IVF in Prague / by Martha Keyes

Warning: LONG post. In this post, I detail our experience going through IVF in Prague, including costs and things to consider for anyone interested in the option we pursued. It's an odd mix of useful information and things I personally want to remember about it all that many people might not give a hoot about.

After 28 months of trying to start our family, thousands of dollars, four failed IUIs, and developing ovarian cysts from our most recent, more aggressive IUI, Brandon and I were at a crossroads of sorts. Due to the cysts I had developed from the medication, we had to wait to pursue any further fertility treatments. Once the cysts went away (assuming they would do so on their own), the doctor recommended that we do a couple more IUIs with injectables where I had to give myself injections to stimulate more follicles and eggs to grow. That meant a few thousand more dollars. And with each IUI, our chance of getting pregnant would be about 15%. We didn't really like those odds.

Making decisions in the fertility process can be very confusing. Most doctors will tell you that doing more than 3 or 4 IUIs is not worth it--that at that point, you should move on to IVF. However, my brother and sister-in-law became pregnant with their first son after ELEVEN IUI cycles. 

We decided we would start saving our money for IVF, but knowing that one single cycle would run us anywhere from $12,000-$20,000 dollars, we were looking at a long road of saving--a tough thought when you've already been trying so hard to start a family for so long, and you know that, even after all the saving and all the procedures, you may come home empty-handed. There are no guarantees in the infertility world. Even the "bring home a baby" guaranteed IVF plans just mean that, if you don't take home a baby, they'll give you your money back.

I came across the option of IVF in Prague in a very unexpected (and merciful) way, reading the comments in a local news article about infertility. I'm so grateful I read the comments section that day (probably the only time I've ever been grateful to have read a comments section on a news article). That same week, I had lunch with a friend who is also experiencing infertility. She lived in Europe and mentioned how much less expensive it is there to do IVF and other fertility treatments. 

Nothing motivates me like a really good deal, so I began doing my research to find out more. Obviously this wasn't like trying to find a cheap pair of pants. This was literally a matter of life, so research was crucial. I wanted to know how legitimate these clinics were, how much it would cost, and how much time we'd have to spend in-country. I was successful in finding a fair amount of information, and I emailed Prague Fertility Centre to get more information. That was on January 30th. We did some back and forth communication, and I found out just how much cheaper it was to do IVF there. We could do three cycles in Prague for less than the cost of one cycle in Utah. For some people, it wouldn't make sense, since the cost of flights, hotels, and missing work would be a big burden. For us--people with hotel and airline points saved up who both work from home--it was a much more feasible option. Brandon and I talked about it some, thinking that we would likely end up doing IVF in Prague whenever we decided to pursue it (aka whenever we had the money), and I continued a leisurely communication with Prague Fertility Centre (PFC). 

Two weeks passed, and I was emailing with Eva (our sweet coordinator in Prague). She let me know the protocol the doctor would recommend for us, and then asked us when we were thinking of starting. That got the cogs turning in my head. I popped into Brandon's office (the bedroom next to my office) later that day to talk about it. He had mentioned to me the day before that he felt we should be devoting all of our resources to starting our family rather than some of our other financial goals. As we talked, I joked, "You know, we could be really crazy and do it this next cycle." And then suddenly I was looking at flights and calendars, and we were actually seriously considering it. It was either now or...we didn't know when. Summer is intense and busy for Brandon, my parents would finally be coming home after 3 years in Australia, and finding flights to Europe using points during the summer is not only more expensive (in points) but nearly impossible altogether when booking so late. So we weren't sure when the possibility would come around again. Which meant we were looking at leaving in 10-12 days.

And then life got crazy! Trying to communicate with a European office whose opening hours are during your sleeping hours is tough, and we were on a tight schedule. There were a couple of times when I was awake for two or three hours in the middle of the night, waiting for responses from Eva. This also came during an incredibly busy week of photography for me. 

The stars had to align for it to work out. Truly. I won't go into all the nitty gritty details of what exactly needed to happen perfectly to make this a functional possibility, but it truly required twenty small miracles. I lost loads of sleep stressing out over all the little things that had to fall into place just so or else it would all just fall apart. One very special tender mercy happened pretty soon after Brandon and I decided to buy flights to Prague (which was, incidentally, before we knew things would work out as necessary for us to actually go). We hadn't told a soul that we were planning to leave (or even that we were considering IVF), but that night I lost tons of sleep due to a million thoughts and worries. I'm a control freak, and I couldn't stop stressing over how many things were out of my control in this situation. The next day, I sent my mom a message to let her know our plan, and I asked for her prayers--"the prayer of a righteous woman availeth much," I told her. She messaged me back not too long after and told me, with a break in her voice, that they pray for me every night but that the night before (this would be the same time I was wide awake and anxious) she had felt a particular impression that I was in special need of her prayers. God is truly mindful of us.

One by agonizing one, things fell into place, including the results from the general health checkup (including an EKG) I had to do to show PFC that I was in good enough health to undergo IVF. The day before we left, I went to the temple. During my study there, I felt chastised by the Spirit for not having had more faith and hope in all our prior fertility treatments. I know that God can perform miracles, but I often adopt the mindset that my case doesn't merit a miracle, purely because I don't want to set myself up for disappointment. But Heavenly Father works miracles according to our faith, and I knew I needed to approach things with more hope. 

Once my cycle started, I had to start doing injections. My stimulation protocol required me to give myself two shots a day for four days, and then three shots a day for three more days. (I ended up having to do a few more than that once in Prague-- 22 self-injections, all told). It takes some getting used to, mentally, to poke yourself with a needle and push the plunger down. One of the medications required that I mix a diluant with a powder. Everytime I tapped the syringe to make the air bubbles rise to the top and then pushed up the plunger to release the air, I felt like Dr. House. On our drive to Las Vegas to catch our flights to Prague, I had to give myself injections in the Chick Fil A parking lot (I've given myself injections in the bathroom at a rock concert, the Chick Fil A parking lot, and the McDonald's bathroom in Copenhagen--the IVF injection schedule waits for no man!). The people who saw me doing this in the car probably thought I was a heroin addict. 

Now for our time in Prague. The morning after our arrival was Thursday, and we headed to the clinic, which is just east of the city center. I had no clue what to expect. The clinic is a grey, boxy, Soviet-style building--a bit intimidating from the outside. It was really nice and modern inside, though, decorated in bright orange and beige. An interesting combination of sterile and in-style.

We got to meet Eva very soon after our arrival. She is the nicest! We really came to love Eva. She helped us understand the process of IVF, the timeline, and then she took us to meet the doctor.  Dr. Martina is ALSO awesome! I love her and am so happy that we were able to work with her. Coincidentally, she has been to Utah three times, and she was even taught the lessons by the missionaries. She is great! I hadn't even felt enthusiastic about my doctors in the U.S. I don't know if it was partly because they were male or that their bedside manner was lacking or what, but Dr. Martina and Eva were all the things I needed, especially coming to a foreign country for such an important procedure. We found out that 85% of the patients at PFC are international patients, coming from anywhere and everywhere--the U.S., Great Britain, Australia, Brazil, etc.

We had an ultrasound, and during it, Dr. Martina explained everything to me: the lining of my uterus, the follicle sizes, my uterus shape. That is what I want in my doctors--people who treat me like I'm smart enough to understand and who realize that I'm invested in my own health enough to want to understand. We found out that I had only one follicle bigger than 17mm. Anyone who's done IVF knows what a disappointment that would be. We had been hoping for many more than that so that we could move to the next step the following day, but with only one follicle, that wasn't about to happen. Instead, we were told that I would need to do further injections to try to stimulate more follicles to grow, return for an ultrasound on Saturday, and then do the egg retrieval on Monday. So I did my required injections, and we took advantage of the opportunity to explore the beautiful city! We both fell in love with Prague.

 

We returned to PFC on Saturday morning. This time, three other follicles had caught up, and Dr. Martina was happy with what she saw. I have diminished ovarian reserve (aka I don't have as many eggs as I should at my age), so she wasn't expecting high numbers. Some women get 20-60 follicles! I had four. But Dr. Martina reassured me that she felt confident that IVF will work for me--maybe not the first time, but she seemed to think that the two cycle plan we purchased would be good enough. 

I did my last injection on Saturday night. Brandon had to take a flight out on Monday morning EARLY, so I went to the clinic on my own for the retrieval procedure that day. I wasn't allowed to eat or drink anything after midnight on Sunday, since I would be undergoing general anesthesia. Once at the clinic, I changed into their relatively stylish hospital gown and waited.

For a long time. Apparently the anesthesiologist was late, which meant that my 9:30 retrieval didn't happen until 11:30. I was in a room full of other women, each on her own little bed. I'd watch the nurses come get a woman, walking with her into the procedure room. Ten minutes later, she'd be wheeled back out, unconscious. Once it was my turn, they did a quick ultrasound and then put me under. I could see the room start to dance in front of my eyes. It was surreal. The next thing I remember is trying to move my right arm to get comfortable sleeping but being vaguely aware that there was an IV needle inhibiting that. I still slept. For two hours, apparently. I woke up to Eva telling me they needed to take my blood pressure. It was low. Like 85/50 or thereabouts. I felt woozy, and my voice was hoarse. I had to move very slowly so as not to tip over from my lightheadedness. 

After getting dressed, I went to see Dr. Martina who told me that they retrieved four follicles with four mature eggs. She seemed very pleased with that result, given my low ovarian reserve. She explained to me the new medications I would be taking (4 of them) and that Eva would let me know the next day how many eggs had been fertilized. Thursday or Friday would be transfer day. 

Because I was still recovering from anesthesia and was alone, I wasn't allowed to take public transportation home. A taxi came to get me and took me back to Karlovo Namesti--my stop--where I got out to grab some food items at the store. If I was gonna be cooped up all day, I was gonna need some serious food! I had been fasting for almost 20 hours by this point, after all. 

I took it easy all that day, hanging out in my hotel room, watching Pride and Prejudice and Zombies, and eating way too much food. Pastries are a weakness for me, which means Europe is a big fat weakness for me. 

The next morning, Eva let me know that all four eggs had fertilized! Yay! That was wonderful news! When you have unexplained infertility, any step in the process is fraught with worry because you wonder if this is where the buck stops--the thing that's been preventing pregnancy all along. So far, though, we had been so blessed. The transfer was scheduled for Thursday morning, so I spent the next two days sightseeing on my own, even taking a day trip to Cesky Krumlov, a darling medieval city in southern Bohemia. 

Wednesday night I didn't sleep very well, despite having walked a ridiculous amount that day. I was a bit nervous, since often women who have 20 or 30 follicles only end up with a couple in the end that they are able to transfer. The numbers tend to dwindle with each step of the process. The fact that we only had four to work with worried me a lot. I went to my 9 am appointment and talked with the embryologist right away. She was a very nice Czech woman with very good English. She was VERY excited about the embryo quality. All four had developed normally and were perfect, she said. She couldn't give me advice on which to transfer since they all looked so good. "I like them a lot," she told me excitedly, and then she picked a random one to transfer. It was surreal, knowing that that randomly-selected embryo could be our future child. Brandon and I had discussed whether we would want to transfer one or two embryos, and we had decided we would see what the embryologist said. Twins sounded overwhelming, but I'd take two over none any day! The embryologist recommended only transferring one, given the high embryo quality and my younger age (the average patient age at the clinic is 41). I had Brandon on the phone (woke him up at 1:15 a.m. Utah time to listen in on the meeting with the embryologist), and we decided on transferring one. They gave me a flash drive of the embryos' time-lapse development which is amazing. I've watched it like 30 times. They each grow from one cell to two to four to eight right before your eyes. Human biology is incredible!

The transfer went smoothly. I was used to it for the most part, since it's similar to what happens in an IUI. However, three of my IUIs were somewhat painful due to cramping as the fluid was injected. That didn't happen in this case. They use an ultrasound to guide the transfer. Dr. Martina was, as ever, bright, smiling, and informative. She said my uterus looked great and that everything had gone smoothly. Then she used the ultrasound to show me exactly where my embryo was--and she took a picture :) They gave me instructions on what to do and what not to do, when to get blood work done, and had me lay down for half an hour. And then I said goodbye to Eva before leaving the clinic and flying home a couple days later. Traveling home alone was a tad difficult since I wasn't allowed to do any heavy lifting but had to recheck my bags onto three different airlines. I must have seemed incredibly lazy to the check-in agents. When they asked me to place my bag on the scale, I used my leg to tip the bag over and nudge it onto the scale. I'm not good at asking for help in general, and I'm a pretty independent person, so restrictions are difficult for me to accept.

The two week wait was pretty excruciating. In my opinion, it's the hardest part of IVF. The day I went in for blood work to check my hCG levels (the pregnancy hormone), I was a mess. Our pregnancy tests thus far had been negative, but the internet provides a lot of false hope to people in such a situation, with stories of women who got negative tests until X number of weeks but were actually pregnant. I got the blood work done and found out a few hours later that my hCG level was less than 1--a big, fat, undeniable negative. The cycle had failed. That same morning, my brother and sister-in-law welcomed twin babies into the world. Historically, I haven't been one to cry over infertility or when people announce pregnancies or welcome babies, but the timing was very hard in this instance, and I cried a lot that day. But Brandon and I didn't wallow long in our misery. We already had a trip to Europe planned for a week after that (one that was planned long before we decided to do IVF), and we went and enjoyed ourselves with my sisters in Scotland and Italy, and then I spent a week on my own in England. It did my heart so much good!

I got back from England on April 23, left to Houston to shoot a wedding on the 27th, returned home April 30th, and then left back to Prague on May 6th. I flew to and from Europe 3 times in 2 months. It was bonkers. All told, in those two months I was gone 46 nights, of which I spent 31 nights away from Brandon. It was not easy. But we were motivated. The second trip to Prague was for a Frozen Embryo Transfer (FET). The three remaining embryos from March had been frozen, and Brandon and I had to decide how many to transfer. After prayer and discussion, we decided to transfer two and let Heavenly Father decide whether that resulted in no pregnancy, one baby, two babies, or some other option. It was a scary decision. My little sister accompanied me since Brandon couldn't take more time off work. It was so great to have her there with me to help keep my mind off things after the transfer and to help me slow down from my typical tourist mode.

The clinic thawed two embryos which, thankfully, both survived the thawing perfectly. Once again the embryologist spoke in glowing terms of our embryos and agreed with our decision to transfer two. I went in for the transfer, and right after it was over, Dr. Martina said, referring to the embryos, "God bless them, Martha!" I just love her. I got another ultrasound picture to show me where they had been placed, and I left the clinic and spent the next 5 days seeing Prague with my little sister at a very leisurely pace.

A week after my return, we got our first positive pregnancy test. That's a story for another day, though. I had a wonderful experience with Prague Fertility Centre, and I would recommend it to almost anyone up for an IVF adventure. I've gotten a lot of questions about the costs and logistics of what we did, and I want to be very transparent about that in order to be as helpful as possible to anyone considering it. So here is a breakdown of what our costs, along with some other pointers and things to consider.

Total Costs: $11,900

Two Cycle Deal: $5,350 (this is for two fresh cycles where you retrieve and fertilize eggs; each FET using embryos resulting from a fresh cycle is $1,000; they also offer other deals)
Embryo freezing and one-year storage: $900
FET: $1,000
Ultrasounds: $500 (we did two of these in the U.S. If we had done them in Prague, they would have been included, but we would have had to spend more time in-country)
Meds: $1,700 (this is for all injections plus post-op meds like progesterone, estrogen, prednisone, folic acid, etc. It would have been cheaper in Prague, but, once again, would have required more time in-country)
Flights: $2,000 (we didn't end up using points, as we found great deals on Norwegian and Condor airlines)
Rental Car: $50 (we drove to Vegas to catch our flights on Norwegian Airlines)
AirBnB: $230 (we used hotel points for about half of the nights in Prague, so we saved money here)
Food: $120 (we are very frugal on food when we travel and almost exclusively shop at grocery stores)
Prague Transportation: $50 (metro and tram use plus a couple taxis)

Keep in mind that, at this point, we are pregnant with twins (13 weeks) and still have one frozen embryo for future use PLUS an entire fresh cycle already paid for in the event that we need to do IVF again for future children.

Things to consider

TRAVEL: I would not recommend the Prague IVF experience to someone who has never been out of the country. Traveling to a new country with a new language and transportation system and culture can be overwhelming in and of itself. If this is not something you are accustomed to, it will only add to the stress of IVF. You need to be able to roll with the punches and be flexible. Having said that, we fell in love with Prague. It was wonderful to see the amazing city and helped take our minds off of things, where we normally might have been stewing and stressing at home. Once you have the embryo transfer done, you have to take it pretty easy, though, so long tourist days aren't recommended. I think I overdid it on our first try. It's just not worth the risk, so you need to be wise and remember that you are there primarily to do IVF, not to be a tourist.
ULTRASOUND & BLOODWORK: if you can't devote the time in-country to do the ultrasounds and bloodwork in Prague, know that you will have to navigate this with your fertility clinic at home, which can be a bit awkward. Our first round of IVF, my clinic was helpful. The second round, they were much less accommodating and made things more difficult when I needed a doctor's order for hCG bloodwork. Just something to be aware of. 
SUCCESS: If IVF is successful, you won't have the traditional experience where you continue seeing your fertility specialist until they release you to an OB. After a couple positive home pregnancy tests, I called up an OB and scheduled to come in, letting them know that I needed to get a 6-week ultrasound to confirm fetal heartbeat. Normally OBs don't see patients until anywhere from 8-12 weeks, so it's important that you let them know that your situation is not typical. 
FLIGHTS & HOTELS: your travel costs will be greatly dependent on 1) your ability to shop for deals 2) the time of year you travel and 3) how high maintenance you are. Our rounds were in March and May. If you go in June, July, or August, you will pay dearly for it, in all likelihood. PFC provides a list of local hotels that offer deals to their patients, starting from about $60 a night. AirBnB is a great option, in my opinion. We chose to stay in the city center and then use public transport for the few times we had to go to the clinic. The metro drops you at a 2 minute walk from the clinic; the tram stops directly in front of the clinic. It's very convenient. For flight deals, make sure you check out Norwegian Airlines. Their flights from certain US cities into Copenhagen and Stockholm are really great deals (e.g. $300 round trip). Google Flights and momondo.com are also great resources to flight shop. Hopper is an app that helps you know when to buy airfare or wait. 
TIME IN-COUNTRY: Our first round, Brandon stayed a week, and I stayed 2 weeks. The second time, I stayed one week.
PICSI & SUCCESS RATES: Prague Fertility Centre uses PICSI during IVF. Some of you may have heard of ICSI. PICSI is a variation on ICSI which more closely mirrors how the body naturally works. Read about it here. It is included in the price of IVF. PFC's success rate for IVF with your own eggs (as opposed to donor eggs) is 46% which is very good!

If you have any other questions, please feel free to contact me via this website. I'd be happy to help out!