red carpet (thoughts on my initial ivf appt)
So I just got back from my IVF intake appointment. They really pull out all the stops. The whole appointment lasted about 3 hours (!), but I met with my doctor, his IVF coordinator, an embryologist, and their financial coordinator in that time. I was really impressed that the embryologist in particular took the time to meet with me, explain the process in some detail and answer my questions. Overall I feel comfortable with them and trust that they do their job well. I felt very well taken care of – I guess this is what happens when you pay the big bucks: you get everyone’s full attention and care. They roll out the red carpet for you. 
It was almost like being at a spa, the way they guided me around from person to person.
I have to figure out a couple of things and I would *love* y’all’s input as well. They do the egg retrievals in their clinic with a nurse anesthetist. According to the doctor, they put you to sleep, but not very deeply (whatever that means.) My grandfather was an anesthesiologist and always, always, always told us never to be put under anesthesia unless an anesthesiologist was present – which there wouldn’t be in this case. The clinic will also do the procedure in the hospital, with an anesthesiologist, but it costs ~$10,000 more. So I’m debating about that. It is a lot of money, but I also have had a hard time with anesthesia in the past …
The second debate is about the number of embryos to transfer back. They will do either one or two, most likely at the blastocyst stage (5 days after fertilization.) If they only do one, most likely I’ll have only one baby (very slightly higher risk of identical twins), but the chances of pregnancy are ~45 or 50%. If they transfer two, my chances of pregnancy are 60-70%, but the chance of twins ranges from 30% (according to the doc) to 50% (according to the embryologist). They are suggesting only transferring one embryo. I am leaning towards that, but it also means there’s less chance that I would get pregnant that cycle. However, they said that ~95% of frozen embryos survive thawing and that there is no difference in pregnancy rate between fresh and frozen embryos. It would just mean (possibly) a longer wait to have a baby, when I have already been trying for two years.
Interesting fact, at least at my clinic: the fact that the cause of my infertility is unknown *increases* the chance that I will get pregnant. Weird. At least there is one benefit to idiopathic infertility. :D
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Posted: April 12th, 2010 under IVF, infertility.
Comments: 8
8 Responses to “red carpet (thoughts on my initial ivf appt)”
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April 12th, 2010 at 6.25 pm
As someone who may end up using exactly the same clinic, I would have no problems with going with the in-clinic nurse anesthetist route… but I also didn’t have an anesthesiologist grandfather. I did have a nurse grandmother, a doctor grandfather and a doctor grandmother, and they all seemed to not trust other medical professionals at all, haha. Anyway, to me the $10k would not be worth the slightly increased risk insurance, but I haven’t ever really had a hard time with anesthesia in the past. What are the complications you are concerned about?
April 12th, 2010 at 6.35 pm
Oh, as for the embryos — I think in our case, we would probably after some debate put in two… but I think a big part of why I would take that risk of multiples is because I have a co-parent. I would be hesitant to take a change of increasing the parent/newborn ratio beyond 1:1.
If they do vitrification (and it sounds like they must, with those thaw survival rates) then there really isn’t much to lose besides a month in doing a single embryo transfer… since if you get a negative on the fresh transfer, my understanding is that you can do a natural frozen transfer the following month. While that does provide a slight delay in the chances of baby, and then an additional $3k, I would find there to be a lot to recommend that. Also, pregnancy will be much easier with a singleton.
As for the payment plans in the other post– I tend to be wary of the bundle packages, since they are never offered to patients if it runs the risk of losing the clinic money. I get how it seems like really good insurance, and I definitely would be tempted, but I think I’ve taken enough statistics that I feel pretty firmly about the pay-as-I-go route.
April 12th, 2010 at 6.40 pm
Duh, I mean DECREASING the parent/newborn ratio below 1… but you know what I mean. Butif you have family members moving in for a while and basically coparenting, that would definitely count and go into consideration.
April 12th, 2010 at 6.58 pm
Hey Guinevere,
Wow, thanks for all the comments.
The complications I’m concerned about are that when I had surgery before they had a harder time waking me up and, more importantly, that I’ve got other health problems that came up when I had anesthesia last time…. Its a lot to figure out. You know, it’d be nice if someone just told me what to do and made sure it all worked out, but of course that can’t happen. 
Good point on the payment plans. I may still go with them just for the extra insurance (and maybe more motivation for the doctors, embryologists, etc.)
Yes, they are doing vitrification.
April 13th, 2010 at 5.37 pm
(This is the “Guinevere” from Mesdames Plus Baby, in case it’s not obvious who the crazy stalker is.) We’ve been thinking a lot about the same issues, obviously, so excited to have someone to discuss with! Yay for vitrification – that was on the list of big questions I had about the clinic, and now it’s resolved! Good point about the more motivation for the doctors if you pay a lump sum ahead of time.
April 13th, 2010 at 6.28 pm
lol, yes, I knew it was you.
I look forward to discussing more, too.
April 15th, 2010 at 6.08 am
my clinic does the same kind of anesthesia — sometimes it’s called “twilight” (CREEPY.). it’s intravenous, so there’s no messing around with your breathing, which makes me feel better about the no-doc situation. my parents are both doctors (who give major respect to anesthesiologists — they’ve both told me that they wouldn’t consider that specialty because of the intense kind of concentration it requires, and they’re already more concentrate-y than average) and they had no problem with me going under that kind of anesthesia with only a nurse when i had my wisdom teeth out.
(full disclosure: i woke up in the middle for a little while. BUT i was sufficiently blissed-out that i remember dispassionately observing to myself that they were be *breaking my teeth* to remove them. wasn’t upset in the slightest. and i loathed that dentist.)
April 18th, 2010 at 4.49 pm
BBM, thanks for the input. How awful that you woke up at your dentist’s!
I am leaning towards doing it at the clinic right now but my mom is going to talk to my uncle who’s a pediatrician and get his take.