The Cost of Infertility

As we continue on this journey, I thought it might be helpful to keep a running total of the costs of the procedures, office visits, and medications associated with the infertility treatment and care. Here is the running total so far. This is our real out-of-pocket cost and does not include the cost covered by our insurance.

• Initial diagnostic ultrasound and blood work through gynecologist: $250
• Follow-up visit with gynecologist (resulted in referral for MRI): $105.54
• MRI (to diagnose prolactinoma) $611.88
• Initial consult with reproductive endocrinologist: $162.17
• Cost for cabergoline to treat prolactinoma: $106.75
• Follow-up consultation with reproductive endocrinologist to determine treatment plan, plus a second antral follicle count ultrasound: $244.03
• Blood work at follow-up consultation (AMH, checking prolactin level, and hormone levels): $61.46
• Third visit to the reproductive endocrinologist: $162.17 (estimate, based on prior bill)
• Cost for first month of Femara (letrozole): $61.46
• Miscellaneous other expenses to track cycle (Ava bracelet, ovulation predictor kit, pregnancy tests): $272.94 

This is a grand total of... $2,038.42. Over $2,000 spent and still no pregnancy to report. Most of this cost has been covered through my HSA. If you have the option to use an HSA, this really is a nice way to save to cover for these expenses. Continuing to save in my HSA and hoping that savings will be going toward bills for prenatal care very soon!

Preliminary Results

I've heard back from the nurse at the reproductive endocrinologist's office. My prolactin level is in the normal range!! This is great news. TSH level also looked good. She told me everything else was normal.

I also received news that my blood sample was received by the genetic testing lab. I'm hopeful we will have those results back by next week.

I need to get in touch with my insurance company to schedule a repeat MRI to verify that the prolactinoma on my pituitary gland is actually gone.

I'm feeling anxious about my ultrasound and wish that I did not have to wait until September for the results. I've been reading some about "diminished ovarian reserve" and worry about the health of my ovaries. Everything looked fine in my initial ultrasound back in the fall of 2015, so I think I'm worrying over nothing.

I have recently found some interesting podcasts and a few others resources about infertility. It helps to know that others go through the same things we're going through.

Next Steps: Additional Testing

We are still not pregnant. We returned to our reproductive endocrinologist's office yesterday for additional testing in determining our next steps. As we expected, this led to further testing. Here are details about the tests we had completed:

Blood Test
I had several vials of blood taken to test my levels of various hormones.
DHEAS: DHEA is a naturally occuring hormone produced primarily by the adrenal gland. Levels peak in early adulthood and decline with age. DHEA is used by our bodies to produce estrogen and testosterone.
Testosterone: While this is typically considered a "male" hormone, it does play a role in fertility. Specifically, testosterone helps with the production of cervical mucus during ovulation.
17-hydroxyprogesterone: This is being measured to detect the possibility of Congenital Adrenal Hyperplasia (CAH), which is a cause of infertility.
hCG: This is the hormone released once you become pregnant. It is included in these tests to determine if I could be pregnant during this current cycle.
P4: This measure of progesterone determines if ovulation occurred during my current cycle.
Prolactin: I've previously written about my elevated prolactin level. We are retesting it to see if there has been any change. If it continues to be elevated (likely due to my microadenoma), I will restart Cabergoline and go for a repeat MRI. 
TSH: This is a thyroid hormone that could also be affecting my prolactin level and suppressing ovulation.
AMH: This is an indicator of ovarian reserve. If my number is low, that would mean I have diminished ovarian reserve or few eggs remaining.

Genetic Testing
I had an additional vial of blood taken to send to Good Start Genetics to check for genetic abnormalities. My husband was already tested through a company that specializes in genetic testing for people with Ashkenazi Jewish ancestry called JScreen and I posted details about his results. My results will take about 2 weeks to receive.
Fragile X:  FMR1 gene mutations can result in inherited intellectual disability, infertility, and neurodegeneration syndromes. In addition to causing developmental disability in future offspring, fragile X carrier status has important reproductive and mental health implications for the individual being tested. Notably, if I have a "premutation," this can affect my own fertility as well as a good chance I could have a son with Fragile X syndrome. 
Cystic Fibrosis: While we already know that my husband is not a carrier of CF (meaning there is a 0% of having children with CF), I know that my older sister is a carrier. Given this information, I have a 50% chance of also being a carrier. I asked if I could also be tested for this to know my carrier status. This will just inform me to spread information on to my children. If I am a carrier, they would need to know their status before trying to conceive.

Vaginal Ultrasound with Antral Follicle Count
I had an ultrasound to look at my ovaries, as well as to count my follicles. The Basal Antral Count is a transvaginal ultrasound that measures my "ovarian reserve," which means my remaining egg supply. This ovarian reserve reflects my future fertility potential.

Now we are just waiting on my results. I hope we will have them on Monday. Based on the findings of my tests, our next step will likely be a Semen Analysis for my husband. This looks at the quality and quantity of his sperm to determine if there are any abnormalities that may be making it harder for us to conceive.

Restarting the blog in the new year

Welcome to 2017! Things this fall were extremely busy for us, and I realized I completely let the blog slide. Sorry about that! I'm back for what will hopefully be regular blog posts.

In terms of fertility, there is nothing new to report. We were so busy this fall that I had a few months where I stopped carefully tracking cycles and ovulation. I'm back on carefully monitoring my cycles. I'm also planning to possibly purchase a new, more advanced ovulation tracker -- I'll plan a separate post describing that.

Happy 2017!

Homebuying Update: The Inspection

Just catching up? We went house-hunting, and made an offer on a house. This post will cover the experience of the home inspection.

We did not know what the home inspection process would be like. It lasted about 3 hours in total. The good news? No major surprises! Our home was built in the late 1980s, so we were hoping for no major structural or other issues that would have possibly led us to walk away from the deal. We do highly recommend getting the home inspection, even if your lender does not require it. Our inspector showed us everything and generated a long (25+ page) report detailing all of the structural aspects of our future home. It is also helpful to consider things that are not major enough to ask the home owner to repair before closing, so you have an idea of some of the repairs that may need to happen in the next few years (e.g., the roof may not need immediate replacing, but it could be showing signs of deterioration which could increase the potential for leaks). 

What to anticipate for the inspection:

1. Plan at least 1 1/2 - 3 hours for the full home inspection. In our case, we had two inspections occurring simultaneously -- the regular home inspection and the termite inspection. It is a good idea to allot plenty of time as you do not want the inspector to feel rushed. Ours lasted 3 hours.

2. Cost. We paid $375 for the home inspector and another $85 for the termite inspection. Budget for this before you make your offer on your home. It is much better to spend a few hundred dollars before closing than end up with a home needing an immediate costly repair after you move in. Even if the seller offers a home warranty, it is best to opt for the inspection.

3. Logistics. The inspectors will be taking several notes and many pictures. Our inspector got up on the roof to look at the cap on the chimney, the condition of the roof, and the seal around the skylight. He went down into the crawlspace to evaluate the foundation, the wood, and look for any signs of structural damage. The inspector will also turn on all of the faucets, check for leaking pipes, test all electrical appliances, and even tests the smoke detectors. Every outlet and every ceiling fan will also be tested to ensure everything is in working condition. Our inspector was also kind enough to show us how to take care of some of the general annual maintenance tasks (e.g., how to change the filters in the furnace). 

Typical things found in a home inspection:

1. Electrical: All outlets located in bathrooms, kitchens, and other rooms with water should have GFCI (ground-fault circuit interrupter) outlets installed (see photo below). These are essential around water, as they reduce the risk of shock by cutting off the electricity if it senses a disruption in the current. Newly constructed homes likely have these already installed, but older homes may not. Our house had a few of these, but not in all of the locations where they were required. We asked for this in our request to the home owners. Other electrical things that will be checked include the circuit breakers, outlets (to ensure they have electricity), lights, and ceiling fans.

2. Water and Plumbing: By turning on all of the faucets, running an empty load on "hot" in the washer, and testing the shower faucets, the inspector can evaluate if the hot water tank is functioning properly. Dripping faucets or leaky pipes under the sinks will also be evaluated. The inspector also carefully looks for water damage or evidence of mold. In our case, the vapor barrier had deteriorated in the crawl space and there was some minimal signs of moisture on the beams. Luckily, the sellers agreed to replace the vapor barrier and have the beams thoroughly cleaned. The new vapor barrier should help prevent moisture from affecting the beams. This is a huge issue to make sure is taken care of -- moisture in the crawl space over time not only can weaken the wood, but also can attract pets (e.g., mice and termites). Mold is also a serious issue. We have friends who walked away from a home they loved after their inspector found the attic was filled with mold and the sellers were unwilling to cover the cost of mold removal. 

3. Major appliances and systems in the home: The furnace, AC, and hot water heater will all be inspected. There are several minor things (like an "earthquake strap" around the hot water tank to stabilize it) that we had no idea were even requirements, as we do not live in an area prone to earthquakes! The inspector will also turn on the oven, make sure the refrigerator is chilling, and run the washer and dryer. The repairs required in this area in our inspection were minimal. The main one was asking for the flexible aluminum dryer vent hose to be replaced by a semi-rigid hose (as the flexible hose is prone to collapse and could cause a fire). 

4. Windows & Doors: Inspecting the jams, panes of glass, and the general condition of the frames. Lucky for us, nearly all of the windows of the home (except 2) were replaced in the last 5 years. One of the two windows that was still original to the house had some wood rot at the bottom of the window. The sellers agreed to fix this, and rather than repair the section with wood rot they just replaced the whole window! 

5. Pests: Termites can obviously cause significant harm to the wood frame and structure of a home. The termite inspector looked in the crawl space, as well as examining all exterior and interior walls. Our new home is termite-free. We plan to look into having another inspection in one year to make sure there are no issues. 

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Are you in the process of buying a home? Did you opt for an inspection? Tell us in the comments what the inspection process was like and if there were any issues found. Happy Homebuying!

Making an Offer on a House

If you missed the first part of this story, click here to read it.

After touring the four properties with our agent, we had a decision to make. I was a hard sell -- mainly because I really had not anticipated falling in love with a house on the first day of touring properties and it was just overwhelming to think about making an offer without even having a chance to sleep on the decision.

The reason why I didn't have a chance to think through the decision longer was because the houses in our price range are moving FAST. We knew this was not just our agent pretending the market was better than it was -- most of the homes we had toured through open houses had offers pending within a matter of days.

This process very much felt like taking the leap and learning to fly on the way down. Thankfully, we have a seasoned agent who could help us manage everything.

I was a nervous wreck before we made the offer. Walking in, I cried (for about 30 seconds) from the overwhelming decision. Mostly it was excitement, coupled with the realization that we were making potentially the biggest financial decision of our lives in the span of about 60 minutes.

We drafted the offer, which was just a smidge below asking price and we also asked the seller to cover closing costs. We finished signing everything with our agent around 6:00PM. The seller had until 10PM to respond.

We waited for what felt like an eternity. I paced around our apartment. C ordered a pizza, but my stomach was doing somersaults and I couldn't eat.

As the clock ticked closer to 10, we grew more convinced they were rejecting it.

Finally, at 10:03 our agent called to tell us "Congratulations! They accepted the offer without countering!"

We were utterly shocked and also very excited. My stomach remained in knots for the rest of the night and I had trouble sleeping.

Two days later, I still can't believe that happened! We are now waiting to get the home inspection and appraisal scheduled.

To be continued...

The Homebuying Process

Sorry for the lack of posts lately. I promise I haven't forgotten about the blog!

We are currently in the process of buying our very first HOME! We just started working with a Realtor last week, but have been spending several of our Sunday afternoons visiting dozens of open houses and getting familiar with several different neighborhoods in our area.

On Thursday, we sat down with our buyer's agent for the first time and discussed what we were looking for in a home. He pulled up all of the newer listings and we decided on five homes to walk through on Friday. Our timeline had been to put in an offer on a home sometime in early June.

On Friday, we went to look at the homes on the list after work. Our list narrowed to 4 (house #5 had an offer pending between Thursday night and Friday morning!). Here is an overview of each house:

House #1: An older ranch-style home in a more rural setting. We arrived prior to our agent, so we just stood awkwardly in the front yard waiting. Eventually, a neighbor walked over to say hello and tell us about the house. We walked around the perimeter and found that while this house was the closest to work, it was a bit too rural for our liking.

Pros: 6 minute (!) commute to work and friendly neighbors.

Cons: Unpaved driveway, too rural (there were random cornstalks growing directly next to the front door), tiny kitchen, very old furnace, and the floor and door jams seems to point to a possible issue with the foundation. The house was also located on a very busy road that cars flew down.

House #2: A cute 1950s-era home with a full basement and very large backyard. The seller had put in new hardwood floors in the main living area, which we really liked. The full basement was unfinished, but relatively clean (given the age of the home). The kitchen was old (avocado green stovetop) and had very outdated cabinets. The bathrooms were also covered in white and gold-flecked tile. The highlight of this house was our agent happening to find a BAT in the hood of the stove. Luckily this discovery occurred with a flashlight and NOT his hand. Gave all three of us an uneasy feeling!

Pros: Nice front porch, large backyard, big basement, formal dining room (the only house we saw with this), most square footage. Loved the new hardwood. 

Cons: Similar to house #1, it was situated on a busy street with noise. Shared an unpaved driveway with the house next door. Kitchen would have needed a complete remodel -- including all appliances. Master bathroom was teeny tiny and only had a standing shower. THE BAT. 

House #3: Prior to looking at the properties, this was our favorite from the pictures. It was also the newest home of the four (built in 1993). It was featured in a neighborhood we really liked and on a quiet street. All brick, with a sun room and nice above-ground pool. Unfortunately, this was a home that photographed much better than it actually appeared in real life. The kitchen cabinets were in very poor shape -- missing handles on about half of them and one cabinet was missing a door entirely. Popcorn ceilings in every room of the home, and there was damage to the ceiling in three or four rooms. Overall, this house had potential but it was clear the current owners had not done much to care for the general maintenance and upkeep.

Pros: Beautiful exterior. Nice sun room and pool, awesome for entertaining! Great neighborhood. Vaulted ceiling and fireplace in the living room.

Cons: Not well maintained. The popcorn ceilings would've needed to be removed from multiple rooms due to damage. The kitchen was perhaps the greatest disappointment of this house. It was also extremely cluttered -- I know you have to live in the home while it is on the market, but it is hard to see beyond the mess to envision the potential of the home.

House #4: This house was located just a few blocks from #3, so it was in the same area (just a different subdivison). This was the most recent one to hit the market, having been listed just 48 hours prior to our visit. Located on a quiet street. Well-maintained and the yard was beautifully landscaped. Vaulted ceiling and fireplace in the living room. Largest kitchen of all of the houses we viewed. Beautiful, well-insulated sun room. Master bath featured dual sinks and a skylight. Laundry room located off of the kitchen, which was the furthest location from the bedrooms -- ideal if we have a sleeping baby in a nursery and I wanted to do laundry!

Pros: Beautifully maintained. Big kitchen with stainless steel appliances. Great neighborhood. Good backyard for entertaining. Lots of windows for natural light.

Cons: No dishwasher in the kitchen. Some of the sinks in the bathrooms were dated colors. Top of our price range.


After viewing all four homes, we decided to make an offer on...

Home #4!!

It really was far and away the best house out of the four we toured, as well as nearly all of the dozens of homes we had walked through for open houses previously.

I'll make a second post about making an offer!