It’s going to cost $5000. Yes, $5000 to avoid the dreaded hysterosonogram and still participate in the Pregnancy Guarantee Program. $5000 to recalibrate the accountants’ tables. I wonder what percentage chance they’re giving us to conceive? Perhaps 5 per cent less than their going stats? Oh, and if they find anything on ultrasound during transfer, this affects the finances — we will have to go to a single cycle plan.

The thing is, it’s not the HYS that is so dreaded; it’s the results. I’ve already said I won’t have uterine surgery so why bother with the HYS? It also irritates me that my previous fertility specialist did not offer or insist on a HYS each year during IVF treatment. Is this standard practice? Has anyone else done this test every year? The more I learn, the more I feel like my treatment was hit and miss, one step forward and two steps back.

Oddly enough, at this point it’s probably better to not do the HYS and pay the $5K. If nothing is discovered on ultrasound (which is probably what will happen given that I just had a clear U/S) then we still get to be in the program. If I do the HYS and something is found then we are definitely out of the program. I am mentally wringing my hands. What to do? What to do? I’m slow on the uptake regarding various medical procedures. That’s why I’m rethinking the HYS. Depending on the donor’s availability we might even go ahead next month! I wonder if doing the HYS during the ED cycle would interfere with the lining? ….just sent an email to the clinic coordinator on that question: apparently not. But my linings are always on the thin side and I’m nervous about doing anything to upset the chances or the schedule. Still don’t know what to do.

A Pregnancy Guarantee!?

September 14, 2009

The other day I was speaking with my former fertility specialist because I needed my records sent to the donor clinic. I told her I realize that her clinic (in Canada) does donor egg IVF, but explained we were going with a different one (in the US) because they have lots of experience doing it and we were attracted by their financial plans. They offer something called a Pregnancy Guarantee. Well, my husband took one look at that and was intrigued.

“Don’t do it!” my fertility doc instructed in her squeaky, shrill voice. (She’s peppy but shrill.) “You never know with these clinics. I just don’t want you to go to a fly-by-night place.”

Does anyone detect a hint of “I’ve just lost my customer” angst on her part? I’m probably more cynical now than I ever have been about medicine, but I think that’s exactly what it was. She is upset that I didn’t choose her. Well, I did choose her many years ago and she did not get me pregnant. Not that it’s her fault. She threw every test and procedure and drug at me in the hopes it might prove a miracle. But the problem is that we’re jaded now. Especially so because I feel that she would have us try and try again until we are bankrupt. When a client (and I think it’s important to use the word client, not patient) walks into a fertility clinic, there is a presumed sense on their part that you really, really, really want a baby and will do anything it takes, without question. You will follow the doctor’s orders until the doctor says, Okay, I’ve done everything I can. Sorry folks.

Somewhere along this emotional road, clients often forget that they can take charge of their infertility choices. They can choose what they will do and what they won’t do. Desperation, angst, hormones get the best of us. That is why I’m putting my foot down with the HYS. Not because I don’t want to relive that horrible test again, but because I have no intention of following up on the results. I’ve decided that for me, having surgery on my uterus is going too far. And I refuse to feel guilty about it.

So, back to the pregnancy guarantee. We are waiting to hear what the US clinic’s finance people will say about not taking the HYS and whether we will have to pay a premium in order to participate in this financial program. But it’s a clever program. It splits the risk between the couple and the center. They quite rightly believe that if a couple conceives, it is worth every penny to them. However, if a couple does not conceive, then getting a part of the fee returned to them – although it does not mitigate the emotional toll – does assuage some of the financial pain.

I feel it’s so typical that insurance has stepped into the business of fertility in the US. In Canada, it’s illegal to sell donor eggs. One can donate them, however. (Typically clinics choose a US donor and fly her up to Canada for retrieval.) In fact, even surrogacy has to be altruistic. That is why so many Canadians head south of the border. Canada wants to produce an educated society capable of competing in a globalized knowledge-based economy, yet won’t acknowledge that this will take both women and men to participate in the workforce. With our falling birth rate and our economic imperative, why is reproductive policy so far behind? Why does it not give couples the most choice possible? We must be ruled by prurient, holier-than-thou blue bloods (actually, I think we are! There, I’ve pinpointed the problem of political leadership in this country!) who can afford to procreate at a young age. In addition, Canada has relied heavily on immigration to keep up its workforce but I don’t think immigrant birth rates stay high over a generation. But anyway, I haven’t really done a lot of research on this topic so I’ll stop right here. Let’s just say that I believe that fertility medicine should be opened to the market albeit with government standards and oversight.

Speaking of standards, I was able to fire back at my former Canadian fertility specialist, that yes, indeed we had checked the history and background and statistics (reported to the CDC) of the clinic we chose and we are happy to say that this is an established clinic with decades of experience. Already part of my cynicism has abated. I feel lighter. I feel what I think is, what I remember to be: hope.