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#1 Teressa74

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Posted 10 January 2015 - 09:36 AM

Hi, 

I am 40 years old, I have bilateral tube blockage due to endometriosis. I also had a LEEP/Cone procedure done about 10 years ago due to CIN III. I also have Non-Hodgkins Lymphoma but no treatment has been done. I am in a "watch & wait" for 3 years now. 
 

My OB/GYN has referred me to Mt Sinai stating that because of my medical issues & my husband having Klinefelter's, they would be the best place for us to try to conceive using IVF or ICSI.

 

I have no clue what to expect, but I am wondering if anyone can answer some questions:

 

1. Will Mt Sinai fax any tests requisitions needed to you so that you can get as much done before the initial appointment as possible to speed things along?

2. Has anyone ever had like a tele-conference with them instead of having to physically go there? 

 

3. Will they make me go through another procedure to check again about my tubes or will the report from my OB/GYN satisfy them?

 

4. Has anyone received financial help from the Power of Hope Cost Reduction Program for Cancer Patients? Any idea how to apply for it?

 

5. I was told before that because both of my tubes are blocked OHIP will pay for 3 cycles of IVF....how does that work? Does the clinic do the paperwork or do I?

 

6. How many embryos will they re-insert at a time?

 

7. Will I have to  keep going back to the clinic once I have conceived or can I just see my OB/GYN? 

 

8. how long does it usually take after the initial appointment to start treatments? my oncologist wants to do another CT scan before I start treatments, but he wants to wait to order it until we find out when that will be.

 

I know I have a lot of questions, and I know I may have to ask them to the fertility clinic or someone else...I am just hoping maybe someone else has gone through a case like mine & has a bit of insight to offer. I know also everyone is different.



#2 Hopingfor1

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Posted 10 January 2015 - 12:31 PM

Hi Teressa74,

 

Welcome!  I was a patient at Mt Sinai.  Although I can't answer all your questions, I will answer the ones that I can.

 

I had been a patient at other fertility clinics for several years and most of my tests were current as I had an unsuccessful IVF in February and got an appointment at Mt Sinai in March so I brought all my records including current ultrasounds for ovarian reserve info, blood test results and info on my failed cycles.  My husband also had blood test results and semen analysis results that we brought.  In my case, the only test they asked me to repeat was a hysteroscopy to ensure some polyps I had removed hadn't come back.

 

As for requisitions, you could always call and ask if this is possible.  You will find that you don't reach a live person when you call.  You leave a message and a nurse will call you back.  Another alternative would be to ask your OB for requisitions for things such as Day 3 FSH/LH/estradiol blood tests. If possible, you may want to see if you can have your infectious screening blood work done in advance.  It is required to be up to date (clinics require it either every 6 months or a year - I think Mt Sinai is a year) and some of the results, mainly the HIV test, may take up to 4 weeks for the results and will be required before you cycle.

 

I wasn't OHIP covered as I didn't have blocked tubes, but from what I understand OHIP pays directly for your 3 cycles.  If you require ICSI or have embryos to freeze, those aren't covered by OHIP.  You will also have to pay for medications which can be quite expensive, so check into any health coverage you have and hopefully there is some coverage for fertility medications.

 

Regarding number of embryos, your doctor will discuss this with you.  As you are older (so was I) they will likely allow you to transfer more than one if you have more than one.

 

After I was successful, the clinic scheduled me for a 7 week ultrasound to confirm viability and after that I transferred to an OB.

 

As far as clinics go, I was happy with the ability to get in fairly quickly and start my cycle fairly quickly.  I sent a referral in February after a failed cycle at another clinic.  Got an appointment for March.  Had my hysteroscopy in May at the beginning of my cycle and began estrogen priming at the end of that cycle for my IVF cycle in June.  After experience with other clinics that timeline is quite good and there isn't much wait at Mt Sinai once you are a patient. 

 

Sorry I couldn't answer all your questions, but if there is anything else I am able to answer I would be happy to do so.  

 

Good luck with everything - treatment is very stressful but you will find this site to be full of very supportive people.

 

 

 


  • gibasgirl likes this

Me: 40  = High FSH (ranges from 8 - 15), Low AMH (2.7), Low AFC = DOR

DH: 43 = borderline sperm analysis

Started TTC#1 January 2010

 

2011 - 2012 - First fertility clinic, lots of testing, operative hysteroscopy to remove polyps, multiple unsuccessful IUIs, 1 IVF (150 Menopur/150 Gonal F) converted to IUI due to poor response

 

2012 - got second opinion and after AMH results came back, advised at 36 I had a less than 5% chance of conceiving via IVF.  Donor eggs strongly recommended but not yet ready for that (I should say - hubby not ready for that.  I was ready for donor eggs - I just wanted to be a Mom).  Decided clinic wasn't for us and back to clinic #1

 

2013 - IVF #1 (after 1st converted to IUI).  Estrogen Priming protocol - start Climara patch 7 days post ovulation and change every other day.  3 orgalutran injections beginning day after first Climara patch applied.  Start stims day 2 triggered on night 15 of stims = 3 eggs retrieved, 0 fertilized via ICSI = no transfer  (300 Gonal F/150 Menopur & Orgalutran)

 

2013 - Switch clinics

 

Office hysteroscopy = all clear

 

IVF #2 (37 years old) June 2013 - Estrace priming protocol.  4 mg estrace started 7 days post ovulation.  Start stims Day 3 (300 Gonal F/150 Menopur & Orgalutran)

Slow response as usual

Triggered on night 12 of stims (given the option to cancel as it looked like we'd get 3 eggs - knew we wouldn't do any better so continued).

ER:  6 eggs, but advised some were small and would be immature

Fert report:  5 of 6 eggs immature.  2 fertilized via ICSI (including one of the immature eggs)

ET:  Transferred our only 2 embryos - a 5 cell and an 8 cell

11dp3dt = BFP - HCG = 65

16dp3dt = HCG 1,305 (cautiously pregnant)

7 week ultrasound = 1 baby HB = 141

12 weeks ultrasound NT scan = NT = 1.7mm all looks good.  Combined with blood work risk is 1/1,400

Got Harmony blood test results back (done for peace of mind) - all clear and we're having a GIRL!

EDD = March 2014 (cautiously looking forward to that date)

However - baby had plans to arrive early. After PPROM and managing to cook the little one a bit longer, our bundle of joy arrived at 33 weeks.  After a 3 week NICU stay, she is finally home.  We are totally in love and forever thankful for our little miracle baby - Ashley Nicole.

 

 


#3 gibasgirl

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Posted 10 January 2015 - 02:31 PM

1. Will Mt Sinai fax any tests requisitions needed to you so that you can get as much done before the initial appointment as possible to speed things along? 

 

This varies by clinic. Some (like Markham) will mail make the arrangements prior to your initial consult and others prefer to meet with you and your partner to get a full history and then they use that to determine which tests they want you and your partner to undergo.

2. Has anyone ever had like a tele-conference with them instead of having to physically go there? 

This varies by clinic. I do not know if Mt. Sinai offers this service. Some of the challenges with a telephone consultation is getting the patient to honour the appointment time. Some of the clinics that I have been to that do not offer it, or ended that service, cited that as a problem. 

 

3. Will they make me go through another procedure to check again about my tubes or will the report from my OB/GYN satisfy them?

 

4. Has anyone received financial help from the Power of Hope Cost Reduction Program for Cancer Patients? Any idea how to apply for it?

I am not familiar with this company. 

 

5. I was told before that because both of my tubes are blocked OHIP will pay for 3 cycles of IVF....how does that work? Does the clinic do the paperwork or do I?

Currently the province of Ontario covers part of the cost of 3 IVF attempts for patients with bilaterally blocked tubes. (This will change when funding is eventually extended to all qualified Ontario residents, but one cycle only).

 

The OHIP coverage does not cover all expenses, so you will still have to pay for medications, etc. It can reduce your costs, though. It is my understanding that Mt. Sinai's cycle fees are pretty much covered by OHIP, but if you are at a more expensive clinic, the OHIP coverage reduces your costs and you end up paying the difference. 

 

When you go to the clinic you will do a number of tests including a saline sonohysterogram (sp?) to determine the shape of your uterus and to confirm whether your tubes are blocked. The clinic may also ask you to do an "HSG" test. This is where a dye is injected into your uterus to determine the shape of the uterus and it also determines whether there is tubal blockage. 

 

If bilateral tubal blockage is confirmed then you will be designated an OHIP-covered (or whatever the terminology is) patient and the clinic will bill you accordingly.

 

6. How many embryos will they re-insert at a time?

It depends on a number of things: your age, the quality of the embryos, and how many you have. Generally when a patient is under 35 and there are a number of good quality embryos the clinic will put one back in because there is a greater likelihood of implantation.

 

When the patient is older, there may be a lower chance of implantation, so the doctor/RE might transfer 2 if the embryo quality is less than ideal. Some believe that 2 poorer quality embryos will help one another along, but you end up with 1 take-home baby when the mother is over 35. 

 

With your first attempt your RE might be inclined to transfer one only just to see.

 

But it is not cut and dry. There is also a lot of guessing in the world of Assisted Reproduction.

 

7. Will I have to  keep going back to the clinic once I have conceived or can I just see my OB/GYN? 

If your initial pregnancy test (also know as "Beta" in this world) is strong and conclusive, you will have an ultrasound at the clinic at around the 6-7 (or 8) week mark before being referred onto an OB/GYN.

 

However, if your initial beta is not conclusive (because it is possible to be "a little pregnant" in the world of IVF), then you will do several beta tests to determine whether the pregnancy was viable or not. Once that is determined, you will either be referred to an OB, or not. 

 

8. how long does it usually take after the initial appointment to start treatments? my oncologist wants to do another CT scan before I start treatments, but he wants to wait to order it until we find out when that will be.

 

It varies by clinic. If you end up doing the testing after the consultation, it can be about 6 weeks depending on the clinic. Some tests can only take place during specific times in your cycle, plus there are limited openings for some of the testing. There can be a lot of "hurry-up and wait" in the world of IVF. 

 

The ladies at Mt. Sinai can give you a better idea of the timelines.

 

All the best to you. 



#4 MuffinMama

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Posted 14 January 2015 - 03:39 PM

Hi there!

 

The other ladies covered pretty much everything (especially the OHIP parts, because I have no clue about that!) but I can chime in on a few things...

 

 

 

1. Will Mt Sinai fax any tests requisitions needed to you so that you can get as much done before the initial appointment as possible to speed things along? It doesn't hurt to ask? I was able to get some testing done outside of the clinic (for convenience sake), but it was after our appointment. After your initial consult, they may decide to run more tests though, so you might have to wait a bit anyways.

2. Has anyone ever had like a tele-conference with them instead of having to physically go there? I asked about this last week, because DH got called in to work, and we had an appointment that we couldn't reschedule. We're with Dr Arthur, and she won't do conference calls, but it may vary by Dr. (DH wasn't able to make our appointment, but I take notes :) )

 

3. Will they make me go through another procedure to check again about my tubes or will the report from my OB/GYN satisfy them? No idea, sorry!

 

4. Has anyone received financial help from the Power of Hope Cost Reduction Program for Cancer Patients? Any idea how to apply for it? I remember seeing a pamphlet about this at Mt Sinai, so they will probably have some information about it if you call the nurses line?

 

5. I was told before that because both of my tubes are blocked OHIP will pay for 3 cycles of IVF....how does that work? Does the clinic do the paperwork or do I? No idea again, sorry!

 

6. How many embryos will they re-insert at a time? They aim for 1 blast at a time, but it will depend on the number and quality of the embryo(s), age, and previous cycles.

 

7. Will I have to keep going back to the clinic once I have conceived or can I just see my OB/GYN? You'll have a confirmation ultrasound to make sure everything looks good, but after that, you can start seeing an OB or midwife. (You can certainly call and make an appointment before that mark, especially if you're planning on using a midwife, since they book up fast!) I was at a different clinic with my daughter, but we had a few issues at the beginning of the pregnancy, so I continued to see the RE until about 16-17 weeks (He delivered babies as well) and then switched.

 

8. how long does it usually take after the initial appointment to start treatments? my oncologist wants to do another CT scan before I start treatments, but he wants to wait to order it until we find out when that will be. It would depend on how much testing you already have done, and how motivated you are. Some of the bloodwork can take up to 3 weeks to get back (depending on what you need), so depending on where you are in your cycle and what you need done, it can happen pretty quickly.



#5 Teressa74

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Posted 17 January 2015 - 09:54 AM

Thank you all for your help :) Surprisingly I just received my phone call about my first appointment on Thursday! I go Feb 19th to have a Sonohysterogram...even though I have had 2 laparoscopies in the past. Hubby will also be doing his sperm analysis test (he's really looking forward to that one LOL) As I said he has Klinefelters, so we already know that they will find issues with him.

The person that contacted me was very nice & scheduled a few things for the same day because she knows we have to drive 4-5 hours one way to get there. She then emailed me some info & my prescription for the antibiotics for the sono test. As well as the IVF video thing.

 

My doctor is going to be Kimberly Liu. 

I'm excited & scared at the same time. 



#6 Hopingfor1

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Posted 17 January 2015 - 10:10 PM

Good luck Teressa74.  Dr. Liu was my doctor as well.  Although once you start cycling, you see whatever doctor is there that day, she will put your plan together for you...I always thought the men get off so easily (no pun intended, lol) when it comes to testing compared to what we have to go through.


Me: 40  = High FSH (ranges from 8 - 15), Low AMH (2.7), Low AFC = DOR

DH: 43 = borderline sperm analysis

Started TTC#1 January 2010

 

2011 - 2012 - First fertility clinic, lots of testing, operative hysteroscopy to remove polyps, multiple unsuccessful IUIs, 1 IVF (150 Menopur/150 Gonal F) converted to IUI due to poor response

 

2012 - got second opinion and after AMH results came back, advised at 36 I had a less than 5% chance of conceiving via IVF.  Donor eggs strongly recommended but not yet ready for that (I should say - hubby not ready for that.  I was ready for donor eggs - I just wanted to be a Mom).  Decided clinic wasn't for us and back to clinic #1

 

2013 - IVF #1 (after 1st converted to IUI).  Estrogen Priming protocol - start Climara patch 7 days post ovulation and change every other day.  3 orgalutran injections beginning day after first Climara patch applied.  Start stims day 2 triggered on night 15 of stims = 3 eggs retrieved, 0 fertilized via ICSI = no transfer  (300 Gonal F/150 Menopur & Orgalutran)

 

2013 - Switch clinics

 

Office hysteroscopy = all clear

 

IVF #2 (37 years old) June 2013 - Estrace priming protocol.  4 mg estrace started 7 days post ovulation.  Start stims Day 3 (300 Gonal F/150 Menopur & Orgalutran)

Slow response as usual

Triggered on night 12 of stims (given the option to cancel as it looked like we'd get 3 eggs - knew we wouldn't do any better so continued).

ER:  6 eggs, but advised some were small and would be immature

Fert report:  5 of 6 eggs immature.  2 fertilized via ICSI (including one of the immature eggs)

ET:  Transferred our only 2 embryos - a 5 cell and an 8 cell

11dp3dt = BFP - HCG = 65

16dp3dt = HCG 1,305 (cautiously pregnant)

7 week ultrasound = 1 baby HB = 141

12 weeks ultrasound NT scan = NT = 1.7mm all looks good.  Combined with blood work risk is 1/1,400

Got Harmony blood test results back (done for peace of mind) - all clear and we're having a GIRL!

EDD = March 2014 (cautiously looking forward to that date)

However - baby had plans to arrive early. After PPROM and managing to cook the little one a bit longer, our bundle of joy arrived at 33 weeks.  After a 3 week NICU stay, she is finally home.  We are totally in love and forever thankful for our little miracle baby - Ashley Nicole.