Final Costs

I went to the clinic today for my last follow up appointment.  I have more to say about that, but I thought I'd separate the posts.  This one is going to be about costs.

If you want to see all my posts documenting cost along the way, you can either click on the word cloud "cost" over to the right hand side, or, you can click here.

So here's the final breakdown:

Previous total cost for 2 cycles	£10,481
Follow up Appointment	£120
Drugs from Healthcare at Home	£729
Egg Freezing Cycle	£2800
Final Total	£14,130

The doctor I saw today did not charge me for the follow up appointment.  I feel confident that if I'd seen either of the other two, they would have.  I'm not complaining.

With 13 eggs in the freezer, that's around £1,100 per frozen egg.  That's expensive.  I mean, that's really expensive, when you consider that one or two may not defrost, and I may not even get a baby from them.  Heck, I may not ever USE these eggs.

It's important to note that I have paid up front for 10 years storage.  If I don't use all 10 years, I should be refunded some amount for the years I don't use (maybe £800 back let's say?).  I also paid for blood tests and things that I might have been able to get done for free or for cheaper through my GP and not through the clinic (£250 or so?).  There was also the added expense of not knowing about Healthcare at Home for my first cycle, and the cost difference for that is explicitly documented in my post about Reducing Drug Costs (£1000 approximately).  

But here's the thing.  If the time comes in the future that I did want to have the option to use frozen eggs, would I regret this if I had NOT frozen my eggs.  100% absolutely.  

In the end it's only money.  Regrets are far more expensive.

Cycle 3: Day 0

My period has arrived this morning so tomorrow will be my first shot of my third and last cycle.  I don't know if it's due to the acupuncture or the natural fluctuations of life, but my period seems heavier and a brighter red.  I swear I've never had much interest in the qualities of my period.  Getting all involved in your fertility does strange things to you!

I had a doctor's appointment on Friday for my pre-cycle scan.  Everything looks okay.  There were 7 good follicles on my ovary.  My cyst looks to be about the same size.  I asked if the seven we were looking at were what we had to work with for this cycle.  The doctors said that some of them will go away, but some smaller ones will emerge and it's a good start.  I think it's similar to the past two cycles, so that's okay.

So tomorrow I'm on 300 Gonal-F and on day 4 I add the Cetrotide.  I'm also going to schedule my next scan for day 4 so that's Thursday.  As we are changing the drug dose this cycle, it may need to be more closely monitored.  The doctor said he might reduce it ond ay 4 or might keep it the same, so we'll see what happens.

I also paid for this cycle which really hurt the bank balance but it is what it is.  When I was paying, I again flagged the issue of the 'follow-up appointment' charge, as I've now been charged twice for it.  This time, she went to speak to the clinic director who said that it is definitely not included.  So I told her that I thought this was really unreasonable.  She said the only time they do a 'free' appointment is in the case of a failed IVF cycle.  But I argued that in that case, firstly, the couple comes in one more time after the retrieval so gets to speak to the doctor, and isn't all drugged up and also secondly, as I knew I was going to do at least two cycles, it was fairly obvious that there was a mandatory 'in between appointment' and it was shit to be charged for it.  She said she would raise it at the next internal meeting, in the meantime however, I'm out the extra money.  I mean fine, in the grand scheme of things it's a small proportion of the money, but I'd rather they bump the overall fee by 100 pounds and then include it then dump it on you like that.  It's annoying.  And what you don't want to be, in an emotional and hormonally charged process, is annoyed by things that seem really stupid.

I also learned that my clinic has been bought by/has joined a larger network of IVF clinics in the UK.  I'm not sure it makes any sort of difference as it seems more of a higher level management issue and each clinic seems to be independently run.  But I suppose it can't be a bad thing in the long run, particularly if in a couple years time I'm not in London but somewhere else in the UK, it might be easier to use a local related clinic then go back down to London but that's a long way away to be thinking about.  I suppose although it's interesting, it really doesn't seem to impact me at all.

The other thing I'm looking forward to now that this cycle is starting is getting my fridge space back!  This is more for my non-UK/European visitors but having had my drug delivery a couple of weeks ago, it's put a serious limit on my fridge space!  I have a flatmate, and she gets the bottom half of the fridge, so as you can see from the picture, space has been a little tight!

Anyway, that's all the news from here.  I'll keep things updated as this cycle goes.

The Inbetween

Just thought I'd throw an update here.  It feels like ages ago since my last cycle even though it wasn't.  In between then and now I have had a birthday which makes me 39.  When thinking about fertility, your age makes you stressed.  There just isn't any way around that.  So I try not to dwell on it too much.

Originally I thought I would do my third cycle in September or October.  Right now I feel October would be better for me.  August has been a ridiculously busy month and I need to get back into a normal routine.  I'm also considering some acupuncture.  Not just for fertility stuff as I'm not particularly convinced it's helpful.  But for stress.  I am generally very stressed these days and I don't think that helps with making my body a fertile place.  I am only going to have one more shot at this, so I need to feel I've done what I can.  Obviously I should also lose some weight, but that's not particularly happening.

It looks like I will end up paying for my third cycle without parental help.  It is what it is.  I know I'm very lucky that my mother helped with the first two cycles.  Still, it is a horribly expensive process.

I also spend a lot of time thinking about jobs and life after my PhD which is nearing its end (hence a lot of the stress).  When I think about jobs and the future I find I fixate on where I can get good maternity cover.  It's not that I have given up on meeting someone and having a partner, but I feel this tremendous time pressure.  I just don't want to be that old and have a baby.  So probably something I want to do in the next 2-3 years.  Scary.  Getting eggs is one thing.  Thinking about babies is something else entirely.

Anyway.  I need to make a follow up appointment with my clinic and order the next round of drugs.  Obviously I'm going for Healthcare at Home!!  I also want to see if I can get to see the clinic psychologist to talk through my stress and baby thoughts.  After all, it's included in my cycle costs.

In the meantime, I am just enjoying my time off from the cycle.

End Cycle 2, Cost Update

At the end of cycle 2, I thought I'd post a cost update.  You can see the full breakdown from the first cycle here (with the cost of my follow up scan added here).  You can also see the drug breakdown comparison from my first cycle bought direct from my clinic to the Healthcare at Home order here.  For ease, costs have been rounded to the nearest pound.

Previous total cost	£6996
Norethisterone delivery from clinic	£11
Drugs from Healthcare at Home	£584
Egg Freezing Cycle	£2800
225 Gonal F from clinic	£90
Total	£10481

The total for the second cycle came to £3485.  Given my estimated budget of  £10k for 2 cycles, that's pretty much right on target.  It would have even been a bit better if I had known about the less expensive drugs from Healthcare at Home for my first cycle.  And of course I expect a refund at some point from the 10 years of storage since I doubt I'll use all ten years.  I think they refund you £150 for every year not used.

Assuming I go for a third cycle I will be able to shave off a tiny bit more- as the norethisterone didn't arrive in time, I have it set for the next cycle and don't need anymore.  I also would get a 450 Gonal-F pen from Healthcare at home as I believe that even if I don't need both doses, it would still be cheaper than the one dose I had to buy extra this cycle from my clinic.  Although I only have one Cetrotide left over so I'd need more of those, maybe it would work out to the same then.

Egg freezing is not an inexpensive process, especially when like me, you need multiple cycles.  I hope that in the couple of years between now and when I hope to use the eggs the costs may come down a bit as the popularity continues.  In the next month I will need to consider my options for paying for a third cycle.  My mother paid for most of the first two (I think I paid about £1000 of the total myself), but that is all she can afford.  I am going to speak to my step-mother about whether or not she thinks it's worth discussing it with my father or not.  I could take money out of my mortgage, or I could use my savings.  I have enough to cover the third cycle myself, although it would take a substantial amount of my savings at a time when I may need it (I'm finishing a PhD and my funding runs out at the end of the year).

Still, at the start of this process I said I probably wouldn't have done it if I had to pay for it myself, but now I obviously feel differently and that it would be worth my own savings to finish this journey.  I think that's probably worth noting.  I have no idea what the future may hold but it's clear that doing this has given me some sense of confidence or comfort that wasn't obvious at the start.

Reducing Drug Costs

I could have also called this post, "I won't do that again!" or "I wish I knew then what I know now!"

I have just received an estimate for drugs from Healthcare at Home for the drugs and I am blown away by the price difference.  Now, just to be clear, my prescription is not quite for enough drugs so I don't 'over order' but let's compare.  This was the previous drug breakdown from my first egg collection cycle:

Drug	Cost
Gonal F 900 pen x3 (£360 each)	£1080
Gonal F 450 pen	£180
Cetrotide x12 (£32 each)	£384
Ovitrelle single dose	£16
Total Cost	£1660

This is what I was just (April 2013) quoted from Healthcare at Home:

Drug	Cost
Gonal F 900 pen x3 (£142.56 each)	£427.68
Cetrotide x10 (£10.80 each)	£108
Ovitrelle single dose	£6.48
Delivery Fee	£30
Credit Card Fee	£11.44
Total Cost	£583.60

Based on my previous cycle, this is two doses short of Gonal F and two doses short of Cetrotide- if my protocol lasts as long as my first.  But lets be clear.  This means my drugs would be almost 1/3 the cost of the drugs from the clinic!!  That is a HUGE difference.  Even if I have to order a couple extra doses, it will still be significantly cheaper, even with the delivery fee and credit card fee.  I mean, I will be getting a Gonal F 900 pen for LESS than the cost of the clinic 450 pen!!

So this means if my previous projected cost for cycle 2 with no changes was £4471, my current projected cost for cycle 2 with the drugs listed above is £3384.  Even if I have to purchase a Gonal F 450 pen and two more Cetrotide from my clinic (although why would I?) the projected cost will be £3628 for a total projected savings of £843.  And if I do need extra drugs and buy them from Healthcare at Home then I will save a bit more (around £40 more based on the above costs) even with delivery and credit card fees, so still worth it!

Part of me is annoyed I didn't know to check this out for my first cycle.  I'm also a tiny bit annoyed that my clinic never mentioned it, although obviously they make profit on selling the drugs, so I don't entirely fault them.  To be honest although I think it would be a nice thing to do, it's really not their job to mention it- I didn't specifically ask if there was any way to reduce my costs either.  However, I definitely know where I'll be getting my drugs from for cycle two.  I need to get on with ordering them now as I'm out of the country for most of May and when I get back for the start of June it will be time for round two.  But I'll keep updated here with my drug purchasing experience.  So far Healthcare at Home has a huge endorsement from me (if you can't tell by my repeating their name and posting the link :) )

Follow-Up Consultation

Today I had my fist meeting with the doctor since my collection.  I am sad to report that I was charged for this visit.  I feel that this is not ideal and that a single follow-up consultation should be standard with an egg collection procedure.  But, you can't be pleased with everything.  So the new update on costs is:

Previous total cost	£6876
Follow-up consultation	£120
Total cost to date	£6996

But it is what it is.  Either I choose a different clinic, or I accept that this is how it is.  Can't be pleased with everything.  And overall I am really generally pleased.  So I am going to stick with them.

So I saw my doctor today and we discussed how everything went and he did a scan to check on my ovary since I said that I could still feel it and I knew it had not gone back to normal size.  I was of course concerned it was the cyst but I am happy to report that my cyst is still the same size as it was before and has not grown at all.  On the other hand, my ovary is currently about twice it's normal size.  The doctor said this was 'normal' and that it can take up to two period cycles for it to return to normal size.  When stimulated it can be 7 or 8 times normal size.  So my ovary has definitely 'gone down' but it's not all the way down yet.  In keeping with this he suggested I stay away from impact exercise and twisting until I don't feel it anymore.  I'm glad that I wasn't making it up that I still 'felt' the ovary and also glad I was taking it easy and not rushing back to the gym.

We discussed how the retrieval went.  In the end there were 10 follicles and 6 had eggs and all 6 were mature.  They can't tell you anything about the quality of those eggs.  I asked if there was anything I could be doing now to help improve number or quality as there are many things talked about online.  He said the only thing he suggested was that I consider some slow weight loss between now and my next procedure.  That's fair.  But he cautioned me it needs to be slow and steady, not a crash diet as that can negatively impact egg production or quality.  So I need to be a bit more serious about seeing if I can lose 10-15 pounds in the next two months.

He said he felt the protocol was good and he didn't particularly want to change it.  He said that as I only have the one ovary he didn't want to be too aggressive or risky because we want to protect the ovary as well.  That seemed reasonable to me.

He gave me a prescription for my drugs and said they are happy for me to source them elsewhere if I can get them for cheaper, so that was good and I need to follow up with that over the next couple of weeks.  He also said that my retrieval procedure was a bit tricky.  That surprised me. I asked why and he said that my ovary moved around a lot during the retrieval.  Apparently the dermoid cyst can make it wobbly or a bit less stable, or even float inside the gut, so apparently it wasn't exactly straightforward to retrieve my eggs.

So there you have it.  I'll post more about drug pricing as I look into that.  In the meantime I have 2 months to see if I can drop some weight.  That's not going to be easy though if you consider I'm back in the States for 3 weeks in May.  But I'll do the best I can.

Costs

I know I promised I'd return with a cost break-down post.  After a couple of weeks I have returned to do just that!  But first some other house keeping.

My period came and went and I finally started to feel less bloated.  It probably took a good 2 weeks before I started to think I felt "normal".  However, I have noticed that I still sometimes feel my side where my ovary is.  I have not had a follow-up appointment with my clinic (though I hope to arrange one next week).  Part of me is concerned that my cysts somehow grew a lot and that's what I'm feeling.  That seems slightly irrational, but I have no other way to understand why I feel "something" even when the rest of me feels normal.

I'm also slightly disappointed that my clinic did not mandate a follow-up appointment post retrieval.  That seems poor form to me.  I'm not sure if it was an oversight, or if it's standard, but I think follow up care is important.  So I'll call that out as something that has not made me happy about my clinic.  But, as I say, I'll try to get an appointment next week.  Mainly because I need to discuss how to proceed with cycle 2 in June.  So while I'm not thrilled with every aspect of my clinic, I'm also not unhappy enough to go elsewhere.

Now, on to costs.

A caveat.

After looking around at IVF blogs, it came to me that in the UK other people try to price their drugs cheaper at certain pharmacies.  It may be that I could have gotten my drugs for less had I shopped around.  My clinic did not suggest this to me, and it honestly did not occur to me.  For my second cycle, I will try to shop around for cheaper drugs, and I will post about that here as I do it.  However, below were the costs of my first cycle, using the drugs provided by the clinic, at the clinic cost.  I had no left-over drugs at all, which I really appreciated.

Service	Cost
Initial consultation and blood work	£490
Norethisterone plus mail fee (£6)	£11
STD Blood work	£115
Gonal F 450 pen	£180
Gonal F 900 pen	£360
Cetrotide x4	£128
Egg Freezing Medical Cost	£2800
Ten year storage (unused refundable)	£1800
Gonal F 450 pen	£180
Cetrotide x1	£32
Gonal F 450 pen	£180
Cetrotide x3	£96
Gonal F 450 pen	£180
Cetrotide x1	£32
Gonal F 450 pen	£180
Cetrotide x3	£96
Ovitrelle single dose	£16
Total Cost	£6876

So here are some quick facts:

• The 'egg freezing medical costs' included all of my clinic visits, all of my scans, and the retrieval procedure and associated drugs (including suppository)
• The initial consultation and the storage are one-off fees which I won't pay again. Total: £2290
• Total drug costs: £1671
• Projected cost of cycle 2 if no changes: £4471

I suppose it's also important to note that I was on drugs for 15 days which is longer than average and so obviously increased the costs.  If I can reduce the drug cost, that will obviously make a difference.  If I could get my cycle 2 cost to under £4000 I'd be happy.  But, I'm also happy to note that this is all pretty close to my rough estimate of what it would initially cost for two cycles (I'd assumed £10k) and that was assuming I wouldn't be on the stimulation drugs for as long.  So there you have it.  Just my experience of course.  I would be very interested in hearing from women in the UK about their comparison costs.  Please leave me a note if that's you!!