Tuesday, February 19, 2013

RE#3 VS RE#4 and...Gambling Sucks

Well, no dice. I was never meant to be in sales, so all efforts to convince the OB/GYN (who I am not thrilled about, which may or may not be related to the outcome of my efforts) that I need a saline ultrasound for non-IF purposes were for naught. As my three-year-old would say, "that's a bummer."

I couldn't exactly lie about the fact that we are infertile (especially since we went through this HMO for 6/7 of our IUIs, so it's right there in the file) nor could I lie about the fact that I've never had any uterine/tube issues, so she concluded that the bleeding/pain wasn't anything to really write home about from a non-IF standpoint and that if there was anything that would interfere with treatment, my RE would catch it. In fact, she indicated that the change in my cycle was likely due to 'hormonal issues' that happen to women in their 30's and 40's. I believe she even used the term 'as you get older'. Look, I would've taken this from most medical providers (I'm not immune to the fact that I am, from a reproductive standpoint, definitely getting 'older') but this doctor's delivery kind of sucked. Add in the fact that she didn't look a day over 29 and I can assure you that her words were not entirely well-received.

*sigh* That was a wasted office fee.  At least I know that I don't like her. And that I miss my old OB/GYN, who is no longer available to me because of insurance. He was a rockstar. First world problems, eh?

Anyhow, Mr. S went in for an SA last week (everything looks almost identical to previous SAs) and I will be doing my CD2 lab workup sometime in the next weekend. This doesn't mean we'll be heading toward a cycle anytime soon, per say. We still have stuff to sort out-financially and otherwise. Because of our Cadillac version of treatment (including saline ultrasound, labs, ICSI, PICSI, and lots of meds for high FSH), we're looking a $20,000 bill square in the face. I know I've already complained about this at length, but this is not something that escapes my feelings about this cycle for a second (if we choose to pursue it).

It seems like the financial piece of this is so rarely talked about in IF land. Is it because everyone that I know/read about has unlimited money and/or coverage? Or is it in poor form to discuss money at all? I figure if you know about how much my uterus sheds during mestruation than the status of my bank account isn't too far off. And even if I don't discuss the ins-and-outs of my personal finances, how is it nothing to mention dropping 20 grand on a one-shot 30% chance (at best)? I'm not even sure high rollers in Vegas are that ballsy. One shot. Seriously. That's what you get. And believe me when I say, I have never been a gambler, so this is not thrilling to me. (if I 'win', yes, that will be thrilling, otherwise, no--not thrilling)

I am meeting with RE #4 next week. Well, I guess in the most technical sense, they could be considered RE #2 as they are out of the same office where I did my IUIs, but I only met with nurse practitioners back then (WAAAY back when) so I consider this guy to be 'possible' RE #4. I don't know if he's a keeper yet. I know that's a lot of REs and I look like a fertility-challenged commitmen-phobe here. You see, I love my RE #3, but there's a few reasons why I'm considering switching:

1. Re #4 (who does work from the doc-in-the-box HMO) has the second highest success rates in the SF Bay Area, higher than RE #3. Considering this is a big place with a lot of clinics, there's something to be said for that. Apparantly, their embryologists are top notch (one of whom is my massage therapist's daughter-totally random) and they just received an award, beating out RE#3.
2. They are about $1500 cheaper overall when compared to RE#3. That's not a lot when you're talking $20,000, but it's something.
3. Not that I think RE#3 is 'lying' to me, but their clinic is privately run and so they have a stake in getting more clientele. They are 'for profit' while RE#4 is part of a larger network who is not, so I'm feeling like he's going to give it to me straight without any push to get more business. And in the very least, I feel that their second opinion might give me some direction and peace of mind.

There's also a few reasons why I wouldn't consider switching:

1. RE#3 historically gives me a lot of sample meds, which saves me a ton of money. They're already offering up some for my cycle, which means it's likely the $1500 cost savings would even out. Maybe the other clinic would too, but I don't know that yet.
2. RE#3 has great success rates, too. I believe they're #3 in the Bay Area.
3. Continuity of care. They know me. Well. Too well.
4. RE#3 gets back to me in 20-30 minutes if they're not immediately available. The doctors deliver all news (Betas, even labs) and they do it on a very predictable schedule. They coddle, so there's this mental health/comfort piece to it that I would be giving up. You're lucky to get a call back from RE#4 within a few days. Maybe that's different when you're cycling, but I think it's a bad sign up-front when a possible patient says they are considering cycling and it takes you that long to respond.

So, I know success rates and money are not the only factors. It's likely it will all even out in the end, but it's totally worth the appointment fee just to explore it. In the mean time, I have to collect all of my RE#3 records and bring them to my RE#4 appointment next Monday. Anyone have a flat bed truck I can borrow? :)


AnotherDreamer said...

That's a really tough decision :( When I switched REs is was really a really easy decision because we couldn't keep going with our old RE. It was still worrisome to an extent though.

I hope that you can get a better vibe for the new possible RE and get some direction. It's definitely a lot to consider.

As for the financial aspect, we never did IVF because it was beyond our reach and I was always afraid of the gamble to. I often use the gambling analogy, I mean really- how many people are okay with throwing down $20k on 30-40% odds? I know it's easy for people to say, "Oh what about IVF?" but I know most of them wouldn't ever gamble that much money.

Baby Smiling In Back Seat said...

I've also felt like the financial aspect is not discussed enough in blogland -- which is why a couple of years ago, Lori and I hosted a blog carnival on the topic. If you'd like to see 39 people's perspectives on the money part of family building:

As for switching, aside from skill, bedside manner can be very important, but for me even more important in your day-to-day satisfaction is the bedside manner of the clinic if you will -- is the receptionist reasonably pleasant, do they call you back, can you get an answer when you need one, etc. Based on that I think I'd prefer #3 -- but meeting with #4 to see if he'll say "I wouldn't treat you because the chances are too low" since he isn't for-profit sounds like a helpful way to calm the profit concern about #3.

Or maybe you'll meet with #4 and he'll have a totally different treatment approach and bedside manner that you'll like better!

Lorraine said...

The money thing is huge. Huge. We had almost no coverage (just whatever blood draws could be billed as related to something else) and no sudden inheritance to cover our expenses. It was the worst part of the decision, gambling that much money on a maybe. Like many people, I justifed it by assuming i would have to spend that much on therapy to come to terms with having never tried in the first place.

Good luck with the RE choice! I felt so good about switching, but in may case the whole thing was way more obvious. Sounds like you don't have bad choices!