Sunday, September 23, 2012

Taking the Next Step- Femara + IUI

It's been a busy few days, and there is nothing better than a truly lazy Sunday. Hubby and I decided to boycot the gym this morning (very rare) and just sleep in, watch Joel Osteen's sermon on TV, and just take it easy today. I've got my hot cup of apple cinnamon tea by my side, candles lit, windows open, Tebow Time is about to begin, and the FedEx Cup golf tournament is on later. We may not even leave our house today, and that is perfectly fine with me!  Ahhhhh, I love days like today.

It's really been a great weekend overall. We had such a fun date night last night, just the two of us. Went to dinner and then a country concert to hear Eric Church play. He's no Keith Urban or Tim McGraw, but still fun to just get out of the house and people watch and listen to live music. You know you are at a country concert when the set on stage is just a bunch of kegs of beer and every song is about drinking whiskey! haha!

Friday was hectic, but good. We had our apt. with the new RE, I volunteered all day downtown, and  then another appointment with a thyroid endocrinologist that opened up last minute. I am waiting on results of my thryoid testing and will post an update once I get it. But first the new RE...THANKFUL; That is the word that first comes to mind. Thankful that we listened to our gut telling us to switch. Thankful that I had good insight from a former nurse at my fertility clinic to help us make the best decision for a new doctor. Thankful that the appointment went so well!

Dr. Vaughn met with us in his office and spent an hour going over our past experiences, my current issues, and how we can address them.  Basically, at this point we have been TTC for 15 months. Although it's true that healthy normal couples have about a 20% chance of conceiving each month when using well-timed intercourse on their own, once you have passed the 1 year mark of trying unsuccessfully, your chances are considerably less. We have been TTC now for 15 months with no viable pregnancy, and thus our chances of conceiving on our own are about 1-2% each month now. That is just how Western medicine views it anyway. It's a pretty depressing statistic, but one I have come to terms with. Even though I got pregnant once in Oct. 2011, they don't consider that a real pregnancy because it ended at 6 weeks, and is technically labeled a"chemical pregnancy." Ugh, I don't even like thinking about that. Moving on...

I like the way he presented our options to us, based on a continuum of what we've tried and what was next in line that might help us. We are approaching this with a goal of remaining as minimally invasive as possible. We don't plan to go straight to using IVF (In Vitro Fertilization) for various reasons. For one, I honestly feel I can get pregnant without IVF. For two, we have zero insurance coverage for fertility and it would cost us about $20,000 to have IVF done. So, we were given two main options for our next step:

1) Pills (ie. Femara or Clomid) with IUI procedure (Intrauterine Insemination) 
2) Injectables (Gonal F, Follistim, etc.) with IUI

Although I was fully ready to move to the more aggressive injectable drugs (They have higher success rates than pills), hubby and the RE both felt that it would be best not to use injectables this cycle and stick with Femara + IUI. I was already on CD2 at this appointment. It would have meant we'd have to come up with $2500 for the injectable meds within 24 hours and would have had to squeeze in an injectables lesson and get started immediately. Keep in mind, the bill would continue to grow with RE visits for 3-5 ultrasounds ($190/each) and the two IUI's that they perform within 24 hours right around ovulation time ($600). The bill could total $4000 easily for just one injectables cycle. That is all out of pocket!

Now, sometimes RE's will do a "combo cycle" where they use pills early in the cycle to stimulate production of eggs, and then will add the injectables in a lesser amount later in the cycle to stimulate growth of those eggs. This can reduce the cost of the treatment, but my RE does not perform combo cycles. He uses either pills or injectables, but not a combination of both. He feels that combo cycles aren't that much more successful than those using Femara + IUI alone, and that it's best to move to straight injectables if you are going to visit that option for increased chances. He said it's also the way he was trained and that he's had the most success with this type of protocol over the years, skipping the combo cycle and moving straight to full injectables instead when that option is needed.

VENT WARNING: It just baffles me that there are no mandates for fertility coverage in this country, and yet most insurers will cover a lifetime of diabetes treatments, heart surgeries, knee replacements, and a laundry list of other ailments for people who choose to eat poorly, not exercise, balloon to 300+ lbs, and take no control of their health whatsoever! Then you have your crackheads who get pregnant while drinking and doing drugs, who we support with our tax dollars as well. Yet, here I am taking immaculate care of my health, being a law abiding citizen, doing all I possibly can, and I have zero coverage to help conceive my own child, despite a medical diagnosis?? Infuriates me! Infertility should NOT be treated any differently than any other medical condition. This country is ass backwards! Period! Thanks for letting me get that out.

Anyhoo, it wasn't just cost that determined our choice of using Femara + IUI. It is about $3000 cheaper than the injectables option, but it is also totally possible we could have success using pills and IUI on their own! Plenty of couples conceive on Femara or Clomid + IUI.  Why jump to a costly procedure that is honestly kind of scary, before we even try the less invasive route first? Femara + IUI is obviously no guarantee, but it will increase our chances from what they are currently. It may just be a matter of getting the little swimmers past any obstacles they encounter on their well-intentioned journey toward my egg, and IUI will help get them as close to the target as possible.

Because hubby has an important business meeting to attend in CA later this month, we started the Femara early this time and I'm taking it CD2-CD6, in hopes we can move my ovulation up a day or two. We'll go back in on CD12 for an ultrasound to see what follies are brewing and how far away from ovulation I might be. We'll then know better when we might be able to have the IUI procedure done.  It looks like it may be the very day he had a flight scheduled to fly out (of course!) but we're hoping it will be a little sooner. He will do anything to make sure it happens as it's supposed to, and I love that about him. I am just keeping my fingers crossed that all the stars will align for us, and that he doesn't have to miss his important meeting in the process. Of course if we end up pregnant, it will all be worth it no matter what! Please say a prayer this works for us!


  1. Praying for a successful cycle for you all!!! In regards to your vent I have to say that I feel the same way about how insurance in most states is allowed to ignore infertility as a diagnosis however there are 15 very lucky states in the USA that have recognized infertility as a problem and have mandated insurance to cover it in varying degrees. Unfortunately I don't live in one on of those states and you probably don't either. It makes me sick and makes me want to do something to change that! But I want to get pregnant first so maybe a little later in life! Here is a link to a website about states that have mandates in case your interested: state-mandatedinsurancelist.jsp

    1. Thank you so much! As for the state mandated coverage I DO live in Texas, a state with mandated coverage. However, it is not all it's cracked up to be. I'm getting an error message when I follow your link, but I have researched that using the RESOLVE website...

      Texas doesn't mandate any coverage until after 5 continuous years of infertility. 5 years? I'll be closer to 40 by then! Way to say you offer something only to try to exclude as many people as possible. Many people may be too old by the time they seek help for infertility if they have to wait another 5 years. It also only mandates coverage for IVF and only after other procedures have been attempted unsuccessfully first and still only at certain facilities.

      Being that hubby's employer is CA based and so is our insurance, I thought maybe that would help, but not really. They are also a state with "mandated coverage" but not offering much either. Take a look and you'll see there are a lot of stipulations and gray areas in this so-called mandate. Right under the sections of "coverage" they go on to say "No coverage is required. Employers decide if they will provide benefits to employees." It's one big loop hole.

      Compare this to RI, NY, NJ, IL, HI, and CT. Now those states seem to have some mandates in place that are actually helpful to people. RI mandates up to $100,000 in coverage to be offered and only up to 20% out-of-pocket cost for the insured individual! I wish I had that kind of coverage!

  2. Yeah I saw the stipulations for some of the states and your right some of the ones that have mandates seem to really try to get out of it with the shades of grey! It is absolutely appalling that we have to pay taxes for the crack whores who get pregnant but we get nothing for ourselves when all we want is to be good loving parents to a wanted child!!!

    I actually joked with my DH about moving to Illinois (my family is there anyway) just so we could get some coverage! However that wouldn't be fair to DH or my step son since he is here in TN!

    Maybe one day things will change as far as insurance coverage goes! At least I hope it does.

  3. I agree about how ridiculous and backwards insurance coverage is. It pisses me off that so many people feel they are entitled to money for kids they can't afford, having their hospital bills covered for their unplanned pregnancy, etc., yet those who plan to take financial responsibility for themselves and their children have to jump through hoops to get any coverage at all, and what we get isn't much.

  4. I wanted to wish you luck and I will keep you in my prayers so this cycle will be it!

  5. I think it's a great idea to try the Femara+IUI first. It's much cheaper and it will definitely increase your chances. You still have time later to do injectibles, but might as well take the easiest route first!