Thoughtful ThursdayRemember the old commercial with the overwhelmed woman who finds peace by sinking into a bubble bath? “Calgon, take me away!”

My Calgon moment involves sitting down with a dessert — maybe a brownie, or a piece of cake — and some milk. Usually Burrito and Tamale have gone to bed for the evening, but sometimes I’ll take this break from life during nap time. There’s a marvelous moment with the first bite: it’s quiet, and I am all alone with no immediate demands on me, and aaaaah. The moment is just as sweet as the food.

What is your Calgon moment?

Thoughtful ThursdayJumping off from the Dollars and $ense of Family Building (and by the way, if you haven’t checked out the blog hop yet, please do — and if you want to contribute your own post, even better!)…

One theme I’ve seen come up over and over again in the Dollars and $ense posts is money spent on failed cycles and other efforts that didn’t pan out. Some people seem to accept it as a necessary part of the process. Other people seem to lament the waste. I’ve referred to it in my own post and in a blog post years ago as water-under-the-bridge money, and for the most part that’s how I’ve approached it.

Some people are prudent in their approach to sunk costs, cutting their losses and moving on. Others keep going because of the resources already invested, even when it doesn’t make any sense to keep going.

Eating something that tastes horrible?
Halfway through watching a terrible movie?
Paid thousands of dollars in repairs for your crappy car?
Invested a couple of years in a bad relationship?
Spent tens of thousands of dollars and years of your life trying to have a baby?

With the little things, eating something yucky or watching a bad movie, I’m likely to just finish, even though it would be wiser not to. When it really counts — relationships, big ticket items — I think I’ve been good about cutting my losses. With infertility, though, I was in between: I accepted the losses as water under the bridge, but I couldn’t ever bear to cut my losses and move on. The hard part is that during infertility, you don’t know whether you’re showing perseverance necessary for achieving your goal, or whether you’re succumbing to the sunk cost fallacy and throwing good money after bad. Of all of the awful things about infertility, that part — not knowing if you will ultimately succeed if you just keep going or if everything you put in will ultimately be wasted — is, to me, the very worst.

When there are sunk costs, do you move on or try to stick it out? How does your typical sunk cost approach relate to your family building efforts?

Welcome to my contribution to the Dollars and $ense of Family Building blog extravaganza!

I am one of the organizers, along with Lori Lavender Luz of WriteMindOpenHeart. At Lori’s blog you can get the background and overview of the project, as well as add a link to your own post if you’d like to join the fun.

Lori and I wanted to get a variety of bloggers’ perspectives on the role of finances in family building, and you can find a dozen others at the main Dollars and $ense page. There are infertility and adoption bloggers with just about every perspective you can imagine. The perspective I’m bringing is that of a longtime infertile who pursued treatments with no regard to the cost.

I didn’t set out to break the bank. I got into treatments, both financially and medically, little bit by little bit. I started TTC at age 26, and after more than a year of patience I decided that my charts just didn’t look right and I needed some help with my luteal phase. I was a graduate student at the time, so I went to the student health center. The pediatrician who saw me obviously didn’t know how to handle infertility, nor did the gynecologists who spent most of their time preventing girls from getting pregnant. They immediately referred me to a specialist affiliated with the medical school, who just so happens to be a world-famous reproductive endocrinologist (Dr. Fancy Pants, as I’ve called him before on my blog). It doesn’t really make sense to send someone just starting out to a doctor at the very top of his field, but that’s where I was sent.

I expected Dr. Fancy Pants to start slowly with a month or two of assessment, but he preferred to jump right in with Clomid and do the assessment along the way. It was just a little pill, it didn’t seem like a big deal. Then the next cycle we added progesterone. Then the next an HCG trigger. Meanwhile I was paying out of pocket for each ultrasound (performed by the doctors themselves rather than a tech, ooh la la), each blood draw, and everything else. A hundred bucks here, a couple hundred there. Before I knew it we’d spent over $10,000, which was all of the money we had saved in the 6 years we’d been married. We stopped treatments, in part because a miscarriage took the wind out of my sails but also in part because we were out of money.

I needed to stay away from treatments for a couple of years but decided to try acupuncture (which was covered by my student health plan). When I finished my graduate program, acupuncture stopped being covered, but by that point I felt like it was benefitting my cycles enough to be worth the expense. Through two long-distance moves I pursued Eastern rather than Western medicine. Casually at first only every few weeks, then I added herbs, then I started going weekly. All of those treatments added up too. Eventually my (3rd) acupuncturist and I simultaneously came to the realization that I’d given Eastern medicine a full try and it was time to go back to Western medicine. He referred me to Dr. Full Steam Ahead.

By that point I had turned 32 and “you have plenty of time” was starting to become “you’re not getting younger.” Along the way we had sold a house at a large profit (thanks, housing bubble!) and had replenished our savings substantially. We decided to go full steam ahead with Dr. Full Steam Ahead, who within 6 months had put me through a full assessment, two IUI cycles, and my first IVF. DH and I had committed to finally getting pregnant successfully, no matter the physical or financial cost. Adding a second IVF that year, we ended up spending so much money on medical expenses in one year that it recently resulted in an IRS audit.

At that point our ample savings had ceased to be ample, and we wondered how much longer we could keep going. As with Dr. Fancy Pants years earlier, each new cycle brought an additional tweak such that each time it seemed like this must finally be it. Add this drug. Try IVF. Try ICSI. After the second IVF failed, though, we’d been through 10 treatment cycles and the excitement had worn off. We also looked at our finances and realized that our large savings had now become rather small. Along the way I’d taken a new job largely motivated by the need to secure (any) health insurance. The new insurance happened to cover IF – but only assessment and IUI, which we’d already moved beyond. Then I learned about a way that I could get health insurance that would cover IVF. (I was sure I’d blogged all about the trick long ago, but I can’t seem to find the post… hmm. Briefly, it requires starting your own company, and it only works in certain states, but if you can pull it off it’s a fantastic loophole.) In preparation for that, I did one last IUI to satisfy the future insurance company’s requirements for IVF, and from that perfunctory IUI came my twins.

In an alternate universe, if it hadn’t worked, we would have secured the IVF-covering insurance and exhausted the 3 IVFs it would have given us, bringing us to a total of 5 fresh IVFs. If that still hadn’t worked, I just don’t know what we would have done. Presumably by that point some doors would have started to close themselves – maybe the doctor would have declared that egg quality or my body’s response was inadequate, or something about the sperm-egg combo, or who knows. We very well might have gone back to paying out of pocket, and if we’d had to pursue something like donor eggs we definitely would have paid out of pocket. Thankfully we didn’t have to find out, and I was able to end my infertility tally at only $70,000.

Now, answers to specific questions that the participants raised.
1. Consider your now or future children as adults, and consider the fact that you had to spend money to either conceive them or make them part of your family. What effect do you think the latter will have on the former one day? What, do you think, your grown children might feel about the funds it took to create your family?
Honestly I think it’s a huge compliment to them, and a testament to how very much we wanted to bring them into our lives. While they’re slinging burgers to pay for college they might lament the “wasted “ money, but without all of that water-under-the-bridge money spent, they wouldn’t have come into existence.

2. How did/would you handle it if your child asks you, “Mom, how much did I cost?” How would you answer at age 7? At age 18?
At 7: We wanted you so much that we did everything we could to bring you into our lives. It did cost a lot of money, and we had to experience a lot of medical procedures, and it was very hard, but it was all worth it. We love you so much, and we loved you so much even before you ever existed.

At 18: Bringing you into the world cost a lot less than we’re about to spend on your college education.

3. When calculating the costs of your family building, what do you include? The direct costs are easy (such as RE fees for a cycle or homestudy fees), but what about fees that didn’t directly lead to your child’s existence in your life, such as cycles that didn’t work, adoption outreach avenues that didn’t work, failed adoptions, avenues that were explored (and that cost something) but not pursued, etc.?
I count everything. Each cycle that didn’t work was a necessary step in bringing us to our children, and each dollar spent was a dollar that we spent.

4. If two children in a family “cost” different amounts, should that have any significance?
My two children happen to cost exactly the same amount because they are twins who were conceived in the same cycle. If we’d had two singletons who came from cycles with different fees, I don’t think that would matter to us. But, if we had one child from treatments and one child naturally (did you know that people have babies without doctors? or maybe it’s just a fairy tale), it would seem significant – though less because of the financial cost and more because one conception was so much “easier” than the other.

5. To what extent have finances determined the family-building decisions you have made? How have you able to balance financial considerations against other factors such as medical, ethical, emotional…?
Finances have determined our decisions far less than they probably should have. As I mentioned above, we stopped treatments for a few years to replenish our savings, and we did opt for our 11th cycle to be an IUI rather than IVF specifically because of insurance requirements. We also opted to start IVF when we did rather than continue with another IUI or two because the IUIs were so expensive with such a low success rate that IVF just made more sense. Otherwise we didn’t pay much attention to money and just kept writing the checks until the account was empty. I don’t know that I recommend that approach, even for those who have the means, but it’s the approach we took.

6. Has institutional and governmental support for certain family-building paths impacted your choices? For example, ART being covered by insurance, tax deductions for adoption expenses, etc.
The fact that ART was not covered by insurance for most of our journey certainly had a huge financial impact. Once we secured insurance that covered treatments, you’d think that it would have been liberating. In fact, in our interactions with the insurance process, I realized how much leeway we had when we were paying out of pocket. For example, in our one covered cycle, the FSH wasn’t approved until it was too late to start the cycle, and I was only able to proceed as scheduled because I had leftover (and presumably spoiled) FSH from a previous cycle. If we’d ended up doing IVFs covered by insurance, I’m sure there would have been a lot of bureaucracy, to the point that it would have interfered with the cycles in terms of timing or even what procedures/drugs could be used. At $15K per cycle saved, though, it would still have been worth the hassle.

7. Have you considered having ART treatments abroad, either due to lower cost or due to certain methods being unavailable or illegal in your own country? In your decision-making, how did you balance the financial savings against issues like the unknowns of the country, perhaps not speaking the language, and medical practices that may differ from those of your home country? If you did travel abroad for treatments, what was your experience? Would you do it again?
The “IVF cycle as extended vacation” idea crossed my mind only because I’d seen others do it, but doing it locally was more practical and there wasn’t anything we could do abroad that we couldn’t do at home. There are other participants who can answer this question differently, though… Speaking of which, it’s time for you to visit the rest of the Dollars and $ense posts! Thanks for stopping by!

Visit Write Mind Open Heart for more perspectives on the Dollars and $ense of Family Building and to add your own link to the blog hop by May 1, should you want to contribute your thoughts.

Audit, Part 7

April 18, 2011

We left off in the office of our surprisingly human auditor

I continued in sleep-deprived blabbermouth mode about how I understood how spending over $40,000 in medical bills despite having health insurance and not even counting the health insurance premiums must seem like a lot and it’s reasonable that it would raise their red flags but yes we really did spend all of that, on infertility treatments, the IUIs and the IVFs and the acupuncture and all of it, and they all failed and we were at it for many years before that and it was another $30,000 in the other years put together and it doesn’t look like we have enough extra income to spend that much money on medical bills but we did and we spent everything we’d saved and now we’re broke but it’s okay because now we finally have babies and they are so beautiful do you want to see a picture but yes we really did spend over $40,000 in one year on treatments that didn’t work.

Auditor: “How much do the cycles run?”

Well it depends on what kind of cycle and which drugs they use and what extra stuff they do but the IUIs are the cheaper ones and they each cost us around $5000 though some people spend less if they go to their gynecologist instead of a fancy reproductive endocrinologist or something but each IVF cycle cost about $15,000.

Auditor: “Oh shit!”

That’s really what happened, I swear.

Come back tomorrow, as all of this has been leading up to a very special bloggy extravaganza! Eventually we’ll get back to the audit story but it’s still in progress so you’ll have to wait.

Audit, Part 6

April 17, 2011

With my magnificent spreadsheets and several enormous folders of receipts that I didn’t have time to organize, on two hours of sleep, DH and I went to meet with the auditor.

We were on time, but after going through the metal detector and wandering all around the federal building (apparently someone should tell those security guards that “the IRS is on the 3rd floor” doesn’t apply to the audit department), we were 15 minutes late.

I was pleasantly surprised to find that our auditor was not the humorless bureaucrat that television had taught me she would be. She was a regular person. The first thing she said was that she understood what a difficult situation it was to be in, but that we didn’t need to freak out. Very human.

Although by nature I’m rather taciturn, when I am sleep-deprived I develop logorrhoea. I proceeded by blathering about how I understood why their red flags would have gone off but it’s all very explainable and here I have everything but I didn’t have time to sort it and I was up all night and we have twins and our nanny has been really unreliable and…

Auditor: “You’ll need to take all of that documentation home and put it in order. I don’t have time to go through thousands of receipts.”

I said, “Of course.”
I thought, “Neither do I! At least you’re getting paid for this! But ugh, fine.”

The auditor then said, “Wow, your spreadsheets are fantastic!”

Awwww yeah. I am the queen of the dorks.

Tomorrow, the auditor’s reaction to our medical bills.

Audit, Part 5

April 16, 2011

Continuing with the audit…

As the date for our appointment with the auditor approached, I still hadn’t gathered most of the paperwork nor organized everything into spreadsheets that someone else could understand. I figured that since I’d already organized and tallied everything when I did the taxes originally, it wouldn’t take long.

I was wrong.

The night before the appointment, I stayed up almost all night putting everything together. It’s not like the government knocks a couple thousand dollars off your taxes for superb organization, but I can’t help it. It’s who I am. My spreadsheets were magnificent.

Or rather, most of the spreadsheets were magnificent. The last one was slapped together — not even good enough to be called half-assed. Quarter-assed? Eighth-assed? I’d become too bleary-eyed to make any sense, so I decided to get a couple of hours of sleep.

Stay tuned to hear what happened when we met the auditor.

Audit, Part 4

April 15, 2011

Continuing where we left off

Another part of the audit prep involved figuring out all of the various visits to the RE, hospital, and acupuncturist during the year in question. When you have enough medical expenses to warrant a separate deduction (a mixed blessing, to be sure) you get to include mileage for each of your doctor visits.

When I’d prepared our taxes, I did a rough estimate. Reasonable, but rough.

Now, I needed a more careful record.

When I add it all up, it turns out to be even more than my rough estimate. The total is well over 3000 miles.

I drove over 3000 miles for infertility appointments in one year.

If I’d traveled that distance all at once, I could have gone to France instead.

Or Spain.

Or Brazil.

Or Peru.

Or, I could have gone to the North Pole. Maybe Santa Claus would have granted my wish for a baby.

Stay tuned for more audit “fun,” all leading up to an exciting bloggy event next week!