June 09, 2010

The Options

I keep going 'round and 'round in my mind, trying to figure out what to do next. Trying to figure out what the heck will get us to the point we actually want to be at - parenthood. But I think I'd have better luck trying to see through walls at this point.

There are a few different options we're mulling, a couple of them with some variations we need to sort through. I tried (but didn't really succeed) being brief in outlining them. Feedback is more than welcome, so feel free to chime in with your thoughts. Things couldn't possibly get more muddled. (I don't think, anyway.)

Option #1 - Another FET with me (i.e. the not particularly hopeful option in my last post)
Pros: We have embryos to work with. I tend to get BFPs with FETs. Insurance will cover the transfer. I have leftover meds from this time around. We're very familiar with the drill. This most recent loss looks like it was ectopic, so maybe it was just bad luck and this could still work.
Cons: The obvious - 6 pregnancies, 0 babies that made it to the 2nd trimester, much less birth. So the odds of success are not in our favor.

Aside from that, there are still costs involved, and the actual FET may be the least of the costs. I want to do intralipids for the next FET, which will involve finding a new doctor, most likely a reproductive immunologist. That requires time, energy, and probably at least $2,000, since RI's don't tend to take insurance. And I think I probably want to do IV antibiotics too - might as well throw the kitchen sink at this if it's our last attempt. Insurance paid for some of it in the past, but there's still travel costs. On top of all that, I have an appointment with ob/gyn at the end of the month to talk about whether I may possibly have endometriosis. More on that in another post.

Option #2 - Gestational surrogacy (i.e. the not particularly realistic option in my last post)
Pros: We have embryos to work with. RE thinks our chances with this approach are "absolutely excellent."
Cons: The cost. We're not independently wealthy. There is no money tree growing in the back yard. If we were, or if there was, we would have turned to this option a couple of years ago.

We've started tentatively talking about this with some of our friends, but no one has come forward to volunteer to carry for us. (A lot of our friends have either had infertility issues themselves or difficult pregnancies with complications that make surrogacy not a viable option for them.) None of our family members are particularly good options, either.

I've done some research into the costs. We're looking at $10k for the testing/transfer, $7k to $10k for legal fees (we would probably have to go independent through an attorney, because an agency would be too expensive), $3k to $5k for travel and miscellaneous expenses like maternity clothing, $20k to $30k for the GC's fee and $20k to $30k for medical insurance for the GC if she doesn't have it.

So we're talking $40k at an absolute minimum (assuming she has insurance) to $85k at the top end. And I would already be out there working a second job and trying to figure out any other way we can come up with the money to do it, except for one thing:

It's a $40k to $85k gamble.

There's no guarantee at the end of it. We would pay the $10k testing/transfer fees up front, as well as at least $5k to $7k of the legal fees, and part of the medical insurance fees if applicable. Then, if there is a BFP, there are small payments made at that point and at the first ultrasound that shows a heartbeat, then the rest of it is paid in monthly installments as the pregnancy continues.

And if something goes wrong at the end and the baby is stillborn or there are complications and the baby dies, we will have paid out all of the money, and have only a dead baby to show for it.

I know that stillbirths are not common, that the odds of us getting to the end of a pregnancy and having complications and having a dead baby are low. But they're not non-existant, and we've been on the wrong side of the odds so many times.

And I think we're at a higher risk than average for those things, because there's a 50/50 chance for each of our embryos to have Bru.gada's Syndrome. There's research that seems to be showing that at least half of all SIDS deaths may really be because of Bru.gada's, so it seems reasonable to think there's also a greater risk of a fatal irregular heart rhythm (which is what Bru.gada's is) in utero, when nothing can be done about it.

R and I are not gamblers to begin with. I really don't think I could lose yet another baby, lose $85k, and still somehow manage to pull myself together again after that. Not to be dramatic, but in total seriousness, that could be just the thing that makes me shatter irrepairably, and I don't think I can risk that.

So unless Ed McMahon shows up on our doorstep with a giant check (is he even still alive?), this option just doesn't seem very realistic.

Option #3 - Adoption (i.e. the not particularly appealing option in my last post)
Pros: Sometimes this works, for some people. If my understanding of recent adoption tax credit changes is correct, we may be eligible to take the credit again, which means this could potentially be the least expensive of all the options.
Cons: We've been badly, badly (did I mention badly?) burned by this option in the past. Badly.

When I say it's "not particularly appealing", I don't mean that I dislike the concept of adoption. In fact, for those of you who haven't been following this blog for the entire time, R and I turned to domestic adoption before we turned to IVF.

And we were lied to (about a birthmom's intention to place), lied to again (about a birthfather situation), and lied to yet again (about drug use). Those were all birthmoms who truly had babies - that doesn't even count all of the scams we encountered but thankfully didn't fall for by women who weren't even pregnant. We spent $30k on those efforts, and we couldn't keep putting ourselves through the heartbreak and feeling being taken advantage of, so we let our homestudy expire and faced the reality of needles and egg retrievals, etc.

So I'm very, very wary about this option. (Okay, yes, "bitter" may be a more accurate word.)

We chose domestic adoption at the time because we wanted to start with a newborn. Now we're more willing to let go of that ideal, and we would be willing to pursue international adoption.

Except, I don't think we're eligible.

R and I both take thyroid meds and anti-depressants, and R has a defibrillator. Granted, he's never had any sort of irregular heart rhythm except the ones induced by medication while he was undergoing an EP study in the cath lab. It's just a kind of insurance policy, in case he was to go into v-fib.

But still, I've made some inquiries, and it seems that other countries frown on the idea of allowing someone to adopt when they have a medical device implanted in their body on the off chance that their heart suddenly goes into a wacky rhythm. And even if he didn't have that, anti-depressant use is highly frowned upon (even if it's past use and not presently being taken), and even common thyroid meds are apparently enough to knock you out of the running.

I've thought about lying - I mentioned these restrictions to our family physician, who said it was ridiculous and has no concerns about us being parents given our health situations, so might be willing to give us a medical clearance - but I tend to be a horrible liar, even when it's a lie of omission. And R, whose character is one of the things I love most about him, vetoed the idea.

So, now that we're at the point we're willing to consider international adoption, it appears to no longer be an option for us. And that one seemed like the closest you can come to a "sure thing", so it's been a bit disheartening.

So yes, we have options. But of the ones that are practical, they don't feel particularly likely to get us to where we want to be - out of this maze, with a baby in our arms.


MiraclesDHappen said...

wow, it's been a rough road for you. I hope everything works out and you get your baby in the end. (((Hugs)))

lastchanceivf said...

Wow Rebecca. I can hardly wrap my head around all the decisions you have to make...all the choices...none of them easy.
Maybe the one I can speak the most about is the medical clearance for international adoption--with our agency and country our doctor just had to write a letter saying we were healthy. It didn't have to be detailed. I know different agencies require different levels of details but in the end, our dossier was approved without a lot more detail than a statement that we were in excellent health. And your husband having a defibrillator is what they should want to see--to protect him from a fatal heart rhythm. DUH. It makes him healthier to have it.
At any rate, email me if you have any questions even though our experience is limited and narrow...

And I found your blog a really long time ago (I think right about the time R was being diagnosed with Brugadas) and I will never forget the words in your header "three spectacularly failed attempts" regarding domestic adoption and honestly it is one of the reasons we just never even considered domestic adoption.

I wish I had a money tree...I hate that money comes into play on this stuff.

Mo and Will said...


I wrote you a long LONG comment. but i don't see it here. did blogger eat it?! will wait and see if it appears and if not, repost. argh!


MrsSpock said...

Too many hard choices. How can you make a hard choice when everything has been so hard for so long already?

I met an adoption consultant at resolve conference up here and interviewed her for my blog last spring. If Mr S and I ever take the plunge, we will hire her absolutely. She seems to have a knack for helping to navigate you to the right agency and the right situation. Let me know if you have an interest in her, and I will email it, though I understand that trying adoption again may be the very last thing you'd ever want to try again.

Libby said...

Wow is right! We're muddling through our own "what to do next," so my opinion probably shouldn't count! If you have enough embryos for more than 1 FET, at least it would cost you the least dollars. I'm assuming you have done an immunology panel for recurrent pregnancy loss. If not, I see Dr. Cou.lam in Ev.anston, IL for RPL, and she is the one who discovered that intralipids suppress natural killer cell activity. My infusions at her office are $600 each. I have heard that some home health agencies will do it for you though if you can get a doc to write the script. Just a thought as I have not been able to try the intralipids to keep a pregnancy going since our last IVF was a bust embryo quality wise.

It would be so nice if you could find a known g/c. If this is your answer, I hope someone steps forward soon. We thought that would be our next step until we started to make crappy embryos on top of dealing with RPL.

As for adoption, SCARES the pooh out of me! How people can be so heartless, I don't know. I am so sorry you have been burned. We also don't think we would be ideal candidates with DH's diabetes and sarcoidosis. We get up and go to work every day but could be seen as unfit parents. Go figure.

Sorry I'm not the one to give you THE answer, but I totally feel for you. Hang in there :)

mara said...

Ugh. This is so tough.

I don't really have any advice. I have done a bit of research on international adoption and antidepressants. Whether or not this is "okay" (so annoying) depends so much on the agency and country. I don't know what countries you were considering, but I know Ethiopia is pretty okay with it, Korea depends on the agency, and China and Russia are not. I think the idea of an adoption consultant sounds really good. There's so much to figure out and navigate.

I also think the FET with you and the intralipids is worth a shot.

Trying to figure out these options has got to be so hard. Good luck sifting through them. Hang in there :)

Thalia said...

I'm so sorry I missed the whole of this dreadful cycle, and very sorry for the miscarriage, just ridiculously unfair and sad.

I don't know, Rebecca, what should happen next. Sounds like you have thought everything through very thoroughly. What does your gut say?

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