We've Moved

The IVF Club has now moved to a new website.

The new website is cleaner, neater and will make it easier for readers to leave comments and post information directly from the site to facebook, twitter and much more!

Starting from Monday 21st September, new posts will start to appear at www.theivfclub.com

Cost of IVF

IVF Costs in Australia

I always thought of IVF as expensive and while I still think it is, it is less expensive than in other countries. For example, in the United States IVF can cost up to around US $12,000.

This is pretty expensive when compared to the cost that Australians pay for IVF. For example, at a leading clinic in Melbourne Australia, the latest cost that I paid for IVF was around $6,900 excluding hospital costs. The hospital costs were $1,900 bringing the total cost of the treatment to AUD$8,800 (US$7,700). That's a massive saving of over $4,000 for Australian IVF patients.

My upfront costs to the clinic were approximately $5,000 including medications. The difference in the cost is explained by the fact that the clinic and the health insurance fund does not charge the patient the full amount and waits to receive the rest of their payment via the government's Medicare system.

Fortunately, my private health insurance covered the hospital costs. I received $3,700 back from Medicare six weeks after egg collection as I had reached my *Medicare Safety Net* threshold. So my total out of pocket cycle cost was $1,300. Expensive yes, but not as expensive as some of my overseas readers who do not get any rebates back.

Interestingly, the Government has announced that they will be revisiting the limits on the Medicare Safety Net threshold for IVF and may cap IVF limits. Details of this are not fully known but what is clear, is that the cost of IVF will be going up.

For overseas readers who do not understand the health system in Australia, the Medicare Safety Net effectively means that I can claim money back from the government from this calendar year because I had already spent a fortune on IVF and was entitled to a rebate.

Tips for Successful Outcomes

Vitamin D Levels Could Predict IVF Outcomes

An interesting study has indicated that women have higher chances of achieving pregnancy if they have high levels of vitamin D in their serum and follicular fluid (FF) after IVF-embryo transfer.

The results of this study was published recently in the online edition of the journal, Fertility and Sterility. The study was conducted on 84 infertile women who were undergoing IVF to assess the link between IVF outcomes with vitamin D concentration.

Whilst vitamin D levels in the Follicular Fluid were inversely associated with body mass index, after adjustments, scientists observed significantly higher rates of clinical pregnancy and implantation when Vitamin D levels were higher.

This suggests that vitamin D supplements may enhance the outcome for infertile patients undergoing IVF as well as improving overall health.

Although vitamin D is known to play a key role in fetal bone growth, its exact role during fertilization and implantation is not really known. There is a need for scientists to now determine the appropriate doses of vitamin D that may help women during the preconception period and during pregnancy.

If you aren't taking supplements, it might be a good idea since it is found naturally in many foods that are not often eaten. These foods include cod liver oil, fatty fish such as salmon, mackerel, tuna, sardines, herring; Vitamin D fortified milk and cereal, eggs.

Vitamin D is also added to milk and is manufactured in the skin as a result of direct exposure to sunlight.

IVF and Your Sex Life

8 Reasons Why IVF Impacts Your Sex Life

It's a pretty delicate topic I know but IVF is not conducive a good sex life. For a start, when you are doing a full stimulated cycle, the following passion killers are likely to, and do, happen:

1. You may bleed for several days after you expect your period to end because you have been taking a contraceptive pill since the start of your period
2. You experience intermittent spotting during your cycle whilst you are taking hormonal treatment
3. Quite likely you may bleed after egg collection and will be feeling quite sore and bloated for a couple of days
4. Your breasts may become sensitive to touch so any foreplay is just out of the question
5. Because you are inserting Crinone Gel to line your uterus, you worry that a pile of it will end up on your sheets (it does!)
6. You decide to avoid intercourse for the for 24 hours after transfer (just in case the embryo falls out)
7. Both of you will continue to avoid intercourse cause you are both scared your partners penis might dislodge the embryo (As if! But as IVF is so darn expensive you both don't want to repeat the process)
8. You then get your period

I think this just about covers the two months when you are cycling. Of course, you do have breaks in between when things get back to normal - whatever that is. But after several cycles of doing this, combined with all that previous experience of trying to conceive, you sex life just diminishes. You know you need it to bring sexy back but it all becomes too hard during this time. Its pretty ironic that this is the case, given that the old testicles need to be used to produce good quality sperm. See my blog on sperm titled Keeping the River Flowing).

The good thing about not doing IVF: Bringing sexy back.

Officially Not A Paedophile

Police Record Check for Would Be Parents

It's official - my husband and I have passed our police record check and we can now start IVF.

The words on the National Police Certificate dated 4th September read "At the data of issue there are no disclosable court outcomes recorded." There are five interesting features about this report:

1. The report arrived within a week of being submitted - not the 10 week delay that I reported in a previous blog.

2. That the word "disclosable" is not even a word since it keeps coming up as an error in my spell checker.

3. That I paid $64 for two certificates that state "At the date of issue there are no disclosable court outcomes recorded." How insulting is that. The report offers the possibility that maybe in the future, I could be in court.

4. This report really it is only relevant for the past, not the future. I could go out tomorrow, commit a terrible crime and quite possibly continue undertaking IVF. No one would be any the wiser.

5. Any other couple who conceive naturally are not subject to getting checked out. Apart from this being discriminatory, it also is a breach of a normal human right which is to bear children.

Diet Plan Working

Weight Loss and Improving Chances of Conception

One week of solid nutritious eating on a low calorie plan and exercising has seen me lose just over 1 kilo over the past week. How exciting! I am now officially overweight not obese. Funny how a one kilo weight loss can move you from being obese to overweight according the a BMI calculator. Psychologically, being overweight sounds better than obese!

In any case, I still have a long way to go. In fact, I am aiming to get my weight back into the healthy weight range to help improve my chances of conception. By my count that means losing about 12 kilos (2 stone). With a bit of luck I should be able to get close to that goal by the end of year. I can then kick start the new year with another round of IVF. I've tried everything else so might as well try the weight loss option which according to research is one of the most significant reasons why IVF fails.

Surprisingly, I have not felt overly hungry. Well - I did for the first couple of days but my body has now adjusted to the portion sizes I am now eating. I am having 5 small meals a day rather than 3 large ones and this seems to have stopped me from thinking about snacking on lollies and chocolate in between meals.

Police Record Check IVF Anger

Police record checks for IVF patients

In an earlier blog, I highlighted that prospective parents planning to do IVF must undergo police records before commencing treatment. I mentioned that I thought the laws were very biased. It seems I am not alone in my views.

What's worse is that now that the new laws have come into effect, according to my IVF nurse there is apparently a 10 week waiting period before the people who have requested Police Record Checks will get them. Seems that while the government has made these laws they have not accounted for extra people to process higher levels of demand.

Fortunately, because of this backlog myself and other women planning to undergo will still be able to do treatment despite not having a police record check. That is a huge relief as it would mean that I would not be able to start treatment until mid November.

There has been comprehensive news coverage about this. For more information, see the article in The Age on IVF.

Still in With a Chance

IVF Conception Still Possible

A visit to my IVF specialist revealed that he still thinks my husband and I will conceive. So despite being nearly 40 and despite my husbands sperm problems, he still thinks this is a realistic goal.

It's funny how a Doctor can be so confident when after 7 failures, you are not. So after asking all the probing questions, he still feels we will get pregnant. Apparently, he has done every test possible to me so from his perspective there is no reason why I should not fall pregnant. IVF apparently helps overcome male infertility issues so theoretically, there is no reason why we shouldn't be able to become parents.

This makes things a little frustrating as it seems everything that should be working isn't. I guess it puts us in no mans land. The other annoying thing is that IVF is not cheap - not by a long shot so every failure means spending more money on another round. Whilst, you can't put a cost on what I perceive to be a joy in having a baby, it does place a financial strain on your budget.

So with this in mind we have decided to continue down this path and try again. Fortunately, we have one frozen embryo left from the cycle I did in January. So apart from giving my body a rest from the drugs it means we will use our last remaining embryo. So if this fails, another stimulated cycle is on the cards. In the meantime, I will continue to focus on having a good nutritional diet, no alcohol or coffee - basically following the suggestions in the Pregnancy Miracle ebook I purchased a few weeks ago.

A Positive Thing About IVF

No need to monitor ovulation

One delicious thing I like about IVF, is that it actually gives me a break from trying to work put when I am ovulating. Seriously! I mean the good thing is that the clinic does all checking and I don't have to monitor anything. I just have to turn up and follow instructions. Given I am a naturally lazy person, this suits me down to the ground.

It also suits me because I work in a job where I am always monitoring everything - from managing and tracking how a project is running to reviewing and analysing sales data. For me, not monitoring anything is like a dream come true! Hand holding at work is not something I enjoy.

Unfortunately when I am not doing IVF, I am back to monitoring and tracking my menstrual cycle. For some reason, I still have some glimmer of hope that I will conceive naturally even though I know that in our case it is highly unlikely. So with this in mind, I now find myself painstakingly recording the results of urine tests and fertility microscopes. The problem is that I've been monitoring my cycle for a number of days and it is now day 19 and I still haven't ovulated. Although this is not uncommon following IVF treatment, I am impatient for my cycle to get back on track.

In any case, my plan of attack has been to ambush my husband and coerce him into having sex with me more frequently. Such a task I know!! He hasn't complained yet but I suspect that he has not really appreciated the fact that he has had less sleep. Such is the joy of trying to conceive.

Crazy Lifestyle Questions

IVF Preconception Care

After several attempts at trying to get pregnant, you sometimes question yourself if there is anything you are or aren't doing right that is hampering your ability to conceive. Sometimes in doing that, you cause yourself unnecessary pain. It's called beating oneself up with negative thoughts about what you should or shouldn't have done. Thoughts like:

- Maybe if I drank a bit less alcohol
- Maybe if I quit smoking earlier than what I did
- Maybe if my diet was better
- Maybe I should have tried reflexology
- Maybe I shouldn't have drunk all those Coke Zero's
- Maybe I should drink less coffee or hot chocolate
- Maybe I am just too fat
- Maybe, I should try reflexology.

Although it's perfectly normal, all these maybes do your head in. I think I have already come a long way from where I was. For a start, I drink a lot less wine these days, I don't smoke anymore, I take folate, CoQ10, Vitamin C and fish oil tablets. I drink a lot more water these days and I rarely drink any soft drinks - diet or otherwise. I've also been exercising regularly for at least the past year or two. Seems to me that a lot of the things I used to enjoy I no longer do anymore.

The one thing I haven't changed is my diet. Actually I tell a lie - it has gotten worse. Since starting IVF, I have been getting progressively fatter and fatter - in fact my BMI has moved from the overweight category and just edged into the obese category!!! Whilst I don't think the hormone treatments have helped my cause, I've noticed that my food portion sizes have increased since I got married. My coffee intake has also increased significantly.

Given that the human body is a complex and finely tuned machine, I have decided to take up the challenge to improve my diet. I will continue to maintain the positive changes I have made in regards to quitting smoking and exercising regularly, but as of today no coffee, only herbal teas and healthy good food choices. I've been reading up on the topic and I think there is a lot of merit in alternative therapies and I think these can be highly successful for some people. Acupuncture is back on the agenda and I might even have a go at reflexology. Now I am not expecting change overnight. I know good preconception care starts about 3-4 months before trying to conceive but if I don't get pregnant within the next year, at least I'll know I have done everything in my power to get pregnant. And that my friends is the only thing that I can do.

What Biological Clock at 40

Back on Board for IVF at 40

Call me ignorant but after months of worrying about not being about to get pregnant before the age of 40, I am not worried anymore.

A sure sign of this is that after months of procastinating with the Police Record Check forms so I can start IVF, I have finally sent my form in complete with cheque. Somehow I don't think I will be getting it back in time for the 1st September deadline when the new laws take effect.

Apart from the fact that my husband's form has not been sent in yet, I imagine there will be a backlog of applications from the late rush of couples who have also submitted their forms. Obviously, holding off like me in the hope that they won't have to do another round of IVF. In any case, I guess it means we might start the next round a little later.

It's strange but I am less perturbed by the later start this time. In the past, I have pushed my body so hard, doing IVF with only a month break in between cycles. Once, I did a cycle back to back with no break. Now that was hard. All of my attempts, of course, have been done in my futile attempt to racie against my biological clock.

But the truth is, I will be turning 40 at the end of September. I am already in the statistically significant, lower end of the IVF success bracket. A delay of one month is hardly going to make a big difference. I think my body also needs a break to get back to its natural rhythm. The scary thing is that I've been doing this so frequently that I don't even know what my natural rhythm is.

Apart, from that IVF is hard - I am in no rush to start again only to get another negative result. I need emotional space to come to terms with the last seven failed attempts. Maybe my birthday this year will not be about trying to conceive - maybe it will be about relaxing and enjoying myself. Now that would be a nice change.

Discriminatory IVF Laws

Police Record Checks for Parents Undergoing IVF

From September 2009, any couple wishing to undergo IVF treatment in Victoria Australia will now need to obtain a Police Record Check and a Child Protection Certificate.

As I sit here contemplating when I will be doing my next round of treatment, I am suddenly faced with the possibility that I need to apply for these various certificates before I can undergo treatment. Given I would like to start treatment again soon, I've decided I'd better get my butt into gear even if I disagree with this repulsive law.

What freaks me out the most however, is that legally, we now have to prove that we are going to be suitable parents. Amazing! I hope that careless driving charge I got when I had a car accident a few years ago ain't going to be held against me.

Actually, I think the aim of the law is stop potential pedophiles from having children. But seriously, putting preventative measures in place for the small minority of couples who undergo IVF ain't really going to solve the problem. Seriously, does anyone truly think that people who spend thousands of dollars on IVF and who experience the rollercoaster of emotions that comes with IVF are pedophiles.

Imagine the public uproar if laws throughout the world were changed so that all couples contemplating parenthood would have to prove that they were going to be suitable parents. Surely, this goes against natural human nature and civil liberty. I for one am opposed to these ridiculous laws that target a small minority of people rather than tackle the actual problem.

Keeping the River Flowing

Tips to Improve Male Infertility

At a recent human reproduction and embryology conference in Europe (http://www.eshre.com), some interesting findings on Male Factor Infertility were uncovered.

One of the studies titled "Keep the River Flowing" was an exploratory study investigating the effect of daily ejaculation for 7 days and sperm DNA damage. Anyway, the study uncovered that 3 days of abstinence followed by 7 days consecutive days of ejaculation, resulted in reduced sperm DNA fragmentation (down from 33% to 21.8%), increased motility and improved morphology.

It was concluded that sex / ejaculation for 7 days leading up to and including ovulation during a normal female reproductive cycle may then increase chances of conception. The implication being that if the same thing was applied leading up to a sperm collection for IVF/IUI/ICSI then the chances of conception may also be improved. There is the usual caveat that more studies are needed to look at this furthr but I don't need any convincing. We've tried many things - might as well give this a go and keep the river flowing as well. My poor husband is going to be exhausted (he works full time and studies part-time)!

Questioning Your IVF Specialist

Questions to Ask After Repeated IVF Failures

After seven failed attempts at IVF, there comes a time when you have to ask some pretty hard questions to your Doctor.

I've been too frightened too ask - maybe I am not going to like what I might hear. But my visit with the Counsellor today did help in exploring what our options and questions we might ask our Doctor.

The questions are:
- Given our history and 7 failed attempts, what is the likelihood of us conceiving?
- Why do you think we lose so many embryos between day 3 and day 5?
- Do you think it has something to do with my egg quality or my husbands sperm?
- Should we try giving Day 3 embryos a go instead? (or Day 5 if relevant)
- Is there any kind of genetic testing that you think we should do?
- Are there any other tests that you think we should explore?
- Should my husband see an Andrologist?
- Should we have his sperm tested again?
- Are there any other alternatives that we should explore?

I am sure there are some that I have missed but these are the questions that seemed most relevant after repeated IVF failures.

Feel free to post any other questions you might have. We can all learn from other peoples questions.

Embryo Debate Continues

Day 3 Versus Day 5 Embryos

The debate between Day 3 or Day 5 embryos continues. I have always done Day 5 blastocyst transfers. The theory being that scientists can monitor the embryo for longer so that they can assess which ones are most healthy. This allows them to process and screen out those embryos that are unlikely to survive and are the most healthier. Although, it is not that they are screened out - they just don't survive.

The risk is that you can lose most if not all of them. Certainly this is something we have experienced. From 19 eggs and 15 fertilised, we were left with only 1 Day 5 blastocyst. The implication being that if this failed to implant we would need to go through the whole process again.

We have now had 7 transfers in total (9 blastocysts) and every one of the them has failed to implant. They say that the definition of insanity is doing the same thing over again. Maybe we are insane. It led me to ask the question of my nurse, should we do day 3 transfers instead. Apart from the fact that she suggested I discuss this with my Doctor, her answer was interesting. She said some women have had no luck with Day 5 blastocysts and have tried Day 3 and got successfully pregnant. Others have had had the same result as Day 5. My guess is that there is no easy answer but I am going to give the Day 3 ones a go. Maybe there are better off in my body than some cultured medium.

Getting Support Doing IVF

A Matter Of Counselling

Yesterday my nurse rang me to tell me the bad news that I already knew. My 5th IVF attempt was unsuccessful. I bombarded her with questions. Should I change Doctors, should I try Day 3 embryos instead of Day 5? Should I do this? Should I do that? In the process of asking questions, I burst into tears.

She was very understanding and asked me if I felt I needed to see a counsellor. I didn't know. I had mixed feelings about it when she asked. I am a strong person. I think I am coping fine but the last time and this time have hit me harder than the other times. Maybe I do need to see a counsellor. The thing is that I am grieving for someone that hasn't happened. No one has died. I know this makes it difficult for people to understand. But maybe I am grieving for the loss of hope or my dream of becoming a parent. Each failure brings this growing realisation that maybe my plans for parenthood are never to be. No - I am not giving up on IVF. I will persevere although I don't know for how long. What I do know is that each failure pushes you in this direction.

With some doubts, I agree to speak to a counsellor and I expect to hear from them next week. However, the Counsellor rang late Friday afternoon to arrange a time. This is happening too quickly but as it turns out, it is not. All Saturday appointments are booked out and the next available weekday appointment is Friday week in the afternoon. I check my work diary and there is a meeting organised. I decide there and then that I don't need to be there. I think I should accept the appointment. I think it is also in the interests of my employer that they have happy people working for them so will discuss this with my Manager when I return to work on Monday.

Oh and what were the answers to my questions. Now that's a long story and I am going to save that one for another day. Stay tuned.

How to Give Support

What Not to Say to Someone Undergoing IVF Treatment

IVF is unpredictable. My Doctor thinks I should be pregnant by now. This makes me feel a whole lot better. Not! The problem with IVF is that the more times you do it, the harder it gets. I am not exactly sure why but I think that statistically the majority of women get pregnant from IVF after 6-7 stimulated cycles. I have now done 5 stimulated cycles and two transfers and I've had no luck. This weight of expectation does not help.

The more you go on, the more there is an expectation that your turn is due. But IVF is never that simple. It makes it hard also for friends and family to understand what we are going through. Often people will say, don't give up. Keep trying. This is probably one of the worse things people can say.

They need to understand that when you get to the point of doing IVF you have already exhausted all other options - there is already a history of failed natural attempts. IVF gets harder the more times you do it. Apart from the money invested with nothing to show, there is also the physical demands on your body and living a life that has become less social and centred around your menstrual cycle and when and what drugs you are going to take. Life to some extent is on hold. You stay in a job with a manager who is critical and treats you badly because you need stability, you need your job to pay for IVF and you want to be eligible for maternity leave in the event you actually get pregnant.

There is also the fact that you are starting to reach a point where you feel you have no control over your body. It feels like your uterus is destined to become a graveyard.

The fact is that there is nothing anyone can say to their friend. Make it clear you are there for them if they need you but don't push it. All they can be is a friendly ear and a shoulder to cry on. Because as time goes on, that shoulder is most definitely needed.

Bring Out the Bottle Again

Confirming IVF Failure

Just as I suspected. I am not pregnant. Another failed IVF cycle. Get me a drink now. A bottle of red or 3 will do nicely thanks.

Whilst my tell-tale breasts gave it all away, my sneaky suspicion was reinforced last night when giving myself a dose of Crinone gel. That suspicion was also confirmed at a visit to ladies room around lunch time today.

It's hard to believe that one could inspect toilet paper so thoroughly!!! Scouring through the folds to see if a flash of red has started to appear. Creepy I know but something any woman I know who hopes to get pregnant has done.

Another failed round of IVF. The last cycle was much more upsetting. After so many failures the expectation of pregnancy diminishes but the hope somehow gets stronger. Surely my turn will come. IVF is a numbers game - hopefully the more times you throw one in, eventually your odds come up. To add insult to the wound, I also have to sit through yet another blood test tomorrow to tell me what I already know. BFN (Big Fat Negative - for the uninitiated).

Expecting a week of intermittent tears. Interested friends - happy for you to make comments on this blog but please don't ask any questions or offer any condolences if seeing me in a public venue - it brings up too much emotion. Me thinks I deserve a red.

Perhaps this is an idea for tomorrow's blog - how friends can handle their fragile friends who are undergoing IVF. Now - where was that red. One glass will do fine given I have not had a drink in ages!!!!

Day 12 Breast Alert

A Sure Sign You Are Not Pregnant

Bad news. Constant breast groping has revealed my breasts are back to normal. They are no longer sore and tender and pumped with hormones. The pimples on my face have gone down only to leave my nose with ugly flashes of red (thank God for make-up).

I take the breast thing as potentially bad news - it seems unlikely that I am pregnant. However, I remain in hope that this is not the case. That hopefully, the lack of tenderness I am experiencing is just a sign that my body has worked hard to remove all those excess hormones that developed as a result of the injections.

I really don't want to think about the consequences of spending another $5,000 on yet another treatment. I am in denial and I am still weeks away from receiving any reimbursement from Medicare for yet another IVF attempt. Next year, some sweeping changes to Medicare will mean that IVF will not get as much favourable treatment so the out of pocket costs will definitely rise. The implications of this are yet unknown.

I contemplate the research I have been doing on IVF and count my fortunes that I do not live in the USA where IVF is more than double the cost of doing it in Australia. I guess there are small blessings in everything. The best blessing though, would be a pregnancy. Who I am kidding!

Day 11 Countdown

IVF, Acupuncture and Male Fertility

I spoke to our Chinese herbalist today. She has been a great source of support to both me and my husband. My husband sees her to help his sperm. His sperm count and motility have improved quite dramatically. However, his sperm morphology and the antibodies in his sperm are still a problem.

I have also been seeing her and have had acupuncture on a regular basis but this is the first time during treatment that I haven't had it. There were a number of reasons for this.

The first was that I have developed an aversion to needles. I am so sick of needles, blood tests and injections that I just couldn't face seeing any more. Whilst acupuncture does not hurt, I just couldn't do it.

The second reason was that my transfer happened on Wednesday. Having acupuncture would mean that I would have to commute for a couple of hours after work in peak hour traffic three times in that week for treatment. I decided, probably selfishly, that my time was better spent relaxing at home rather than stressing out in traffic. Maybe I am trying to make myself feel better about not going, but it sure feels like all her good work is undone when I get back into the car and stress out in the traffic.

On a positive note, my lovely IVF nurse has arranged for me to have my pregnancy blood test on Friday which will be Day 14. So with a bit of luck or misfortune, I will get to find out if I am pregnant... or not.

Normally, the clinic asks you to have a blood test on Day 16 but that happens to fall on a Sunday but the clinic is closed on Sundays. I also think my nurse is feeling sorry for me and does not want to keep me in suspense. Mind you, my period is as regular as they come so I don't think I will waiting the whole weekend to have an answer any way.