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!