True North: A family magazine for Bend and Central Oregon.

Infertility: How much will your baby cost?
Part 1: Understanding your options
by Amy Moll

Whether it's the first time, or the fifth, having trouble conceiving can be scary, frustrating, and expensive! When the desire to have a baby is great, it is easy to push forward at full speed, trying one infertility treatment after another, without stopping to consider all the options or create a clear plan of action. Even in a time of economic plentitude, affording infertility treatments remains a large financial burden. Help from insurance is often minimal or absent, and it is easy for medical bills to pile up quickly. Every couple's situation is unique, however there are general guidelines for knowing where to start. This article is the first in a two-part series and will focus on understanding the fertility treatment options available to people and associated costs. Part 2 (which will appear in the June/July issue of True North) will focus on budgeting and financial resources for couples trying to conceive.

Seeking Help
Start by finding a doctor knowledgeable in treating infertility — someone who listens, cares, and answers questions clearly. Reproductive endocrinologists (REs) have highly extensive training in treating infertility. They often do the most thorough testing and evaluation up front. For women of advanced maternal age (over 35), or who suspect a serious complication or underlying disorder, working with an RE is probably the best place to start. RE's from the Oregon Reproductive Medicine Clinic in Portland come to Bend on Fridays to offer their services to Central Oregon. An initial consultation is $300.00. For people under 35 and without any obvious symptoms or pathologies, initially consulting a gynecologist or general practitioner may be more affordable, and a good place to start getting some baseline testing and analysis. Some insurance companies will cover diagnostics and testing, so do call to find out.

Do the Tests!
Women should have their hormone levels tested on the third day of the menstrual cycle including estradiol (E2), luteinizing hormone (LH), and follicle stimulating hormone (FSH). Based on symptoms, it may be important to do more in depth blood work, an ultrasound, laparoscopy, hysterosalpingogram (HSG), or other tests to check for polycystic ovarian syndrome, endometriosis, fallopian tube blockage or defect, thyroid conditions, hormonal imbalances, STDs, immune system disorders or other problems. Work with the doctor on deciding what tests are appropriate.

It Takes Two to Make Three.
Male factor infertility is estimated to be involved in 30% or higher of cases. It makes no sense for a woman to undergo expensive and invasive testing, only to find out afterward, the problem resided with her partner. From the start, men should have a complete semen analysis to check for spermatozoa amount, motility, and morphology. A physical exam should be conducted to check for structural or congenital abnormalities affecting fertility. In some cases hormonal testing is done to rule out endocrine disorders, and blood tests for STDs. Once all the information is gathered, couples can more intelligently explore their options — and costs.

Clomid and other fertility drugs
Clomid (Clomithene citrate), has become a popular fertility drug for women that promotes ovulation. It is most appropriate for women with poor ovulation or anovulation, and often used in cases of unexplained infertility. Clomid is typically taken for a 5-day period prior to ovulation. Ultrasound monitoring is conducted to test for the development of follicles. The drug is considered quite safe by the medical profession. It does increase the chances of multiple pregnancies. Side effects most common include bloating, breast tenderness, flushing, increased perspiration, dizziness, depression, mood swings, and vision changes. More serious reported side effects are rare, but include ovarian hyperstimulation syndrome, ovarian cysts, grand-mal epilepsy, and hallucinations. Because of its anti-estrogenic effect, it can dry out the cervical mucous thereby potentially impairing fertility. Clomid costs approximately $70.00 per month, not including any ultrasound monitoring. Tamoxifen is a similar drug often used if women have unwanted side effects using Clomid.

Intrauterine Insemination (IUI) or Artificial Insemination (AI)
In order for sperm to reach the egg residing in the fallopian tube, it must first make it past the tiny opening into the uterus called the cervix. For most days of the month, the cervix is guarded heavily by the body to prevent anything from penetrating the opening and compromising the uterus. For sperm to make it past the "guards" a woman needs to produce the right kind of cervical mucous, a gelatinous egg-white like mucous that, on a microscopic level, creates a type of mesh screen permitting sperm to wiggle on through. This mucous also needs to be the right pH level, allowing sperm to survive a lot longer than they normally would otherwise. If a woman's body is not producing this delicately balanced mucous prior to and during ovulation, conception becomes very difficult. IUI is a way to bypass this problem by injecting sperm directly into the uterus. For unexplained infertility in women 35 and under, this is a widely used technique. It is also helpful when the male's sperm counts are low, or lack adequate motility. IUI is often used in conjunction with Clomid to ensure ovulation that cycle. The process requires close ultrasound monitoring to determine the best day for insemination. Including ultrasounds and sperm washing, each IUI can add up to $500.00.

In Vitro Fertilization (IVF)
For couples who have tried everything else, have poor egg quality, or other medical complications necessitating it, IVF technology can offer hope that 30 years ago did not exist. IVF is the process of harvesting the female's (or donor's) eggs and fertilizing them with sperm in the laboratory before inserting them back into the uterus for a hopeful implantation and pregnancy. These procedures are performed by reproductive endocrinologists and their assistants. Medications for one IVF can add up to $3,000 - $5,000. The actual procedure along with pre- and post- monitoring costs $7000 - $8,000. Other tests or procedures prior to doing the IVF may include a semen analysis, bloodwork, baseline ultrasound, hysterosonography, dopler ultrasound, and trial embryo transfer, adding to well over $1,000. Sometimes intracytoplasmic sperm injection (ICSI) is recommended, a process of choosing the healthiest sperm, and injecting them directly into the egg before implantation. This is another additional cost. If you are considering trying an IVF, plan to spend $10,000 - $15,000. Double those numbers if you will be using donor eggs. Also consider budgeting for 2 weeks worth of traveling expenses and missed work.

Acupuncture and Oriental Medicine
Oriental medicine has a lot to offer a couple trying to conceive including acupuncture, herbal therapy, nutritional therapy, moxibustion (transferring heat from a specific herb into acupuncture points), and qi gong or tai chi as relaxation methods. Utilizing these tools will help improve blood circulation to the uterus and reproductive organs, balance hormones, promote ovulation, improve the health and quality of the eggs and sperm, calm down the sympathetic nervous system, ease stress and improve mood. Oriental medicine can be used as a stand alone therapy, or in conjunction with fertility drugs, IUI and IVF procedures. A recent study utilizing acupuncture in-house before and after IVF procedures showed a significant difference between the group of women receiving acupuncture and those who didn't. In the acupuncture group, there was a 55% rate of clinical pregnancy (detection of fetal heartbeat) versus a 34% rate in the control group. The rate of pregnancy loss was also significantly lowered in the acupuncture group at 4% versus 23% in the control group.

An acupuncture treatment typically costs $65 - $80, with initial appointments being slightly higher, $95 - $125. Many acupuncturists recommend 1-2 appointments weekly for 3 to 12 months. If regular acupuncture does not fit into your budget, do consider trying Chinese herbs for 3 - 12 months instead. Chinese herbs alone are very effective at bringing the body back into balance and improving fertility; they are also one of the most affordable treatments. Costs range from $50 - $100 per month. Not all acupuncturists practice Chinese herbal medicine, so include that question when inquiring about treatment and services. It is important to note, couples who have decided to address infertility through natural routes alone should still meet with their doctor for baseline testing and evaluation. Western medical tests and diagnoses are very helpful to a practitioner of Oriental medicine and acupuncture, playing an important role in treatment strategy.

The Multi-Billion Dollar Supplement Industry
A recent study showed that over 30% of men diagnosed with infertility had low vitamin D levels, prompting more research into the role vitamins and minerals play in fertility. With hundreds of companies trying to get a piece of the supplement industry, it can be confusing figuring out what supplements are safe, effective, and useful. Rather than trying to figure it out alone, consult with a nutritionist, naturopathic or medical doctor, or Chinese medicine practitioner, who is knowledgeable in the needs of couples trying to conceive. It is a good idea to talk to several healthcare practitioners to gather information, ask questions, and create a nutritional plan. A high quality multi-vitamin can cost $30 - $40 per month. Consider budgeting $60 - $200 per month for combined supplements.

Ovulation Predictor Kits and the Latest Technology
For couple trying to conceive without the help of artificial insemination or IVF, it is important to know when the woman ovulates each month. Studies show that it is best to have intercourse several times within the 4-day period before ovulation. Ovulation predictor kits only confirm ovulation occurred. They don't tell couples what their 4-day best window of opportunity for conception is — but the OV Watch does! Using a completely different technology, the OV Watch has a special sensor that detects chloride ion changes occurring on the skin based on hormonal changes in the body. A woman wears the watch at night beginning on the 3rd day of her menstrual cycle. It then literally tells her what her four most fertile days are each month. The watch takes the stress out of guessing. It costs $99.00. The sensor has to be replaced each month at additional cost of $30. To find out more, visit www.OVWatch.com.

A Holistic Approach
When addressing infertility, it is best to have a holistic approach. What that means is, instead of focusing all attention on the outcome — getting pregnant, work towards improving overall heath. This includes the physical, mental, and spiritual health of each individual, as well as the health of the relationship. Facing infertility is stressful, yet it is that very stress that can become one of the biggest barriers to conception. A holistic approach, one that includes healthy eating, exercise, stress management, good communication between partners, and a skilled healthcare team advising couples along the way, will generate the best chances for success. Incorporating the cost of all of these components into a fertility plan can add up very quickly. This is why planning, discussing, and budgeting are so important.