Thursday, September 16, 2010

Tough Decision - Transfer Number (CCRM FET Costs Mentioned)

Such tough decisions....

**Any success rates I discuss below are strictly from CCRM's CCS Study stats...they are different than their conventional IVF and Donor Egg programs**

Both A and I are pretty strong in our beliefs to do an e-SET (elective Single Embryo Transfer) on our upcoming FET. That was until I called CCRM's business office to get an idea of the cost of another FET if our first one is a BFN. It's so unfair to treat your upcoming FET as a business transaction amongst other concerns.

Our chance for success are identical if we did two separate transfers compared to one transfer with two embryos. Okay maybe not identical as no FET is identical with respect to the uterine environment and no embryo is identical - but stats are close. But the advantage to do two separate transfers, we slice the twin rate which is currently close to 50% for the CCS study. Ugh...this is tough.

Here are CCRM's FET costs:

CCRM and FLC Lab Fees = $4,470 USD
*Medications = $850 to $2000 USD/CDN
**Travel = $1800 CDN

*my current FET meds cost $950...so lets say minimum charge...but if I have lining issues the costs skyrocket as I'll need more meds.

**3 nights hotel, rental car, flights for both A and I. I could just fly down on my own so then subtract $600.

So that means it will cost another $7120 to do another FET!! USD to CDN conversion fee not included – so more like $7300 CDN.

Oh...this decision is so so so tough. This number ticks me off because at Calgary, the cost of an FET is like $1500 and that includes meds.

Hook line and sinker...

We’re already into this $53,000 this year alone. The only fees left to pay this year are our travel costs back to CCRM at the end of October, so another $1800.

This sucks...what to do...what to do...

The current CCS success rate is a 61% live birth rate with a single embryo transfer. But this rate is calculated on women using their OWN eggs and an average age of 37.5 years of age. The twin rate is close to 50%. Very, very few donor egg patients elect to do the genetic screening and thus there are no stats.

It is MY belief (EDIT: formerly "WIDELY believed") that our specific success rate will be well over 61% if we did an e-SET because we used donor eggs (who has championship fertility), A’s numbers are also “championship” and the donor’s age is 33 years old.

On the flip side...I'll list MY concerns about carrying twins (no flames please):

1. Main concern is that carrying twins increases defects and potential problems 4-6 times higher than carrying a singleton as per my OB.
2. Pre-mature birth is apparently the leading issue with twins (according to my OB).
3. Just an overall higher risk pregnancy as many more things can go wrong.
4. Potentially jeopardizing our child's health risk to save $7,120 USD.
5. Guilt in trying to increase the pregnancy rate to spare our ever so limited emotional reserve to be lucky on our first transfer.
6. Okay...and I'm gonna throw this out there...but raising twins will be exhausting! It will be hard enough to life raising one baby let alone two. It's just been the two of us living alone for the last 10 years!
7. What if one of the embies splits? Then we have a high order pregnancy on our hands and a whole different set of worries and problems.

In no way do I infere an IFer to "playing God", but I can see why God makes the majority of the decisions when it comes to pregnancies and births. Another kick in the face to an IFer...feeling that God has largely left us in the dark when it comes to such decisions. I mean, it is my belief that he gave humans the intellect to create reproductive technology for our advantage, but this "gift" came with major strings attached.

What to do...what to do...

Since I had interest from a couple of my commenters about our CCRM fees to date from yesterday's post, I'll post the total CCRM fees in tomorrow's post.

I hope I don't stir up a whole hornets nest of nasty comments. But please respect these considerations as my own. I hold zero malice and judgement to any one of you who transfers one, two, three or more embies at a time. We all have our very unique reasons and rationale why we come to the decision on how many to transfer. And I can only say that I have nothing but respect for ALL of you because this.is.a.tough.decision!!!

8 comments:

  1. That is such a tough decision, and I hope the answer comes to you without too much worrying!

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  2. This is a tough decision that we've struggled with too... We'll probably transfer two but I agree with all of your concerns!! I think partly b/c our embies aren't perfect AAs... but also because I rather risk twins for the higher success rate of transferring two. I don't think I can take another failure. But I do think about this decision often and wonder if it's the right choice.

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  3. I have no words of advice for you. I chose to put two back, because in my heart I would be fine with twins. I was quoted an 80% success rate, so you just never know. I know in the end you will make the best decision with the facts you have at the time.

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  4. Lisa, this is such an agonizing decision. It's too bad there's not a large enough sample size for you to know how much greater your odds would be with DE CCS normal embryos. I'm confident that you'll figure out the best decision for you.

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  5. Lisa--you need to do what's best for YOU and need to account for your fears etc. re twins.

    I did want to comment on one thing--where did you get the "WIDELY believed" from? My understanding is that once you have normal embryos, age doesn't matter. CCRM put out a press release in Oct 09 saying the following:

    ***
    “Although our older patients are at higher risk to produce aneuploid (chromosomally abnormal) embryos, once we identify euploid (chromosomally normal) blastocysts to transfer, these women have a similar clinical pregnancy rate as our CCS patients who are in their thirties. This is very exciting, as it gives hope for healthy pregnancy to women in their early forties,” says Mandy Katz-Jaffe, PhD, Director of Research at CCRM.

    http://www.colocrm.com/newsevents/09-10-26/CCRM_Improves_Pregnancy_and_Implantation_Rates_Using_Comprehensive_Chromosomal_Screening_of_IVF_Embryos.aspx

    ***
    which gave me a lot of comfort, seeing as I'm in my 40s. Also, on the old IVFC a while back some people were insinuating that CCRM only recommends transfering 2 normals for older women (which I have to say offended me a little). So when it came time for my transfer, I asked Dr. Su and my nurse, several times, if the reason Dr. Su was recommending 2 was because of my age, and I was told over and over, no, they recommend 2 for everyone (this was back in April). So while 1 normal certainly gives good chances, I don't think it matters if it is a donor normal or "regular" normal as long as it is normal. At least as far as the info CCRM has released so far goes.

    --PBJmom from IVFC

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  6. Thanks PBJ for the info. The geneticist never said "widely believed" but just the tone of the conversation made me feel that the chances for an e-SET would be higher than the current e-SET rate. So I should clarify that no CCRM professional has ever told me that DE "normal embies" are "better" than another "normal embie". But the alluded that perhaps with all factors considered, we potentially have higher odds. No one knows for sure as the stats are so few with CCS and DE.

    But you are right. In fact, your analysis of this statement now makes me believe that success probably depends on the embryo quality on Day 5 more than "normal or abnormal". Very interesting...thanks for the discussion as your comments may shed a different point of view for me and thus may help me arrive at a decision. So I guess I'll have to wait the CCS results before we can make a decision.

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  7. When I was talking to one of the Dr. at RFC in Calgary they had said that if I chose to do DE at CCRM or SRM that they would ship the embryo's to Calgary so that the FET cycle could be done there. If in fact that is the cast could that be another option for you? I'm not to sure if that is true but it was just a though I had because I completely understand the $$ aspect of it.

    Hopeful1

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  8. You pose some very tough challenges to transferring 2. I need to get my head around it. I always assumed I would follow the RE recommendation. I never thought to challenge it.

    I really respect your commitment to explore this. Your control (ha!) of the situation impresses me and I am proud of you. Who on earth would question or flame you? Are there really people out there like this?

    I think I am tracking - I got an 85% DE success rate from CCRM due to the planned fresh transfer and yours initially changes to 60% due to FET. However we anticipate a higher success rate based on your donor classification. (Nevermind the fact she is beyond super star.)

    I am feeling a little overwhelmed right now between reviewing clinic stats and drooling over donors. I want to help you but the best I got right now is "Yeek. Good question." I am always here reading and rooting for you.

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