GCCjr, Embryo Version 1,2, & 3
Do we want to have a child? We discussed this topic many times over the years. For a long time we both thought the answer was no, but… then things like maturity, love, and a strong relationship happened
Like most people, we knew how to make a baby the old fashioned way. But no matter how hard we tried (or how many times), it just wasn’t happening. Perhaps this had something to do with the vasectomy I had about 12 years ago?
Determined to extend our family, we explored our options, comparing costs, success rates, and convenience factors.
Although we had health insurance at the beginning of our journey, it seldom (or never) covers the costs of infertility treatment, so cost efficiency was important. Why pay more than we had to?
Here are the results of our path to pregnancy
Vasectomy Reversal
While we were still in Seattle, we looked into vasectomy reversal. I wanted to know about costs and success rates for the procedure, but the internet was quite useless in this regard. There were many paid ads and websites promoting “Doctors” that reminded me of Dr. Nick Riviera, the quack doc from the Simpsons.
I asked around and was referred to an ex-army Doctor that had performed thousands of vasectomy reversals (“back when the military paid for this procedure, I did a lot of them”)
This is what it cost me $300 and 5 minutes to learn:
A vasectomy reversal microsurgery has a 95% success rate, at least when it comes to connecting the tubes back together. This success is temporary though, as eventually scar tissue will result in complete blockage of your little swimmers’ escape route. This means after the procedure you have 6 months to 1 Year of fertility, plus or minus (but also leaves the possibility of an “oops” even years later)
Somewhere between 7 and 10 years after a vasectomy, your body will recognize that it is pointless to make more sperm. What little sperm it does create, while being completely normal and healthy in terms of DNA, will be stunted and unlikely to have the strength to swim the distance, if you know what I mean
Thus what the doc told me: “I give you a 95% chance that I can connect the tubes successfully, but a 5% chance at fertility.”
The cost of this procedure was estimated at $6,000 (or more if there are “complications”), which included his fee of ~$2,000 and about $3,500 for use of the “cheapest operating room in the Seattle area.”
Spending $6,000 for a 5% chance at fertility didn’t seem like a great choice.
The old fashioned way was out of the question
In Vitro Fertilization
Our next best option was In Vitro Fertilization (IVF.)
IVF is a process whereby an egg is fertilized outside the body, the so-called test tube baby. This requires stimulating ovation in the woman, surgically removing the released eggs, fertilizing the eggs with sperm in a petri dish, cultivating the eggs for a few days, and then implanting the resulting embryos into the woman’s uterus. An explanation in great detail can be found here.
Because of the vasectomy, sperm extraction was also required, whereby sperm is removed directly from the testes while under anesthesia. Unless you like getting a needle into your nether regions, having some sperm frozen at this time is a good idea, providing future options
Because of the long period of time since the vasectomy (over a decade) assisted fertilization is also required, whereby a single sperm is manually injected into the target egg.
I was able to find a great online IVF cost estimate tool. Our estimate is shared below (this does not include the cost of obtaining sperm, but does include the manual fertilization process aka ICSI)
For two cycles of IVF in United States, we would be looking at nearly $30,000.
In addition, the cost of sperm extraction would be several thousand dollars, pushing our total towards $35k
Medical Tourism to Taiwan
For perspective, last year we spent less than $35k on our permatravel lifestyle. That seems like a steep price to pay as a down payment on a GCCjr
But with time and freedom on our hands, we didn’t have to stay in the US.
Taiwan had several benefits. Costs were substantially lower than the US and it had a booming IVF industry with a strong track record. Being in Taiwan also served double duty, allowing us to visit Winnie’s family while we went through the IVF process
(As an added bonus, Winnie is a citizen of Taiwan which means she is eligible for the single payer National Healthcare system after being in the country for 6 months. This doesn’t impact any of our IVF costs, but might affect the cost of childbirth if we choose to do that in Taiwan.)
Our IVF Experience
We interviewed two doctors before selecting the second, working out of a hospital affiliated with a medical university. We worked with a Urologist in the same hospital
The IVF regime is lengthy and intensive. Daily injections in the stomach are required to induce hyper ovulation, a painful process. In total this produced 15 eggs. 8 were extracted during surgery, of which 6 were manually fertilized (ICSI.)
Obtaining sperm was relatively easy. I went under anesthesia and woke up with only mild discomfort, so my contribution was done within a day. We even froze sperm for potential future use. By comparison, Winnie’s process was nearly 6 months, and of course that is just the beginning
An overview of timing and cost is shared in the table below
| Date (2014) | Winnie | Jeremy | Comment |
|---|---|---|---|
| Feb 17 | $40 | $47 | W: Doctor interview, general health check, blood test J: Urologist visit, blood test (is body still producing sperm?) |
| Mar 6 | $13 | W: Dr visit, see results of blood tests (determines drug regime) | |
| Apr 1 | $163 | W: Dr visit, shots to excite ovulation: $13 W: Supply of ovulation drugs: $150 | |
| Apr 3 | $152 | W: More ovulation drugs | |
| Apr 7 | $151 | $40 | J,W: HIV Tests W: More ovulation drugs |
| Apr 9 | $164 | $71 | W: Dr visit, blood test (are drugs having desired result?), more drugs J: Urologist visit, Chest X-ray, EKG (evaluate risk of anesthesia) |
| Apr 11 | $680 | J: Surgery for sperm retrieval | |
| Apr 12 | $1740 | $18 | W: Surgery for egg collection (8 total) J: Urologist visit, change bandages |
| Apr 15 | $1953 | W: Freeze embryos, sperm, ICSI (6 eggs total): $1233 Embryo implant (3): $500 Drugs / misc: $220 | |
| Apr 29 | $13 | W: pregnancy test and Dr consult (not pregnant) | |
| Jun 20 | $12 | W: Dr consult Re: round 2 | |
| Jul 11 | $18 | W: Dr consult, estrogen free sample | |
| Jul 22 | $60 | W: more estrogen | |
| Jul 26 | $682 | W: embryo implant (3) | |
| Aug 8 | $165 | W: pregnancy test (yes!) more estrogen | |
| Aug 22 | $176 | W: Dr consult, ultrasound (heart beat!), more estrogen | |
| Total | $5502 | $855 | $6,357 |
Total expenses through the hospital were ~$6,357
This doesn’t include the seemingly daily supply of home pregnancy tests that were used by a certain curious someone throughout the process :)
Also not included is a regime of Chinese Medicine that we undertook after the first failed attempt. There is a Doctor in Taiwan, trained as an MD and in CM, that specializes in pregnancy. I’m a skeptic on CM in general, since it has little (if any) evidence based credibility, but there are things you don’t argue about :) This supply of herbs set us back about $97 a week, for a total of $723
The majority of the hospital expenses were paid for with a cash back credit card, reducing our total costs by ~$95.
Conclusions
Overall, we are very pleased with the results
By pursuing fertility treatment outside the US, we saved 80% off the estimated US price, have a child on the way, and are still guaranteed free birth control in the future
In terms of cost efficiency, it doesn’t get much better than that. $6,357 for 12 years (so far) of 100% effective birth control is also quite reasonable as well, less than $1.50 per day
And better than expected, we are expecting :)
Congratulations! How exciting!
Thank you, we are really excited!
Congratulations, Jeremy and Winnie! Very happy for you both!
Thanks Brandon!
3 embryos implanted, only 1 heartbeat, right? How awesome would triplets be? lol
Not awesome at all! haha
But after watching this video we thought twins would be pretty cool:
https://www.youtube.com/watch?v=to7uIG8KYhg
Even with 3 embryos the probability of triplets is only 2% +/-
I had a friend that had 4 successfully implanted but fortunately/unfortunately (depending on how awesome quadruplets would be) two stuck and now they have twins.
One at a time is a great way to introduce you to parenthood. One’s enough trouble!
Congrats! Great to see all the numbers for everyone to see as well. Hope everything goes in a spectacular fashion!!
Thank you!
So cool to see medical tourism working in your favor. Way better price than we got! I highly recommend using http://www.babycenter.com. Plug in your child’s birthdate and it will walk you and Winnie, week by week, through your kiddos development in the womb and after birth, a week by week update on what to expect for normal development as well. This relieved a lot of anxiety for my wife and I and proved to be very informative to us as new parents. Good times ahead!
Congratulations!
We did the IVF dance over 16 years ago.
3 embryos implanted, triplets delivered.
The first ~6-months with multiples is brutal, very little sleep.
Thanks Heywood
Three 16 year old hooligans sounds brutal too! haha
Congratulations! So now that you are facing parenthood with the awesome advantage of having all the time in the world to raise your child does the fact that you do not have any income scare you?
Not that I expect it would but I sense a post on how this will impact your FI would be coming soon!
Hi Peter, thank you. And great questions
There just might be a post with that topic coming soon :)
For now, let’s just say we aren’t worried in the least.
This is great news! Having kids is definitely an expensive though value added proposition if you are so inclined. You’re in for a fun ride. it will definitely be interesting to see how your travel style evolves with the new addition.
I’m sorry we couldn’t meet up in Taipei. But here is a review of my brief sojourn into your current hometown.
http://www.milesdividendmd.com/breakfast-in-taipei/
I hope we’ll have the opportunity to meet up in the future.
Alexi
Hey guys,
I’m really excited for you. Having kids is so rewarding for the parents!
I was sorry to have not hooked up in Taipei, but I can see that you were busy!
Incidentally I think my past comments were removed by your spam filter. But I had a nice brief visit in Taipei, and look forward to going back.
Hi Alexi, hopefully we can meet up next time! It looks like you had a great morning adventure
I found your message in the spam filter and fixed it. I think my comment on your blog may also be in the spam folder :(
Thank you!
Jeremy
Damn Spam Filters!
So necessary but so imperfect…
I’m sure our paths will cross another time. In any case you have bigger fish to fry with your imminent parenthood.
Alexi
My wife and I also underwent IVF, but in the States. Cost approx $19K, insurance only covered 90% or so of Meds. That was 2 rounds of implantaion. First round was twins our of 2 embryos, they were lost around the 5 1/2 month mark. Life changing experience. Second round, one embryo and one child. We were lucky, we know people that have been through many more rounds with less success. Thank goodness for the technology or we would be childless. I am looking forward to your posts on expenses with the child. I figure we should plan on another $100K or so per child (max 2…) saved before quitting. Been a fun journey so far, looking forward to being up to date on the blog soon!
I am curious to hear your perspective on the vasectomy decision at this point. Obviously it has all worked out for you … but would you advise your younger self not to do it? Or are you still happy with the decision?
Happy as can be / best decision ever.
GCC,
Love this post and congrats (2 years later)! I am reading this at a good time as I am 28 and considering a vasectomy as well.
I slightly disagree with the Army Doctor’s advice and statistics above regarding the reversal procedure…
If the vasectomy is performed by an experienced micro-surgeon AND the reversal is also performed by one as well, the chances of scarring when connecting the tubes back together is a lot less; 5% of vasovasostomies and up to 15% of epididymovasostomies. Does it cost more though for an “experienced micro-surgeon”? It depends, I would usually look at the take/fail rates of reversals for a certain doctor to at least understand his competency!
https://www.theturekclinic.com/services/vasectomy-reversal-reverse-reversals-san-francisco-bay-area-los-angeles-beverly-hills-california-reversing-urologists-doctor-new/failed-vasectomy-reversal-failure-reversals-scar/
Also, after 7 to 10 years it is true to a point that sperm motility and even quantity will go down. However, there is a great placebo controlled study that shows even for men who have a reversal at less than 15 years since they first got snipped, they recover on average, 93% of their “patency” back (100% is their full sperm count as measured before the snip) and even total motile count (sperm that can swim upstream) is high.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253133/
I hate to say that a lot of what the doctor mentions might have been his clinical experience before micro-surgery tools became more advanced, and also difficult reversals he might have tried to perform after another surgeon mucked up the initial vasectomy. As long as one does their research and finds a legit surgeon for BOTH procedures (if needed), they shouldn’t have any of these problems :)
Side effects do occur, however, and these can be unpredictable! That is why I stored enough of my sperm cryogenically before getting snipped, so that I don’t have to have a reversal (screw that) and can also hold off on IVF in place of IUI…
It’s an interesting tradeoff – side effects of a reversal, or the effect of it not working (again this is lower than in the past) or IVF which can be very expensive in the long run (even in Taiwan, for several cycles) and putting one’s companion through hell for a few months or longer.
Thoughts?