Saturday, December 31, 2011

What has happened so far?

I had someone ask me the other day what the testing and preparation is like leading up to a decision to continue with IVF.  One thing to note is that this ultimately could be very different for anybody, but essentially the "basics" are:

Basal Antral Follicle Count (transvaginal ultrasound):  This is normally completed on day 2 or 3 of your cycle.  It measures the ovarian reserve (essentially how many egg follicles you have in your arsenal).  This number acts as a predictor for how many mature follicles you have that should react to the stimulation hormones taken during the IVF cycle.  If you have an above average number (like 8 or more), your chances are much higher that you'll retrieve a good number of eggs.  My specialist stopped counting at 12, so we're sitting pretty there!

Hysterosalpingogram (HSG):  This is done at the radiology lab.  A dye is injected through the cervix into the uterus and fallopian tubes.  My RE (reproductive endocrinologist) actually performs the procedures.  This helps look for blockages of the tubes, issues with the uterus, etc.

Hormone Blood Test:  One of a few different blood tests required.  This one is done the same day as the follicle count and is another assessment of the ovaries' ability to be stimulated and produce eggs. This is sometimes also called the "Clomid Challenge Test", which measures the hormone FSH at two different points in the cycle.  One issue with this test is that you can't really get a positive one, rather just a negative one.  Said another way, it can identify issues with your hormone balances and quality of eggs, but a "clear" test does not mean problems DON'T exist.

Preparatory Blood Tests:  These basically test for HIV, Hepatitis, Rubella, Rh, and  your Blood Type.  This is done on both partners.

Semen Testing (Morphology and Immunobead Test):  Obviously this one wasn't on me :)  This test verifies sperm count, motility, microscopic structures and looks for sperm antibodies (most likely produced after a vasectomy reversal - essentially antibodies that try to eat up your sperm).  Hubby had major count issues, antibody issues, and some morphology issues.  Hence, the IVF!

Sonohysterogram (vaginal ultrasound):  This was the last procedure we did before moving forward with the IVF decision.  Sterile water is instilled into the uterus through a small catheter in the cervix.  The water helps separate the inside walls of the uterus and allows any defects to be detected.  This is the time for a trial transfer as well - the doc utilizes the same tools for the embryo transfer so he cn measure the depth of the uterus.  This way, he'll know the best placement of the eggos at the actual time.  This one was pretty cool, as we could see the "empty" uterus - and hope the next ultrasound we saw had a baby in it (or two!).

Other common tests include many related to endometriosis, which is can be a common cause of infertility.  As I have had procedures unrelated to this done in the past, our doctor knows I have no endo, and therefore no tests were required here.

If anyone is having issues and wants to go through the testing to at least get the "lay of the land", I do highly recommend it.  While neither of our insurance will cover fertility treatment, both will cover fertility testing.  This is pretty common.  The trick is that once you are diagnosed or treated, all further coverage stops.  The out-of-pocket costs of the above would have been around $5,000, but fortunately I just had my copay for all of it.  Now that we're moving forward, insurance has washed its hands of us, but it was nice to not have to worry about money to at least get to this point.

If you do need to go down this route, be sure to check with your insurance very specifically on when coverage would stop (i.e. they consider a procedure to be treatment rather than testing).  I had heard rumors of a woman having her gyno prescribe Clomid when she had difficulty getting pregnant, while not really doing any testing.  However, that Clomid is then seen as treatment, and no fertility coverage is allowed past that point.  You certainly don't want to jump the gun with any treatment before absolutely necessary. 

So that's what got us here...I'll start my first medication sometime next week (a big, bad.....birth control pill?), and off we go!

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