IVF coordinator meeting - what to ask? Or to expect?

[chocolatepie]

We are meeting in the morning and the only thing I know we are covering is schedule, medication, and how to administer. 

What else is usually covered? What questions did you ask or wish you had asked? Will we learn more about financial responsibilities at this, too? Did your DH attend?

(brief history: have had testing done, have diagnosed cause, and are planning a FET - she said to plan for an egg retrieval around first week of Feb)

[seeyalater52]

If they don’t offer I’d find out what their schedule is for updates on embryos as they develop. Clinics have different schedules for when they notify you about progress and it’s a super nerve wracking part of the process so it might make you feel better to know what to expect.

If you don’t know the answers to these already they might be good to know:
If you have an after-hours question who do you contact?

What are their times for am monitoring? How long is the typical wait time to be seen for those appointments? (You’ll be there a lot for a couple of weeks!)
Who typically does monitoring during the cycle? Nurses? Techs? REs? When do you get info each day about whether to stay on the same protocol or make adjustments based on monitoring?
Will your doctor do your egg retrieval or depending on timing could it be another doctor (if there are multiple)?
Same with transfer.

Some people like to verify that all the embryos will be frozen in separate straws (not two to a straw) if they’re planning for single transfers. Some clinics seem to favor freezing two together and it can create logistical issues if you decide you only want to transfer one.

Are you doing ICSI, assisted hatching or any other non-standard stuff? If not, are there circumstances where they’d recommend adding these and what does that decision look like?

If you’re doing PGS testing you may want more info about the testing company they use, what level of detail you’ll get about the embryos, and your clinic’s policy on allowing transfer of mosaic embryos vs discarding them.

If you like to have details you might want to ask what type of stim protocol you’ll be on and why.


Good luck! It can be overwhelming so remember that you can always call back any time and get answers to questions you forgot to ask or anything that comes up during the process.

[pickel]

What seeyalater52 said! LOL She’s got great advice!

[woowoo]

seeyalater52, covered everything I was going to say, but I did want to add that yes, DH should go if he can. I'm glad mine came, mainly because my IVF nurse looked him straight in the eye and said "DH, your only job for the next several weeks is to say 'what do you need, and how I can help you' to her." It was such a funny moment but also reiterated to him that I would need endless support and nothing more.

[shoeless]

I don't remember your diagnosis and this might be too late but I'd also ask some of the "what if" questions just so you have the information now (if you don't already). Whats the minimum number of follicles and size your clinic wants to see before doing a retrieval? If you don't meet that criteria will you be allowed to convert to an IUI? If you have OHSS will that delay your FET?

[seeyalater52]

How did it go today chocolatepie? I hope you got all your questions answered and it wasn’t too overwhelming!

[chocolatepie]

ETA: this ended up so long :/ Sorry!

seeyalater52 thanks for asking, and for all the great questions! Thankfully they gave me a Q&A sheet with a lot of it already covered when we started so I didn't seem as high maintenance with my million questions

I didn't expect to be there that long - we were there almost 2 hours (+1 hr travel time) so DH was annoyed since he was technically working. BUT it was super important he came because they did labs on him (STD) and showed him how to do the trigger shot in the butt - I'll do the other injections myself.

Things I didn't realize:
- I have to have a mammogram before I start my injectables. Maybe because I'm 40? So I've got to get that scheduled first thing Monday so it's not held up. She handed me a script and said any radiology place will do it.

- we both have to take antibiotics before the egg retrieval

- evidently there is a $2400 "facility fee" and $400 anesthesia fee that is not even submitted to insurance so I'm guessing it doesn't even apply towards my deductible :/ So that's ~$3k we didn't know we'd need to bring to the table in a few weeks.

I was fairly annoyed by 2 things but I've been extremely happy with everything else with the clinic so I'm not going to make a fuss.

1. They tell me today, when we're supposed to be getting a breakdown of our financial responsibilities, that I should have registered with my insurance company. I read ALL the documents on our provider site and it's never mentioned so I didn't know to do it and all this time, the clinic never informed me. So they couldn't tell me anything financial or insurance related other than the two $$ items above + she said "well, and some insurance plans require other procedures before approving IVF and we just don't know" which now freaks me out. I called as soon as we got home and a nurse is calling me in a few days to go over my history and give me more info on coverage. I should have proactively called just in case I guess.

Finance lady also told me she's been helping cover the front desk and hasn't sat at her desk in 2 weeks so she hadn't worked on my file yet. Thanks?

2. But then, finance lady says that my insurance company won't approve the labs and ultrasound (the ones done on first day of injectables) if we don't have a day 3 testing - they did labs a couple of months ago on day 3 and got the AMH # but evidently didn't test for everything and she says that has to be done for the insurance company to allow us to start the injectables. So I'm guessing she's going off what she knows abt my insurance because she clearly had no information on MY benefits yet.

We were slated to start meds Jan 25, with a retrieval sometime Feb 5-8. But now with the need for this day 3 testing, that doesn't work. So, coordinator is having me force a period end of next week, do the testing, then start another pack of BC, force a period on Jan 28, and start the meds Feb 1 with a retrieval Feb 12-15. So we only lost a week and I'll end up with 3 periods in the month of January. Grrr.

Missing those labs was totally on them (because I was there on day 3!) but I'm thankful the coordinator didn't just say "oops! We'll have to wait another month!" because I'm anxious, feel in limbo, and get more and more worked up about my age each day that passes.

She only has me scheduled for labs/ultrasound 4 times during the med portion so that was way less than I anticipated. She also has me taking DHEA & Baby Aspirin starting today. I'm guessing that's standard?

So now I just wait anxiously for the insurance co to call and make sure they have all the documentation needed to start the IVF. Word on the street is that our plan is extremely generous and others have not had to jump through hoops but I remain cautious.

[seeyalater52]

chocolatepie wow that’s a lot to process all in one day! I’m super annoyed for you that they didn’t do any legwork on your insurance in advance of your appointment, especially because there’s no insurance in the world that wouldn’t require comprehensive cd3 testing before they’d pay for an IVF cycle. You would think they’d have prepared for that better, but at least they can get you back on track pretty quickly with some cycle manipulation.

I would double check the extra fees they are quoting you. If your insurance covers IVF and retrieval, unless there is a specific exclusion for anesthesia (ie: they consider it voluntary) it strikes me as weird that they wouldn’t submit to insurance - and without knowing the details it’s very possible that charging you additional fees for what should be covered services is a violation of their contract with your insurance network. You could call insurance to find out although a regular customer service rep may not be very helpful. Is the facility fee just an extra fee? Similarly to the anesthesia it’s possible this isn’t allowed if the services rendered are what is covered under your plan. Are you sure it’s extra and not a separate deductible or co-pay applied to outpatient surgical procedures? If it’s the latter it may count toward your deductible or OOP max.

I’m glad you have a plan in place! The only other thing I’d double check on is the baby aspirin directions. Many clinics don’t prescribe it prior to retrieval because of the blood thinning properties. They may have instructions for you to stop taking it before retrieval and resume again during your transfer cycle. Baby aspirin is most common during transfer cycles.
I only had 4 monitoring appointments during IVF so that doesn’t sound super unusual but it ultimately will depend on how you respond so it may get shifted around a little from what they have planned.

Good luck with everything!

[Jalapeñomel]

Oh I’d be hesitant to trust them after they failed to give you all the appropriate info at the start.

[chocolatepie]

seeyalater52 Good thoughts on the insurance side. I am hopeful that the insurance nurse calling me this week will offer some insight on financial responsibility and I can ask her about what the clinic rattled off. The finance lady clearly did not have it together and did not explain anything clearly. She told me she'd call me once my insurance company "registered" me and she could better see my end.

I will ask about aspirin, too!