Undergoing IVF is no easy task. It is not only financially draining, but mentally/emotionally and perhaps most noticeably, physically as well. Each doctor, each clinic, is going to do things a little differently. Their processes will differ, so will their protocols... but overall IVF is IVF. Broadly looked at, we go through very similar experiences: injections, ultrasounds, egg collection etc. But when we narrow in, you'll often find each individual's journey is vastly different from the next. And I'm not only referring to how much medication is administered, how many days of injections there are, how many eggs are produced, or what fertilization rates were, but rather the process itself.
Having been born and raised in Canada, I was afforded the comforts of public healthcare. I never knew or understood what all the fuss was about in the US. I would hear grumblings over lack of insurance, or grumblings over Obamacare, but I never really had a grasp of what it all meant. I was privileged to not have to find out. I had my coverage, and that's all that mattered to me. When I discovered I was dealing with infertility, a little question in my head lingered... "Why would Americans complain when even IVF is covered there!?" Well not for everyone... and not everything. Let's compare.
When we underwent our first cycle of IVF back in Canada, we had been waiting for ages it felt like. Once referred, we had a long wait with no information. Our names were submitted and we were to wait for the call. Months went by before we finally did receive that call, only to book an appointment months out from there. It was a long arduous wait to even BEGIN the process. But once we were there we felt well cared for. We loved our doctor, he gave it to us straight, and we made the decision to go straight to IVF which he allowed us to do.
Because IVF is not covered under public health in Canada, IVF would be out of pocket. So signed the crazy amounts of paperwork, paid our deposit (I can't recall the dollar value, but as you can imagine, not cheap), and we officially were beginning our cycle. We had an in person appointment with the nurse to go over injections, how they're to be administered etc. and on our way out of the clinic we were to stop by the pharmacy window located in the office and were handed our bag of medications. It was in a purple plastic bag, all well organized with everything we would need for the entire cycle. We were fortunate to have good insurance coverage that allowed for basically all of our meds to be covered, but that was it. The price tag of monitoring, egg retrieval, ICSI and transfer were all bundled up into our out of pocket expense for IVF.
Each appointment we had a different doctor, as about 6 or more doctors rotate in that clinic... perhaps due to it being public health, I don't know. And it was the only clinic in our province!!! So we literally had no other options. I didn't see my own doctor once between stimming and transfer so when we went for our follow up "wtf" appointment, he was a bit surprised to hear we weren't successful given our age and "unexplained" diagnosis. When I told him the transfer was difficult, he was also surprised given it wasn't noted in my file. Hmm...
The second round wasn't much different, except we lucked out and ended up having him perform our transfer. It went much smoother and he gave us hope touting that perhaps our lack of success previously could have been attributed to trauma to the embryos. Our second "wtf" appointment didn't offer any new considerations, and when I asked about a lot of new techniques, tests and otherwise, I was told studies weren't yet conclusive so they won't try them. And in regards to testing, well even if it did show something was wrong, they didn't have means to treat any of it because the treatments were not yet proven. I felt like I was going in circles, and so we took a long break.
When we moved to the states for my husbands work, we were excited to give it another shot. I had been in many forums with these women trying all sorts of different techniques and treatments and was hopeful that intralipids were my winning ticket. (spoiler alert: they weren't). This time we had the luxury of actually choosing a clinic to work with. We did a lot... and I mean a LOT of research, and I eventually stumbled upon SIRM. We chose the clinic specifically due to their stance on immune related factors, something that in my gut I attributed our failures to, and set up a consultation. I could have gotten in within a week or so with one doctor, but I chose to wait and work with the clinic director, someone who I trusted based on women's experiences with him. But even the added wait was only a few weeks long, a far cry from the months to get into the clinic in Canada.
So we had our consultation and it was refreshing to hear him take all my concerns seriously and offer the various tests and subsequent treatments. Unfortunately, many of these tests would NOT be covered by insurance. So in the end we couldn't afford all the testing we wanted to have if we were going to be able to afford IVF. We had to learn quickly about co-pays and out of pocket caps and ignoring "bills" that were not bills, but could be bills... Our heads were spinning. Had I not already undergone IVF and understood the ins and outs of the actual process, it would have nearly made me collapse to the floor in sheer overwhelm combined with the complexities of insurance. In the end, portions of our treatment were covered, but even to this day it's not clear exactly how much we spent out of pocket. We still are disputing bills that should have been covered by insurance. And on top of that, a lot of medication wasn't covered.
The process itself was also different. Each and every time I went in I was seeing the same nurse, my doctor, and oftentimes the same receptionist and blood draw nurse. It had a real sense of care, and they remembered me, and I them, and I felt an investment in my care. On top of it, my doctor makes himself accessible via email anytime... which is a daunting task when you have numerous patients. I try my best to not over utilize this, respecting boundaries, but it's nice to know if something comes up In Canada I'd often have to wait for a call back, or for next appointment or whatever, to get my questions answered... and usually from a nurse. This felt like a luxury and was so much appreciated.
But when it came to getting meds, I was having them sent in the mail... something totally foreign to me. I stressed about the medications that were needing to be refrigerated, and how well they'd be packaged. Turns out, they've done this a time or two before ;) they know what they're doing. But I definitely had to do a lot of coordinating and playing middle man between provider, pharmacy and insurance. It was stressful, and confusing, a far cry from my little purple "gift bag" carried out with me back in Canada.
I'm now undergoing my next FET again here in the states. This time I further complicated things by moving states and having to do remote monitoring. Because you're not their patient, they don't seem as invested and take their sweet time getting results sent to your actual clinic. And then you have to play middle man also between the clinics ensuring one sends and the other receives. On top of it, prescriptions are further complicated when they won't ship from state A to state B. Intralipids!? Forget about it... can't be prescribed by an out of state doctor. The hoops I'm having to jump through this time are absolutely shockingly ridiculous. I'm not sure how it would have worked as an out of province in Canada, though I'm sure there'd be hoops there too. I would have happily just lived in NY for 2 months, but as you can understand, that's not exactly a cost-effective option.
Anyways, my point is, there are always pros and cons to each system. Decide for yourself what's most important to you to make your call. Anything I missed?
CANADA PROS
- pharmacy on site
- clear instructions and overall helpfulness
- ease of insurance (no playing middle man)
- clear costs
- nice facility
CANADA CONS
- long wait time
- only one clinic
- rarely see own doctor
- no email communication access
- out of pocket IVF (no coverage available)*
- coverage for meds dependent on your insurance plan
- refusal to try experimental testing/treatments
USA PROS
- short wait times
- choice of clinics
- see own doctor each time (generally speaking)
- email accessibility
- IVF coverage available (dependent on insurance)
- openness to new (perhaps experimental) tactics, testing and treatments
USA CONS
- IVF and Medication coverage entirely dependent on insurance (no equality in treatment)
- unclear out of pocket expenses
- dealing with confusing insurance providers and pharmacies
- bills
- US attitude (this is a thing... service providers by my experience have been quite a bit friendlier in Canada)
- having to be a much more active advocate in your care/service
- price gauging on medications
* my understanding is that certain provinces are starting (and some already have) to offer coverage for limited cycles.
