11 Feb 2017
Following my egg retrieval at the end of July 2016, I waited. I had gained 7 kg in weight during my last procedure, which I hoped to lose but did not. My egg retrieval in July 2016 had only been partially successful, since only 4 ova had been vitrified. It took me however another 6 months to consider it again. Work-wise there was no opportunity. I finally contacted IVI at the beginning of February to inquire whether I could do it for another cycle this month.
They replied quickly with a positive response, within 48 hours of my request to be exact, however advising that I should start with taking the pill Microgynon for two weeks. Fearing that taking the pill would mess up my cycle and hoping to do the procedure when I was actually available work-wise, I asked whether I could do it without taking the pill. The rep of the international department suggested that I could, but would have to confirm on my first day of my period by an ultrasound that I had no cysts or follicles bigger than 10 mm.
1. D1 Scan
So I did, the ultrasound at my local gynecologist confirmed that I had no cysts and only four follicles below the 10 mm mark, 2 in each ovary. First, I was relieved but the representative from IVI also informed me that 4 follicles was very low and that I was accordingly unlikely to have a good yield: if there were only 4 small follicles that meant it was not likely that there would be many more. Given my age and situation at work, she nevertheless suggested I start treatment and make another ultrasound on day 4 at my local gynecologist. Based on my poor first cycle results, the IVI doctor increased my dose of menopur to 150 UI (previously 75 UI only) with Bemfola remaining at 225 UI.
Pathetic result on Day1 (right and left ovary)
Because only original EU prescriptions are accepted in Germany, IVI had to directly fax my prescription to a pharmacy in Berlin, which they agreed to do without hesitation. Unfortunately, the meds are more expensive in Germany. So, IVI suggested to prescribe only as much I would need before coming to Spain. The following were the prices for the meds:
1. 1 Bemfola pen 225 UI EUR 116.50
2. 1 pack of 10 Menopur 75 UI EUR 318.34
3. 1 piece of Orgalutran 0.25 mg/0.5 ML EUR 51.04
Bemfola single pack
2. D4 Scan
At my D4 scan, my gynecologist found that I had a large in-bleed cyst in my right ovary. My left ovary contained 4 small follicles under 10 mm. In fact, it appeared that the two follicles previously identified had not grown at all. She advised to cancel the treatment and to come back at the beginning of my next cycle to check on the cyst. 3 days earlier there had not been a cyst. Given that she did not specialise in infertility issues, she couldn't advise me whether the cyst had been overlooked or whether it was a result of the medication.
The cyst Left ovary
Left ovary
I immediately sent the results to Valencia, but the rep was not able to reach my assigned doctor before the end of her shift at 4pm. At 6pm one of her colleagues called me who suggested that I continue the treatment, since it was too early to tell. The issue with that cause of action is that every day I use the medication, I spend an extra EUR 200. Moreover I was worried about the cyst and the effect on my fertility and health. Since I spoke to the international rep and not the doctor, she was unable to answer my many concerns. Moreover, she admitted that the doctor had not seen the ultrasound images I had earlier sent to the other nurse. She agreed to consult with another doctor and that I again send her the ultrasound pictures and the assessment of my gynecologist (which I had already sent in the afternoon). She returned my call at 8 pm, suggesting that the doctor consulted suggested that the cyst might not be a cyst at all but an overgrown follicle (at 37mm??) and that the only way to find out whether this was so was doing a blood test the next day. In any case, I should continue the treatment. In case it was in fact a follicle, I would have to stop, and cancel the course of treatment. Again I had several questions the rep was unable to answer.
I realised quickly that I would be unable to find a clinic to do a blood test on a Saturday in Berlin, nor would I be able to do so on Sunday. I thus would have to wait until Monday to do a blood test and a further scan. Being unable to speak to the doctor myself but for my own gynecologist, I decided to stop the course of treatment. I felt it was not worth spending EUR 1200 plus EUR 2300 a flight to Valencia to vitrify a maximum number of 4 eggs, most likely less given my previous result. Although I realised that given my age, it was possible that this may be as good as it gets, I am not ready to accept that yet.
The international department called me back today to inquire as to whether I was able to do a blood test, thus being responsive in this sense to my needs. However, the lack of access to a doctor and the late response on the day I needed answers had hampered my course or treatment and caused me a day filled with anxiety. I had stopped the medication.
Following my experience, my advise is to go on a two week holiday to Spain, if one wishes to do the procedure, or generally if one wishes to do the procedure outside of one's own country. It allows better access to doctors and is cheaper: the meds are cheaper there and all scans and blood tests are included, meaning that does not need to pay for extra blood tests and scans with another gynecologist in one's home jurisdiction.
This is one reason why, despite the less than optimal legal framework in Germany, I am now considering finding a more client focused clinic here, where direct access to doctors is guaranteed, when I need it. The lack of me being able to speak Spanish further exacerbates the situation. While some doctors may speak English, most are evidently more comfortable speaking Spanish. This may explain the less than optimal client care from the doctors.