IVF – how many cycles, egg retrievals? What option to pick?

posted 3 months ago in TTC
Post # 31
Member
298 posts
Helper bee
  • Wedding: July 2015

mama2bee71 :  it isn’t possible that you wouldn’t have any eggs to use, but it is possible that the eggs don’t fertilize or don’t keep developing during the 5 day period when they become embryos. Sometimes people have unexplained issues when the egg and sperm come together that can result in a large number of them being lower quality or having unexplained issues. So you could have them retrieve 20 eggs and end up with only 1-2 embryos after 5 days. But I’m not sure how often that happens. For reference I had 13 mature eggs retrieved, 6 of them fertilized and 4 of those kept growing to day 5 blastocysts. But that was more than enough for me. I got pregnant from the first fresh transfer and have the 3 frozen. I also had no issues with my own health as far as they could tell and only male infertility. 

Post # 32
Member
8016 posts
Bumble Beekeeper
  • Wedding: October 2013

bellarose606 :  shared risk means you can do as many cycles in the program to take home a baby or you get your money back.  some are 100% refund, some are less.

so say you do a retreival, get 15 eggs, 10 mature, 5 fertilize and make it to blast. you transfer 1,  freeze the other 4.

if that one sticks and nine months later you have a baby, they shared risk is over.  the frozen embryos are still yours but when you are ready for a sibling, you either have to join a shared risk program for an FET or pay per cycle.

if that first transfer doesn’t work.  you will be able to do an FET with the embryos.  if it is 6 transfer, you have 5 transfers left.  in this case, since there are 4 embryos left, the 4 could be transfered individually or multiples. if the shared risk covers multilple retreivals, you could do another retrival if you haven’t hit the max transfers.

does that make sense now?

 

so i didn’t do a shared risk.  i had a little insurance coverage when I went through IVF.  i did 2 fresh cycles, was able to freeze 5 and have my son. our first transfer was successful.  when i was ready to give him a sibling, we were OOP.  it was more than the price of 2 FETs to be in the shared risk program.  since our 1st transfer was successful, we decided to risk it and pay per cycle.  we were lucky again and our first FET worked.

Post # 33
Member
2444 posts
Buzzing bee
  • Wedding: April 2014

So, I haven’t read all of the responses but I am going to chime in with who or why someone should choose a shared risk program.

Women with poor egg quality, DOR, multiple miscarriages or ectopics are great candidates for this program. Of course, if you have more than one of these above mentioned, even better. For example:

I have DOR, had two miscarriages and a mild MFI issue. My RE gave us a 20% chance of getting ONE embryo that was of transfer/freeze quality. My AFC was between 2-4 each cycle and we had 6 failed IUIs. The 20% chance was a HUGE gamble when paying OOP – our retrieval cycle alone was about $12k, and my meds were expected to cost around $10k (luckily insurance pulled through here). 

Our first cycle, we got ONE embryo that made it to freeze (from 4 mature eggs retrieved). We did NOT PGS test this embryo due to the cost, and had about a 50% chance that it would be viable. Because of my DOR and hormone levels, my RE told me that it is fairly possible that any pregnancy would kick me right into menopause and I wouldn’t ever ovulate again, therefore no chance for a second biological child.

We opted to do a second retrieval immediately: which meds were now fully covered, but we still paid about $8500 for the retrieval. We got 2 (non-PGS tested) embryos to freeze from this one.

Our first FET failed, leaving us with only 2 remaining and a cost of $750 to do the transfer, not including meds.

Our second FET was successful, I’m currently 33 weeks along. We paid another $750 + meds and have one more frozen for a potential sibiling.

Our OOP costs were likely the price of a decent retrieval package. 6, IMO, is a very large and taxing on your body amount of needed. But, here is another example.

A friend of mine has had 4 retrievlas. She got a package for 3 – all yeilded 2-3 PGS normal embryos (6 total) and the clinic allowed her to do them back to back before a transfer. Unfortunately, the first embryo did not survive the thaw. Her second ended in an ectopic, third transfer was failure to implant and the 4th, another ectopic. They have 2 left but chose to do another retrieval cycle. They want more than one child. They might need to use a surrogate. She has been going through IVF for 3 years now and as you can see, the package was absolutely worth it in their case.

 

If you have had no previous pregnancies, miscarriages, hormonal issues other than MFI. I would honestly take the risk and pay for one OOP to see how many embryos you can get to day 5/freeze. There is a good chance you will have plenty, the average woman retrieves 12 eggs and has about 30-50% of fertilized make it to freeze. Even if you had to pay OOP for transfers, it could very well end up being less expensive than a package. If the cycle doesn’t go well, then maybe consider a package prior to any other attempt wiht the IVF process.

Hope that answers some of your questions!

Post # 34
Member
622 posts
Busy bee

6 retrievals/transfers sounds like overkill, especially if your issues are mostly male factor. This can usually be pretty well overcome with ICSI. I have a uterus so tilted it was basically upside down, and I got pregnant on my first IVF (husband has severe male factor). 

We did opt to do a package, but not shared risk. We didn’t get a refund if I didn’t get pregnant, but got a second chance at a highly reduced rate. We paid 1k extra for this, and had I not gotten pregnant, we would have paid only for a few additional charges like anesthesia and assisted hatching (and meds, that’s usually a separate expense). This made sense for us because it was 1k extra versus 10k for a second IVF if it had failed. We ended up losing that 1k when our first try was successful (it does NOT roll over, once I was discharged at 10 weeks the offer expired), but it was basically like a small insurance policy and well worth it. 

I would definitely consider a package more like this vs. the shared risk, personally, as it sounds like you have good chances of success early on. FWIW, we got 3 embryos, 2 now frozen. 

Post # 35
Member
298 posts
Helper bee
  • Wedding: July 2015

ajillity81 :  oooh ok that makes much more sense lol. So if she ends up with any frozen when she’s done with the one baby she would only have to pay for transfer oop to give them a shot for a sibling. That’s much better! 

Post # 37
Member
517 posts
Busy bee

mama2bee71 :  I would ask when the package ends before getting 2 retrievals and 4 transfers- if you have 28 visable follicles on baseline, you are going to be a high responder. If thats the case, you will be on a very low dose of meds and respond well to them yeilding a good number of high quality embryos to freeze and transfer in the future. For arguments sake, if you get 6-8 to the freezer, would you really want to delay transfer for a second retrieval? Probably not. And your package may expire once you get pregnant/stay pregnant (that’s how ours worked). I know that our 1 retrieval 2 transfer package (which we upgraded to 2 retrieval 2 transfer) would have ended with a pregnancy so a transfer for a sibling for my current pregnancy would never have been covered. Why pay for something that you probably don’t need? I would ask about 1 retrieval/2 transfer package and upgrade choices if the poo hits the fan (which is exactly what we did- poo hit the fan we upgraded for $10,000 for the 2nd transfer- we paid for exactly what we used).

Post # 38
Member
2444 posts
Buzzing bee
  • Wedding: April 2014

mama2bee71 :  If I’m being completely honest, the majority of doctors are in this field for the “business” aspect. They aren’t on your journey, and while sure, they want to do whatever possible to get you pregnant/up their success rates…they are not nearly as invested (especially emotionally) as you are. I’ve seen far too many clinics or doctors recommend packages or multiple cycles that are not necessary, because they make money regardless of success.

I would ask your RE what the % of success is for you and your DH combined issues. How many eggs do they expect to retrieve during one cycle? How are the clinic’s fertilization rates (or what are they for conventional IVF vs ICSI), and how many are expected to make it to blast? Personally, my RE was always up front and gave us a 20% chance of getting just one embryo during a retrieval. While we succeeded with that, she was spot on and we only got one. Based on labs, your AFC, and clinic rates, you should be able to get a decent success rate for all of the above mentioned…and then base your packaging on that. I honestly would be second guessing a doctor who tells you to buy a package with 6 full retrieval cycles – because while I’ve seen a lot of stories and personally needed multiple retrievlas – the odds of actually needing that many are quite low. (I can think of only one person who has done that many off the top of my head.) 

Post # 39
Member
209 posts
Helper bee
  • Wedding: November 2012

Thankfully I had to only go through one cycle/retrieval.  Your situation sounds exactly like mine.  Me: healthy, fertile.  Him: slow/low count (he had sperm extracted from his testicle.  No fun for him!).  

We did ICSI, too, because at the time I was 36 and had no idea how the whole situation would pan out for me even though I checked out A-ok in the Dr’s eyes.  I kept reading about (and know some) women who went through rounds and rounds of IVF before success and that scared me!  

Anyways, I think I had 19 eggs total. I did a three day transfer with two embryos and got pregnant.  At the end of five days I had only one embryo good enough to freeze.  Fast forward four years to this past December when we thawed it and used it.  I and am due mid-August.  

Whatever you choose, I wish you the best of luck!  😉

Post # 40
Member
298 posts
Helper bee
  • Wedding: July 2015

mama2bee71 :  They didn’t tell me how many follicles I had at baseline, but at the end of stimming I had about 15-16 that were large enough to measure and ended up with 13 mature eggs from that  🙂

Good luck! 

Post # 41
Member
298 posts
Helper bee
  • Wedding: July 2015

 

Oh Ps if there is another RE you could see it might be worth a second opinion. I am also confused as to why an RE would try to sell you on 6 retrievals for male infertility when most of us seem to have done well with one or two. But I’m also always super paranoid lol

Post # 42
Member
329 posts
Helper bee

mama2bee71 :  No, the 8 eggs was what was retreived. Once they’re fertilized, they’re called embryos (or blastocysts), not eggs.  We had 3 embryos left by Day 5.  So 3 out of 8.  

Post # 44
Member
298 posts
Helper bee
  • Wedding: July 2015

mama2bee71 :  sounds good! Good luck! FYI I did get 4 embryos total from those 13 eggs that made it to day 5 which they said was good and what they expected (6 fertilized to begin with) so I would expect any number of eggs that get retrieved to possibly yield about half or less in viable embryos on day 5. I didn’t know that and was expecting more lol. They said they expected 45-55% to fertilize which is average for them so you could also add that to your list of questions to ask your dr! 

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