discussion on Tuesday though. One clinic is in Dallas. The other is in New Jersey. Both have excellent success rates. The clinic in New Jersey, RMA, is very similar to CCRM with their approach and lab quality. We scheduled consults with both. The Dallas clinic (Fertility Specialists of Texas) was last Friday. RMA will be on 12/30.
So we had our consult with the doctor at the Dallas clinic on Friday. He gave us a ballpark figure of 50-55% chance of success. The cycle would be a freeze all cycle with a frozen transfer later. This is a common theme with all the 2nd opinions we have received. There are studies that show that uterine receptivity is much better on frozen cycles as opposed to fresh since the body is not trying to recover from all the stimulation medication. PGS would be done if we have more than 2 blasts that result from the cycle. Due to my response on my previous cycle, he would keep the same protocol but push harder with my stim dose starting at 450iu to maximize the number of eggs retrieved. That would give greater odds at having a couple good eggs in the mix. He spoke heavily about sperm quality and that the role is larger than is typically thought. He recommended that we speak to a male fertility specialist in Chicago (best in the country he claimed) to make sure we have all the bases covered before starting a cycle. He thought that there may be a possibility that hubby could do TESE (retrieving sperm directly from the testicle before they make the 3 month long trip down the vas deferens which is where they become damaged) to get better sperm for ICSI. But he could not speculate at the time on the best course of action and said the male fertility specialist would make that determination. Relating to egg quality, he said there is not much that can be done to improve that. Our embies had high fragmentation on day 3 which is evidence of egg issues. But the poor progress from day 3 to day 5 is also indicative of a sperm issue. He said that my reserve looks good though and that by stimming at a high dose, I should be able to produce some good eggs. I don't have to do repeat testing. They will want a hysterscopy before the frozen cycle, but that's it. Right after our consult, the nurse called to follow up and introduce herself. Then the financial coordinator called. The costs are VERY reasonable. Almost uncomfortably so. Lol. It's ridiculous how much variability the costs are from clinic to clinic. Our Chicago clinic was pricey. SIRM was a lot less, CCRM is like the Rolls Royce of the bunch (literally would equal the cost of a new car), and our original Indianapolis clinic was the cheapest. When we were there, we didn't even come close to the 5k max our insurance company has. We will go over at the Dallas clinic, but only slightly over. Anyway I was impressed with how responsive this clinic was. It's very rare to have ALL the information in a matter of a couple hours. Usually it has consisted of a talk with the doctor, an email from his nurse a couple days later, and then a discussion with the financial coordinator a couple days after that. I'm just a little hesitant on doing out of town cycling there. I can't find much info with women going there from out of town. Also slightly nervous about being pushed hard. My first cycle my E2 got very high and my eggs were bad as a result. Of course this could've been due to poor lab quality as well - it's difficult to tell. Since we switched both protocols and labs with our 2nd and successful cycle, we can't narrow down what it was. Of course I was no where near to a high E2 number this past cycle so I think that's why this doc thinks I have room to be pushed. As far as logistics, he said we could plan the cycle out so we could arrange for travel. This would involve me being on the pill. I'd have some monitoring done here and then would travel there to finish up stims and have ER. Then I would go back home and wait for the frozen cycle the month after, involving another trip down there. So 2 trips total.
So that's what's happening right now. Like I said, we have another consult on 12/30. I also want to call CCRM to see how much their testing would cost after insurance. In order to get their thoughts on protocol and prognosis, hubby and I would need to travel there for their "one day work up" which involves a whole day of testing for both of us and talks with nurses and financial coordinator. I don't know if this would be covered by insurance or not. If not, it would cost us over $4k plus the cost of travel. That's before we even do a cycle! Also, the work up needs to coincide with my menstrual cycle. There is a range of days within my cycle when we can do the work up but planning a trip around that will be tricky. With all that said, since we want the best and don't want to do this again, CCRM would be the way to go.
Decisions, decisions....
