Insurance coverage and lower quality cycles


#1

This has been on my mind a lot lately. In August, we did our first IVF cycle in a state with a mandate for IVF insurance coverage. The cycle started out well (19 antral follicles) 20 eggs retrieved. However, it ended with only 14 mature eggs, only 7 fertilized and all of them became poor quality embryos. We have MFI so the lab did ICSI. Before transfer the RE mentioned something about questionable egg quality.

While I understand that this COULD be an issue, we have no other reasons to believe that. I was only stimmed for 8 days and only on 375 of Follistim. It seems that maybe Menopur could have been helpful and a few more days of stimming/ultrasounds/bloodwork. Has anyone else ever wondered if clinics in states with mandated coverage might purposefully try to use less meds and monitoring in order to maximize profits?

Or maybe I’m just trying to convince myself that I don’t have bad eggs :frowning:


#2

I hate to say it, but I have thought that as well.

Our story is very similar, we have MFI, used ICSI, and after my first IVF, there was talk of egg quality issues.

Furthermore, my state also mandates insurance coverage, and during my first IVF, I lost 8 embryos between days 4 and 6.

I am wondering if my doctors know I am good for 4 paid in full cycles (bc of insurance) and are going to milk me for those.

I’ve been a bit of a research nut and started challenging my doctor a bit, in hopes that she understands I am no pushover. I even challenged her on the use of Menopur, because some doctors feel too much LH can also hurt a cycle. Her response was that 95% of their patients do better with a little LH in their cycles, so perhaps that is something to ask your clinic about? Also, maybe you can change protocols?

Having said all that above, there are so many factors involved in IVF and I want to think (I need to think) that my second IVF (starting tomorrow) will have better results.

Best of luck to you… I wonder if we live in the same state. I am in NJ.


#3

I’m not sure if mine had to do with insurance or just a bad clinic. They were too busy and their rates on Sart were not good. 3 ivf’s and 1 failed fet and didn’t have any answers. I do believe the fet should have never been transferred. I’m not sure if the embryos were still alive!!! This was done for the $$$.

Unfortunately I didn’t recognize the issue until we used up half our coverage.


#4

KTB- thanks for the response, it’s good to know that I’m not alone. I am in HI and there aren’t many clinics here. The mandate here requires that the insurance companies pay for one IVF cycle and while I really liked my RE and the clinic, I felt that there were a few things that could have helped our cycle be more successful but would have cost the clinic more money. Since I work in healthcare, I know that the same issues come up with Medicare/Medicaid and the the limit on reimbursements. I’m sure that if we stayed at this clinic and paid for a second cycle, they would adjust some things but we would be paying for everything at that point.

Our next cycle will be somewhere else (maybe OR) but it will be out-of-pocket. It seems strange to think that this might help us.

Good luck with your upcoming cycle!


#5

Aryan- the single most frustrating thing that I’ve discovered from working in healthcare is that sometimes it is just about the $$$. It shouldn’t be like that. I’m so sorry about your failed cycles, will you be trying again somewhere else?


#6

(I do not live in a state that mandates coverage, but had coverage)
I guess that’s always possible but in my experience they are most worried about their success rates because people want a clinic with the best stats. So purposefully not doing a good job would make their stats look bad and patients will go elsewhere, which doesn’t seem like a sustainable business model. That being said, if you have concerns about your protocol speak up and negotiate a change.


#7

Music-- Yes I’m on my second round at a much better clinic. The 2.5 hour drive is worth it. My old re had a great set-up with a spa attached. But, my new clinic is a traditional doctors office setting… But I could tell the lab is much better. They give us answers and when I saw pictures of the embryos they looked soo much better. Even if the new re doesn’t work… I will have no regrets!!


#8

You raise an interesting question.

Was your treatment kept short and economical because of the minimal fees the clinic would receive?


#9

Ghost- I guess that’s my question. From what I’ve heard, Menopur is quite expensive but from what I’ve observed, it seems that it is common to use it along with the Follistim. If only 14 of the 20 eggs retrieved were mature, it seems that I could have stimmed for another day or 2 in order to let them grow a bit more.
I dunno. There is no doubt in my mind that my RE had the best intentions of the cycle working but my underlying question is…could a few extra measures have made it better? and if so, why were they skipped?
Like I said, I’m probably just in a bit of denial about the ‘bad eggs’ reference but I am definitely going to have a conversation with my new RE about modifying the next cycle a bit.


#10

I had a horrible first cycle (in siggy) the dr said I had bad eggs. At 26??? I couldn’t believe it. Then I did a diff protocol and had a bfp second cycle with 8 frozen. I think drs dont want to admit their protocol was the issue, not us. Then again I am only a few weeks preg so it could still be a bad egg. Anyway my DH always says ivf and infertility is a business.


#11

[quote=musicgal]Ghost- I guess that’s my question. From what I’ve heard, Menopur is quite expensive but from what I’ve observed, it seems that it is common to use it along with the Follistim. If only 14 of the 20 eggs retrieved were mature, it seems that I could have stimmed for another day or 2 in order to let them grow a bit more.
I dunno. There is no doubt in my mind that my RE had the best intentions of the cycle working but my underlying question is…could a few extra measures have made it better? and if so, why were they skipped?
Like I said, I’m probably just in a bit of denial about the ‘bad eggs’ reference but I am definitely going to have a conversation with my new RE about modifying the next cycle a bit.[/quote]

Some REs think the “LH activity” (it’s mostly from hCG, not LH) in Menopur is good, but some don’t like it. It obviously is a successful product on the market.

I think you might have a point about the short stim giving fewer mature eggs. Not sure about the Menopur.


#12

Ghost- thanks for your input, it is always very helpful and appreciated!

Buckeye- Congratulations!! I am hopeful that my next cycle will be as successful as yours. We probably only have enough frozen :dance: for one more cycle so it feels like the pressure is on.


#13

Never gave this much thought, but it is criminal how little insurance company’s pay compared to oop. I paid over 14K for 1 round of IVF w/ ISCI and assisted hatching, not including meds, which were 4,500. We got 24 eggs, 18 mature, and a bunch frozen.

My insurance company only pays 8500.00 for the exact same protocal. My RE did say he wanted to drop back on the meds b/c he wants quality over quantity this time, but he would bring me in for more frequent monitoring to make sure I didn’t need a med ajustment. I am not sure ultrasounds are included in that above number…but I think I will stress to him before I start that I am one and done regardless of the insurance coverage. I can’t handle years of this…and I do think they care tons about their success rates. If this doesn’t work, we will do whatever FETs we have embryos to do, but I am only doing one fresh cycle. Perhaps stressing that at the start will make them realize that this is their chance.


#14

[quote=nlhousewifey](I do not live in a state that mandates coverage, but had coverage)
I guess that’s always possible but in my experience they are most worried about their success rates because people want a clinic with the best stats. So purposefully not doing a good job would make their stats look bad and patients will go elsewhere, which doesn’t seem like a sustainable business model. That being said, if you have concerns about your protocol speak up and negotiate a change.[/quote]

I think this is a very valid point.


#15

I’m 100% OOP but can say that my clinic will stim no less than 10 days… Anything less, even if E2 levels are high result in poor quality embryos.

I would make sure you come to an agreement with whichever clinic you are going to that their protocol’s are flexable and that they are actually monitoring your LH as well… Many clinics have their way of doing things, no matter what your body does, which is horrible.


#16

Wow, I had never thought of this before, but then again I was never fortunate enough to have a single dime paid for. But what I can relate to is having the MF infertility and possible poor quality eggs at a young age. My DH and I went through 4 fresh IVF cycle never getting more than 10 mature eggs, all in my early 20’s. I was said to be perfect and our issue was male factor, but after two negative cycles and 2 early miscarriages, we decided to move on to donor embryos and now have a wonderful little boy! I am not at all saying you need donor embryos, just saying that it is possible to have less than perfect eggs at an early age.

I tend to agree with one of the other posters that it seems like they would be too worried about their stats to try anything fishy. It hurts them every time a patient has a negative cycle. But I do find it strange that you were only stimmed for 8 days, if your eggs were not ready at that point. Do you have some lead follicles (ones that were a lot bigger than the others)??? Good luck to you in the future, if you don’t trust your clinic then you may want to move on to another. You always want to feel like your RE has your best interest in mind, and that you trust their decisions.