Help me decide - SG or GIVF

[tr]

Hello ladies,

I am a newbie on this forum. After 3 failed treatments we are trying to change clinic.
I am 27 POF, hubby 31. We have attempted 3 DE IVF overseas with known donor (33 yrs old) and all 3 failed (implantation failure).
Have underwent Hysteroscopy which came back normal. Husband is completely normal.
So after spending close to 50K, we are still where we started :-(

I am seriously thinking going to SG. Could any of the veterans please answer few questions -

1) With 1:3 program do you get enough good eggs, embryos? Should we go with 1:2.

2) Were you able to find the donor of your choice? I am 5'8'' and I see very few choices which are 5'6''+ much less other characterstics.

3) There is another clinic called GIVF. They seem like to have much better donor seletion. But they charge 50K+, don't have donor sharing and allow only 4 attempts.

4) We live in Boston area. Is distance going to be big issue. Local donor agencies here charge upwards to 15K which is quite unaffordable at this point for us.

I would really appreciate if you can share your thoughts.

Thanks and good luck,
tr.

[dolcib]

Hi there:

I am with the SG program (1:3), and can only speak to my experiences.

I have done 1 cycle with SG and did have a BFP although I m/c @ 8 weeks (wasn't a surprise, baby was a sluggish doubler). As I am in the shared risk program, I have 5 more cycles or I get the full refund. As soon as my beta goes down to <5, I can have another donor access code and start on cycle #2.

As for 1:3, we received 10 eggs on our first cycle and 7 fertilized normally. We transferred two 5 day blasts. I did not have any to freeze as SG's freeze standards are pretty high. I would imagine you would have more of a chance of eggs to freeze with the 1;2 but it is not guaranteed. Also, SG charges about 5 k for every FET done (unless you are in the shared risk program and it is during your 6 attemps). However, my friend who has a healthy pregnancy on her first attempt has only 1 to freeze and they are reluctant to transfer 1 embie due to the cost.

As for donors at SG, it depends on when you look. The pool changes every couple of weeks. I believe there are a few girls currently who are over 5'8. I'm long past worrying about whether the baby will look like me although I'm 5'8, too. I agree that my height is nice but to me, it is less important than a proven donor with a good history. What I like about SG is that they will help you (you have to ask) for donor advice. On this cycle, we are going to give our RE/nurse a choice of 3 girls and let them pick. I don't recommend a new girl, there have been too many disappointments on this board with unproven donors (for example, not enough eggs, donor backing out, etc...). I do believe SG does a great job with screening of health issues but they seem to have had some surprises with new donors not responding well to meds.

Like you, I live far away from SG. I am in touch with my nurse primarily by email and have my monitoring done locally (I'm in NC). Last cycle, I went up for my initial consult and lining check before transfer. This cycle, I will only go for transfer as the last one went just fine. My DH just has a frozen sample at SG and that way he doesn't have to go up to do his thing on retrieval day. I found that SG kept in touch with me extensively throughout my cycle and when this baby looked funny, I was able to speak with my DR and nurse frequently.

SG is a big, busy clinic and one way to ensure attention is to be an informed consumer. You have to be the one to keep in contact with them and if you have a question, you have to ask. If you have a history of failed cycles, it is important you address your concerns directly with the RE. Many Drs there have the attitude that a pg will happen eventually. Frankly as I'm not one to sit back and wait, I've pushed the issue on asking for more diagnostics if I feel I need them (I have Factor V Leiden) which involves lovenox throughout the transfer process. I am also lucky that my local RE has been aggresive in speaking to SG if he feels he needs to.

I hope this helps you make your decision.
Good luck!
Gabrielle

[SmilingIrishIs]

tr - I don't want to confuse the issue since I'm sure you've done lots of research to get to this point. However, I was wondering, since you're willing to travel, why don't you have one of the clinics with high DE success rates on your list (like San Diego Fertility Center or Oregon Reproductive Medicine)? Both have success rates around 80%. I used Oregon and can say they have a good pool of donors and reasonable prices.

I can understand thinking about SG, since its shared donor and shared risk programs are very attractive, but why GIVF (I think their DE success rate is less than 40%)?

[rjc0704]

Hi - So sorry for your failed cycles. I know the heartache. I've had three fresh de cycles through SG shared risk program. But have found some immunity issues and a hydrosalpinx (fluid) in the fal tube. Most people are successful there by the 2nd time.

I started off in the 1:2. I did 1 cycle with a repeat donor. Regardless of the program, the avg # of mature eggs retrived is about 18. So I only got 9 eggs, 8 fertilized. Two blasts tx'd and 1 to freeze. Then we upgrated to the 1:1 for two cycles. Both cycles yielded 16 eggs. The first I had none to freeze. The 2nd I had 4 to freeze.

SG caters to out of towners. I'm in CT. I went down there once for the prescreening for the shared risk. DH went also and left his sample which is on ice-free of charge for a year. We should have enough for nearly all the cycles. You will only need to go back for the transfers. You can find someone local to do your monitoring for you and fax results to SG. It really hasn't been too bad so far. But no matter what clinic, they have high standards for freezing. They have to be good quality so they can keep their FET stats decent.

SG is busy and all care teams are different. But they are very flexible and work well with accomadating your needs.

[title1]

I am not familiar with these clinics. What does SG and GIVF stand for?

[tr]

title1 >> SG - Shady Grove, GIVF - Genetics and IVF. Both are around VA area.

SmilingIrishIs >> You brought up interesting point. I didn't know givf has only 40% success rate. The only reason I am researching these clinics is that they have shared risk programs and are close to our place (Boston).
We have spent close to 50k already running all around the world (mostly overseas clinics) doing IVF but without success and wish we could get money back :-(
Could you share some more information on Oregon clinic? Did you go with pay per cycle or a refund program?
I quickly checked their website and seems like they have good donor pool and claim close to 70% clinical pregnancy rate which is very good.
We are on the East coast but can travel if the clinic has good shared program like SG.
I see your hcg numbers are going up pretty nicely. God bless you and your baby. Good luck wth your pregnancy.

Gabrielle >> Thank you so much for taking time to reply. I am sorry for your mc but isn't it comforting to know that you 5 more tries or your money back. I am sure it'll work for you next time.
It's good to know that you get blasts even with 1:3. Money wise this is cheapest and best for us (we are still under debt from our last treatments :-( I was concerned about 40% cancellation, and only 10% blasts rate for 1:3. But guess each cycle is different.
It does make sense to use proven donor. I used my sister as donor and embies didn't stick. May be her age (33 yrs) was factor.
I believe your local RE is monitoring your lining. It's great to have RE you can trust and who is willing to help you find answers.
I wish you good luck with your next cycle.


Rhonda >> Thank you my friend! It indeed is disappointing when you do all in your power to make it work but it doesn't. And you don't know what else to do. You did a wise thing enrolling in shared risk program. I was stupid thinking it will work this time, this time and again. Have been travelling overseas to cut costs but lo it's no good either.
I don't have immunity tests done but had everything else - Hysteroscopy is normal, Hubby's morphology and karyotype is normal.
Anyways, I know we'll all soon see the light. I know - God has a plan for all of us.
No doesn't mean never. It just means not now. We'll get there. Amen!


Gabrielle/Rhonda >>

Do you mind if I ask you few more questions -

1) How much $$ you spent on top of shared risk cost (29K I believe) during your first cycle?

2) How long after you selected donor and paid for treatement were you able to start treatement?

3) Does SG help identifying or fixing implantation failure issues - immune or other? I am sure you had to pay for these tests out of pocket or may be insurance covered them. How much approx do they cost?

4) I have had 3 cycles overseas which failed - sometimes not great embryos, sometime implantation failure. Do you think I will be accepted by SG. We meet all other crietria. My lining was 11.5 mm but somehow embies decided not to stick :-(

Do I need to tell about all failed cycles.
Should I get immune testing done before starting treatment. I worry they might deny us.
I just can't afford to pay for individual cycles anymore.
But I feel we have good chance considering our age.

5) Is there any SG location (MD, DC or VA) better than other? I think MD will be closest to us.

6) Do you think we can start with 1:3 and if needed can move up to 1:2. Each $ counts now for us. Any problems with 1:3. I know choice of donors is limited.

7) My overseas clinic asked to undergo ACA IgG IgM and LAC tests. Any idea what they are?

Sorry if I am asking too many questions.

Best of luck. You ladies rock!
tr.

[elli75]

tr- I am also in the 1:3 program at SG. I was just recently accepted into the Shared Risk program and I just went through all of the tests that were necessary to qualify. I am now able to start selecting my donor. I was very worried about being able to qualify since I have known immune issues, endo, and poor response to meds to build a thick enough lining during my many ivf attempts with my own eggs previously. I was so relieved that I was able to qualify and my lining became thick enough. My health insurance covered the hsg, sono hsg, mock embryo transfer, b/w, and u/s that I needed to qualify for the shared risk program. They will not cover anything that is related to having a donor, the required visit to the social worker, etc. Please feel free to ask any questions you have about the process since I just went through it myself. Good luck to you!

[rjc0704]

TR-

1) How much $$ you spent on top of shared risk cost (29K I believe) during your first cycle? I'm in the 1:1 (56K) but shared risk, regardless of sharing donor - all have the same protocol. You only have to pay for your meds and Ins will cover them...so just your co pays. If you don't have ins. the Lupron, Del E and Progestrone you will need totals about $250.00 Insurance pays for my meds(and I'm over 40 and don't have fertility coverage-but they still pay for it for some reason) For me, my copays are about 150.00 per cycle.

Because I am out of state and do my monitoring local, I have copay for my two u/s for lining check. The rest is covered in the shared risk package.

2) How long after you selected donor and paid for treatement were you able to start treatement? It it is usually about 2 months. But if you are in shared donor program, you dont start until all the matches are made. If a shared donor doesn't have a complete match all recipients after something like 4 months, then you get a free upgrade. I.e. if in the 1:3 and only two matches, you are in the 1:2 at no extra cost.

3) Does SG help identifying or fixing implantation failure issues - immune or other? I am sure you had to pay for these tests out of pocket or may be insurance covered them. How much approx do they cost? To an extent. They don't believe in reproductive immunlogy like SIRM (out of NY) But they will look at uterus and other factors, like thyroid, tubal infections, stuff like that. That would all be covered by your ins because it's not considered infertility treatment...it's testing. I had infection fluid in a fallopian tube which could have contributed to my failed cycles.

But I also did immunity testing through Beers in CAL. VERY EXPENSIVE!!! Costs about 2k for tests. My treatment protocol suggestions from them for slightly elevated NK activity and a few other borderline issues
ran over 8k a month. YEAH RIGHT!!!

4) I have had 3 cycles overseas which failed - sometimes not great embryos, sometime implantation failure. Do you think I will be accepted by SG. We meet all other crietria. My lining was 11.5 mm but somehow embies decided not to stick :-( Do I need to tell about all failed cycles.

I think SG is one of the rare ones that will likely let you in the program with failed cycles...though I'm not 100% sure. I wouldn't mention it..unless it was with your own eggs and now you are trying with de. They accept some 90% into the shared risk and of those 80% have a baby before cycle 6 who stay in the program. Unless you have major defects in the uterus, you will be in the program!

Should I get immune testing done before starting treatment. I worry they might deny us.

I wouldn't really recommend Beers if you do. Only for the fact they don't take ins. And when you try to submit to ins after the fact, you just dont know what you are getting back. I did get back about 800 for testing. But NONE of the treatments were covered--even thought they say they are. Ins will deny as Not FDA Approved use...even if they don't mention infertitly. You could try SIRM in NY. I know with repeated failures they will recommend it! However, they usually won't treat you unless you are a patient...and they have a very limited type of shared risk package...nothing as good as SG. They have a discussion board and you can ask the DRs questions directly about your concerns with implantation failure. My d eggs were questionable as well...but overall, we transferred 6 good/fair quality blasts and all BFNs.


5) Is there any SG location (MD, DC or VA) better than other? I think MD will be closest to us.
SG does have other offices, but the donor program is only out of Rockville. You will need to go there for initial screening/tests (bloodwork, u/s, baseline) then you don't have to go back until ETs. I suggest you get all annuals out of the way, like pap smears and mamos so that doesn't hold up the process. It only takes a few weeks to get accepted in once you do your baselines. AND FYI YOU CAN CALL THEM NOW FOR TEMP PASSWORD TO DONOR DATABASE for a sneak peak at their donor pool/profiles.

6) Do you think we can start with 1:3 and if needed can move up to 1:2. Each $ counts now for us. Any problems with 1:3. I know choice of donors is limited. YES!! I started in the 1:2 and after 1 cancelled donor and 1 failed shared donor, we upgraded to 1:1. I know you can upgrade, dont know about downgrade. There are limited donors in the 1:3. Most donors are in either the 1:1 or 1:2, or both. I.e. if in both, and someone in a 1:2 picks them first, then the donor is automatically in the 1:2
7) My overseas clinic asked to undergo ACA IgG IgM and LAC tests. Any idea what they are? I think the IgG and IgM are immunity of some sort. not sure of the others.


I know it's alot to learn and the decision is hard!! I truly think you should go shared risk if you can afford it. It takes so much pressure off not losing the $$ every cycle. You will have more chances, without the guilt, stress, pressure of spending more $$.

Check out SG presentations and stuff on the website. They really are open about pretty much everything...ACCEPT:
1. They only give you access to the donor database 2 weeks on/2 off, but you can insist on full access.
2. They don't tell you that in shared risk, they will try to freeze all good eggs. That's a good thing, but if there is only 1...you have to do an FET with 1 emby..even if out of state..which seems like alot to go through. However, for me, my first complete cycle we had 1 frozen, and because I upgraded, they let me move on with a fresh cycle. I now have that 1 emby and 3 totcycles from my last cycle.

[tr]

Rhonda, Thank you very much. This is really helpful.
Bye the way, do you have list of screening tests that SG does?

Good luck with your next steps!
tr.

[rjc0704]

TR - I don't have a list, but it's just all the standard stuff all clinics do. They would want to examine you around cd3. They would check your basic hormones and do an u/s to make sure no polyps or other issues. It's nothing more extensive than the routine stuff to get in the DE program.