Everything starts with a blood test: IVF

It wasn’t a surprise when our fertility specialist suggested that we try IVF. I knew the odds of conceiving via IUI weren’t high; IVF was the natural progression. I was actually a little happy that we could jump ahead to a procedure with much better odds.

I read up on what the procedure involved. I expected pain during the egg retrieval, and felt prepared for that. I didn’t think too much about the fertility medications. I assumed they’d be no different to the medication I took during the IUI. This assumption was wrong.

My first cycle didn’t go quite to plan

Everything starts with a blood test. At least I was familiar with this part of the process. In the afternoon, the nurse called to say I was good to go, and I started the injections that night.  Injections are never fun, so I made Jay do them for me. 

After five days of injections I felt a bit bloated and uncomfortable, but nothing completely out of the ordinary. I went in for another blood test, and that afternoon the nurse called;

“we’re a bit concerned about how rapidly your oestrogen has risen. You’ll need to come in for another ultrasound and blood test tomorrow so we can figure out what is going on.”

I kept taking my injections as normal, but that night I struggled to sleep. I felt nauseous, the bloating hadn’t gone down, and that’s when the emotional side effects started.

The next day we went to the clinic early in the morning. Jay was taking notes for the sonographer. In total, there were 36 follicles. Jay ran out of room on the page and had to start writing in the margins. I knew this number was too high; at our first appointment the fertility specialist said she aims for 10.

I was on annual leave, and Jay was on school holidays, so we kept ourselves occupied with ice-cream and a visit to Paperchain bookstore. When the nurses called that afternoon, they didn’t hold back:

“I’m sorry, I don’t have good news…”

My cycle was cancelled. Apparently my oestrogen had risen too quickly, and it would be too risky to continue.

That night my stomach started to balloon. It got rock hard as it filled with liquid and I gained 2 kgs in just over a day. I felt nauseous, and cried in the shower (but I still don’t know why). I tried to sleep, and put pillows between my legs, and tossed to find a position that was comfortable. Nothing seemed to help. I eventually gave up, and Jay kept me company while I watched the latest season of Grace and Frankie.

IVF wasn’t fun. I’m feeling back to normal now, and hoping next time won’t be so hard.   Even if is, I’d still do it again, but I’ll make sure to stock up on ginger ale, wheat bags, and binge-worthy tv.

 

Lesbians TTC – Will Medicare pay for it?

Trying to conceive with the help of a fertility clinic is an expensive process. Even if you happen to be one of the lucky few who conceive in the first cycle, you’re still looking at thousands of dollars. So when Jay and I first made an appointment to see our fertility specialist, one of our first questions was “but how much does it cost, and will Medicare help us?”

To be entitled to a Medicare benefit, that is able to make a Medicare claim, you will need to have incurred medical expenses in respect of a “professional service” (see section 10 of the Health Insurance Act). While you might have paid to see a doctor, whether you can make a Medicare claim depends on whether that appointment was for a professional service

Under section 3 of the Health Insurance Act a professional service means a service:

  • with a “Medicare Benefits Schedule” (MBS) item number;
  • provided by a medical practitioner; and
  • is “clinically relevant.

There is an MBS item number for both IUI and IVF (see items 13203, 13221 and 13200 in the Health Insurance (General Medical Services Table) Regulations), which in most cases will be provided by a medical practitioner; this means points one and two of the definition are sorted. The issue which might trip up lesbian couples, is whether the service is clinically relevant.

A clinically relevant service is a service that is generally accepted in the medical profession as being necessary for the appropriate treatment of the patient (see section 3 of the Health Insurance Act).  

The legislation doesn’t get much more specific than that unfortunately, so the payment of Medicare benefits for IUI or IVF largely depends on the medical practitioner’s decision that he or she is providing a clinically relevant service. This decision will vary between clinicians, and may be influenced by your background, medical history, age and other factors.

if you have no known cause of infertility, you can contact your fertility clinic to ask what their policy is regard same-sex couples and Medicare claiming. Anecdotally, many fertility specialists will regard a service as clinically relevant once the patient has paid for two IUIs out of pocket.

Another question for the fertility clinic I’m afraid – don’t forget to add it to your list!

What more information?

Visit the Department of Human Services’ website. Feel free to make a comment below, or visit me on Facebook for any other questions.

What is ‘IUI’? intrauterine insemination explained

A year ago Jay and I wandered into our doctor’s office and nervously explained that we wanted a baby. Since that day there’s been several hours of counselling, blood tests for every disease imaginable, ultrasounds and a toe-curling procedure call a ‘hycosy’ (it involves saline being injected into the uterus and fallopian tubes). Finally the treatment begins!

IUI, Intrauterine Insemination or Assisted Insemination

Jay and I are starting out with a procedure called ‘Intrauterine Insemination’ (IUI).  IUI is

a form of assisted conception involving assisted insemination into the uterus. IUI can be carried out with a woman’s natural cycles or with ovarian stimulation (superovulation) using clomiphene or follicle stimulating hormone, with ovarian monitoring. This process is used for either donor insemination (DI) or with a partner/husband’s semen (AIH) (Genea).

Like IVF, IUI is provided by a fertility clinic (we’re with Genea) and a specialist doctor. Many of the medications are similar, but as the eggs aren’t removed from the woman’s body there’s no operations or hospital stays. It’s also a bit cheaper which is always a bonus.

Medicines

While IUI can be done using the woman’s natural cycle, our specialist prescribed three medications:

  • Puregon – it helps follicles to develop (those small round sacs containing egg-cells)
  • Pregnyl – ripens an egg cell in the ovaries and releases the egg (ovulation)
  • Oripro – prepares the uterus to receive and maintain a fertilized egg

The Purgeon and Pregnyl are self-administered injections which had me a little worried. I’m now a few days into it, and it hasn’t been that bad; more psychological than anything else. The needle is very small (much smaller than the needle the doctor uses to give you a flu shot), so you only feel a very small pinch. 

The Oripro is a progesterone pessary, which is inserted at night. It’s very messy, so wearing a pad might be a good idea.

Tests

The fertility clinic monitors how your follicles are developing and responding to the medicines by regular blood tests and ultrasounds. Genea has a ‘morning clinic’, so I didn’t need to take time out of work to have these procedures.

The blood tests monitor the amount of estradiol (estrogen) in the blood. I got my first blood test three days after beginning the Puregon injections, and they continued roughly every two days until insemination.

The ultrasounds monitor the size and growth of the follicles. Ultrasound scanning uses an ultrasound probe placed in the vagina. There’s no need to have a full bladder for this test. I had four to five ultrasounds per cycle, which started five days after beginning the Purgeon.

Insemination

The insemination involves placing the washed sperm directly into the uterus. It is very anti-climatic, and feels similar to a pap smear.

I arrived at the clinic 45 minutes before the insemination. During this time I filled out paperwork, and a nurse took my pulse and blood pressure.

The procedure itself takes about five minutes, but I was asked to ‘marinate’ for another 15 minutes afterwards to give the best chance of conception.

After the insemination, I went home and watched netflix with Jay. It was a nerve-wracking time, but physically I felt fine and able to get on with my usual activities.

Donor Sperm

Congratulations! You and your partner have hired a u-haul, successful raised a happy fur-baby, and now you’ve decided to take the plunge and get knocked up.

One problem – sperm.

As a lesbian couple, the first challenge is to get your hands on some sperm (I know, I know – the thought grossed me out too).

Unknown sperm donor

One way to get sperm is to use a sperm bank. Many Australian fertility clinics use Fairfax Cyrobank,  which is based in the United States.

You can select your donor based on their height, occupation, blood type and even get copies of their baby photos (I’m not sure whether I think this is cute or creepy).

The main draw back with this option is cost; at a minimum you are looking at $1000. It could be much higher depending on: the number of children you plan to have; which clinic you go with; and the quality of the sperm (how many sperm per vial).

Children conceived by ‘unknown’ sperm donors still have the option of finding out their donor’s identity when they turn 18. In all Australian states and territories, fertility clinics must be accredited with the Reproductive Technology Accreditation Committee and comply with the National Health and Medical Research Council ethical guidelines.  Under these guidelines,  clinics must not use sperm (including sperm from persons overseas) if the donor’s identity cannot be established.

Known sperm donor

Your second option is to approach a close friend or relative to donate sperm. If you are thinking of using a known sperm donor, there are a couple of limitations:

  1. A ‘minor’ cannot be a sperm donor (hope that goes without saying!);
  2. Embryos (i.e. children) must not be created from close genetic relatives;
  3. Family members can donate sperm (e.g. a brother in-law, cousin etc), but the nature of the relationship means it requires special consideration; and
  4. Older donors create additional risks which you should carefully consider.

If you go with a DIY method, it is relatively inexpensive to conceive via known donor sperm. In fact, it is illegal to pay someone to donate sperm in Australia under each state and territory’s Human Tissue Act. However, donors can be reimbursed for any out-of-pocket expenses, such transport costs, taking time of work, and any medical expenses associated with the donation.

If you decide to go through a fertility clinic (like we did), your costs will add up quite a bit.  You’ll need to pay for:

  • blood tests (SO MANY BLOOD TESTS);
  • andrology tests;
  • freezing sperm;
  • counselling sessions (yes, you need to get counselling to use donor sperm); and
  • specialist doctor appointments.

These costs are not covered by medicare, and in total you’re looking at just shy of a $1000. The main benefit (in terms of cost) of a known donor, is that you can get much larger quantities than if you purchased it from a sperm bank.