IVF+ ICSI - Overwhelmed by choice and cost. Help!

[Frazzlerock]

Hi there, I have just started thinking about IVF after DP says we could afford it.
I have PCOS and DP has low morphology after his last test - although we have had three pregnancies but we lost all three babies. I also wonder if it was taken at a bad time as he'd been on a big stag week so, despite leaving it 48 hours between drinking alcohol and the test, he had had a very heavy week previously. So I'm not sure how true to life that test was.

Anyway, my biggest problem is my age. I'm 40 . We lost our first baby 3.5 years ago so this has been going on for a very long time and I've just about had enough of waiting, while every other man and his dog (literally) has babies. And obviously I also have PCOS whihc I control as much as I can with diet, Metformin, and supplements.

I've been researching clinics and costs but it's such a minefield. How can I possibly know what we will need exactly, as all treatments are broken down?

Speaking to a friend who has been through it she said we will definitely need, at least:

IVF+ICSI
HEFA fee
Embryo freezing + 1 yr storage
Virology tests for both of us
Blood tests x 3
Initial consultation.

Is there anything else we will most likely need?

Which clinics should we be avoiding and which ones should we be seriously considering. It's such a huge cost that I would hate to make the wrong decision. My friend says they spent a good £7k at the Lister and is pregnant now after the second go. I've looked at Zita West, Lister, CRGH, and ARGC (which I have found on MN to be super expensive)

We are London/Kent based if that helps at all. My RMC consultant is Maidstone who we are seeing again in Nov.

Any help would be gratefully received.

[Lauren83]

You will need to factor in a repeat semen analysis and ultrasound scan usually too, plus meds approx £1,500 (more if your ovarian reserve is low) you may want to consider doing a little research into PGS too considering your age and history or recurrent miscarriage, you will get mixed views on this but worth a look into IMO

[Frazzlerock]

Hi Lauren, thank you for your message.

My AMH was high last time it was checked about 3 years ago - thanks to PCOS and barely ovulating over the years. I don't remember the number but the consultant said I had the egg reserve of a 25 year old.

I will find out what 'PGS' is. That is another thing, all these acronyms. I've no idea what anything means when I have a look at past MN threads.

[Lauren83]

PGS is pre implantation genetic screening, embryos are biopsied on day 5 to check for aneuploidy (abnormalities) aneuploidy is one of the biggest causes of pregnancy loss and failed IVF and once a woman hits 36 you often see around 50% of embryos created would have it so it saves you having embryos transferred that wouldn't have a chance of becoming a live birth, in my opinion it's worth thinking about if you are likely to create plenty of embryos. I had IVF 5 times although moved to donor eggs myself

[Frazzlerock]

It certainly looks like a good idea. I have added it to my costs notes.
We know for a fact one our last baby has Trisomy 16 which, I was told, is not genetic and just 'one of those thing. Though I'm convinced our first one had the same as we lost her at the exact same stage and also a MMC.
I'm not convinced it is just 'one of those things'.

[Frazzlerock]

*had not has

[Rosehip345]

Do you know why the pregnancies haven’t been viable?
We had the same problems you and your husband are faced with and I took Clomid and had an IUI whereby they basically chose the best swimmers.
My problem with the PCOS was that my hormones meant everything was out of sync, not releasing eggs or releasing them too early.
I’m guessing if you’re looking at IVF you’ve been down these routes already?

[Lauren83]

I think it's worth considering even more so then, the additional cost which is usually around £3k can be justified if you would possibly be spending money on frozen embryo replacements of non viable embryos, you usually have to pay for a separate FER once the results are back so it's good to look into a clinic that works with access fertility as their packages included a FER in the price so it usually means you have secured a second egg collection for very little more if the first cycle fails

[Rosehip345]

I’m sorry maybe I’ve misread but would this be your first attempt? Do they no longer offer first try on the NHS?

[LillyLeaf]

Also look at access fertility, which is a multi round refund program. If you need multiple cycles it saves a lot.

I would also recommend pgs testing. I'm 37 and out of 11 embryos, 2 miscarried, 1 is normal and 7 were abnormal.

[Frazzlerock]

Hi Rosehip345, I have 2 DC from a previous marriage, both pretty hard to conceive due to my PCOS really playing up and I also didn't know about diet and supplements back then. So this means I wouldn't get IVF on NHS.

No we haven't been through clomid and IUI. I understand clomid helps to release eggs? I do ovulate, I use Ovusense which confirms I ovulate, just quite late. My cycles are around 40 days which is really good for me. They used to be 100 days + when I was TTC my 2 DC.

I don't know anything about IUI. Is it expensive? Is it worth doing before we go ahead with IVF consultation?

[Frazzlerock]

Hi LillyLeaf, I couldn't get my head around Access Fertility. From what I understood, they don't help you if you're over 38?

[LillyLeaf]

On their website it says programme options for under 45? Maybe that doesn't include the refund programme? But there are other options. No matter which way you go it costs a lot, then with meds on top which is hard to budget for as you never know what drugs you'll be on.

[Frazzlerock]

Rosehip345 I meant to add, we only had our third baby tested as the NHS don't test before three losses. Our little boy had Trisomy 16 which I'm told is the most common reason for baby loss before 12 weeks and not genetic.

[Rosehip345]

I would definitely recommend looking into the clomid/IUI option before IVF. Especially because of all your symptoms etc
It’s considerably cheaper than IVF, some people skip it as if it doesn’t work your option is then back to IVF.

My own cycles are exactly like yours, and still are. I am 6week cycles approx. We had seven years of failed pregnancies and various pills and diets, we then did one go NHS, second private (both successful).

The way it was explained to me was that pregnancies can be unsuccessful if you release eggs either too early (not ready so don’t develop at certain stages as well) or if you release them too late (they’re essentially past their use by date). The IUI takes the best sperm sample and inserts it at the precise moment that creates the perfect possible chance.

You need initial consultation
Sperm analysis
Ovary scans £120
Then scans weekly to determine precise time
And procedure costs.
Clomid was about £60-120
Each scan was £150, I do not remember how much everything was in total but it was closer to the £3k mark than 7!

[Lauren83]

You can still do the Access multi cycle just not the refund package, it's a tough one with IUI it's a good option for some people but the success rates are a lot lower and you would be looking at around £900 each month + medication and a tubal patency check beforehand approx £500, even if you were under 30 with no male factor infertility and no history of loss you would only be looking at around 10-15% chance with IUI.

Most people I tend to know who do it are same sex/single women using donor sperm who can't try naturally, I think considering your history, pregnancy loss and your partners SA results you may get encouraged to go straight to IVF/ICSI

[Frazzlerock]

Thank you so much Rose and Lauren.

I worry that IUI will be wasted money if we end of going for IVF/ICSI. I also worry that time isn't on my side to try it out. I think I just want to get going immediately, you know?
I have just spoken to Access Fertility and we would be eligible for their Multi Cycle program. For Lister it will cost £11,100 and for CRGH it is £13,400 - both will give us 2 fresh cycles and unlimited frozen transfers. Seems a lot given our friends just did two lots with the Lister for about £7k. I just don't understand what the benefit of the Access Fertility program is? Maybe its the unlimited frozen embryo transfers?

[Lauren83]

With Access there's obviously a risk you may lose money as if you have a live birth on the first cycle you will have overpaid roughly by around £1,700 in most cases although if you do PGS and a FER then you have usually got your money's worth from the package when you factor in the cost of the FER, I work in a clinic myself and not many people do single cycles these days

[Frazzlerock]

Yes I don't think our friends had PGS as she is younger than me.
Sorry, what is FER? I tried to google but it kept wanting to change to 'FET'

[Lauren83]

Just priced up a single V multi cycle (meds and consultation fee excluded) at a clinic in your area

Single cycle ICSI
IVF with ICSI £4,500
HFEA fee £80
Extended culture £525
Freezing and storage £552
(FER would then be £1,725 + HFEA)
(Time lapse if you chose to use it £795)

Multi cycle ICSI £9,650
Includes....
2 x cycles of IVF with ICSI
Extended culture
Freezing and storage - 1 year
Transfer of all frozen embryos
HFEA fees for all fresh and frozen
Use of the time lapse incubator

So it would be £12,900 to go twice doing single cycle thats without any FERs

[Lauren83]

It's the same as an FET sorry
Frozen embryo transfer/replacement

[RubySlippers77]

Have a look at Hammersmith hospital for IVF too OP - they were very good with us, and cheaper than some other clinics (although we were NHS):

https://www.hammersmithivf.com/fertility

And for you, it sounds like a very tough time.

[Frazzlerock]

Oh wow, thank you Lauren, that is really useful information. so I guess it really would be worth it.

I've just asked them if they do an instalment payment plan as I just can't wait any longer and it would take us at least a year to save £13k

Ruby, thanks I will have a look now, although it's not terribly close to where we work in London - I'm Aldgate and DP is Islington, and we commute to/from Kent

[Lauren83]

They used to but I believe they stopped offering the payment plans last year, you can't pay by credit card either so a lot of people use a low rate personal loan. If you need anything else feel free to PM me

[Frazzlerock]

You're right, they emailed me back and they don't offer a payment plan.

I will check out loans, thank you x

[Marmite83]

Hi @Frazzlerock, I'm sorry for everything you've been through. I also have PCOS (and endo) and have been ttc dc2 for 2 years. I recently did my first IVF cycle and got my bfp but sadly had a mmc. I'm about to start my first FET cycle. I'm with Gennet City Fertility in Farringdon and we went with Access Fertility. I have to say that when I got my bfp I genuinely didn't care that it meant we'd overpaid. When I had my mmc it gave me peace if mind that we could do FETs with our three frozen embryos and another fresh cycle if needed and just pay for meds. The Acccess Fertility brochure I have for my clinic says that a 2 cycle multi cycle for a 40 year old is £8300 with ICSI or £6250 without. You would then need to pay for initial consultation with scan, AMH and semen analysis £350, screening blood tests about £475 for both of us I think and meds (£1500-£2000 for a fresh cycle). FET meds are generally cheaper as you don't need all the stims. We weren't sure if we would need ICSI as my dh had one bad sperm analysis but 3 good over the last 4 years so Access Fertility said we could buy without ICSI and just pay the clinic direct if we needed it which meant if we did need it but only ended up doing one cycle we would only have paid for one ICSI instead of two. I really like my clinic, its very professional and everyone is really friendly. Might be worth having a look if you haven't already. Good luck with whatever you do!