An overview of an IVF vacation

It has taken me a while to be ready to post this overview of our trip to Costa Rica and Panama for IVF. I wanted to be able to give anyone reading this a great review with details and advice, and I didn't want it to be tainted by my sad feelings about ours being unsuccessful. I hope that this will give some of you who are contemplating this route a better idea of what it was like and will help you make a good decision for you and your family. I'm warning you now, this will probably be long!

I'm going to break it into different categories and then do some general recommendations for those that plan to do a Costa Rica IVF.

Travel:
This was the best perk of the entire process (well, the price was pretty sweet too!). Mr. CB and I got to spend 19 days together traveling through two amazing countries.

Costa Rica is one of the most beautiful places I've ever been. There were so many activities, and our time there was filled with amazing adventures. I know other women who have traveled with their children to do this had a more difficult time traveling, but for us it was great. We spent time in three different areas of the country, plus some time in San Jose where we had our appointments. Being on vacation while doing an IVF cycle allows you to really relax and sometimes almost forget what you are there for. I do admit that I still had some stress and worry, but I don't think there is any way to avoid that while you are doing IVF. I definitely think that I was WAY less stressed and WAY more relaxed than I would have been if I were doing IVF at home.

In Panama, most of our focus was on the actual egg retreival and transfer. We were pretty much forced to stay in Panama City, so we didn't get to see as much as we did in Costa Rica. We rented an apartment near the clinic, which was a really good choice. It allowed us to be comfortable, make our own meals when we wanted and cuddle up on the couch and watch movies.

When you do an IVF vacation, at the end of the cycle, no matter what the outcome, you still have your memories and the time you spent on vacation. Our negative was so difficult, but I look back on our trip and I feel so fortunate to have had the time there with Mr. CB and it's an amazing memory that we will always have.

Price:
The reason we even looked into an IVF vacation as an option was because of price. We are totally OOP for IVF, and were looking at $10,000 for the cycle (not including ICSI if we needed it) plus another $2000-4000 for medication. Here is a breakdown of what we spent for our entire trip:

$2800 Procedure (ER and ET, including ICSI)
$85 x3 Monitoring appointments
$250 450iu Gonal-F (I had the rest donated ~ 1800iu's Gonal-F and 4 syringes of cetrotide)
$100 Estrogen patches (specifically for my lining ~ not needed by everyone)
$100 Progesterone shots
$350 Passport Medical fee

$1600 Lodging for the entire trip ($825 for 11 days in Costa Rica, $775 for 7 days in Panama)
$1000 Flights for 2
$385 Rental car for 11 days in Costa Rica
$2500 Money for food, fun and extras

$9340 Total Trip Cost

Doctor:
Dr. Perez is very nice and personable, and I felt very comfortable with him from the first day. There is defintely a language barrier. He speaks English, but I sometimes thought things I said or asked weren't fully understood. One thing I had wanted to know is if we had a fertilization issue, and I asked Dr. Perez if he could see if our sperm and eggs would fertilize on their own without ICSI. He seemed to understand and nodded and smiled, but when we got to ET we learned that all of them were ICSI'd without trying for a normal fert. My best suggestion is to speak slow, and get everything written down. Also be aware that the nurses don't speak any English.

Centro Fecundar is THE place to go for Costa Rican women who are dealing with IF. Knowing this before I went, I was expecting a big, state of the art facility. It may have been state of the art as far as technology but boy was it super small! The offices in Costa Rica and Panama were like mini-suites. For the ER and ET, I was on a table under a shelf in the corner of a tiny room.

When you go to your egg transfer, you have to be strong in your opinion of how many embryos you want to transfer. Mr. CB and I had spent a lot of time talking about this, and we knew if we had good embryos we were only willing to transfer 2. Once we got there and saw them, Dr. Perez and the embryologist tried to talk us into transferring more. They said that each grade 1 had a 20% chance of resulting in a pregnancy, so if we transferred 3 we would have a 60% chance. I'm not good at math, but even I know that it doesn't work that way. Using that math, we could have transferred 5 and had a 100% chance of having a baby! Do your homework and know how many embryos you are comfortable with transferring.

Protocol:
Dr. Perez uses a very standard protocol for all his overseas patients. All the other women who I know and have talked to that went were first time IVFer's and we all did the same thing. If you have a specific issue or have had slow responses with injectables, I don't know how or if he would change his plan for you. It seems like a one size fits all approach.

I did have lining issues, and he prescribed estrogen patches to help with that. I actually had the best response out of all my treatments as far as my lining goes. One thing I look back and wonder is if I was oversuppressed. I was on birth control pills for over five weeks, and my antral follicle count and the number of follies I ended up with was definitely low compared to previous cycles.

Passport Medical:
We used a medical tourism facilitator to help book the appointments with Dr. Perez. For me, it was helpful to have someone take care of all of that, and I did get some good information about what to expect before we got there. I think the price was high for the services we received, but the company did do what they said they would.

The other American we met and spent time with that was there for IVF didn't use Passport Medical and booked directly through Dr. Perez by email. She did have some mix-ups about where the clinic was located and didn't receive all the helpful tips that I did.

If you are booked and ready to go, here are some of my tips:
~ Make a binder and keep everyting together and organized. I had tabbed sections and was able to keep my medical records, appointment information, travel confirmations and other travel info together. My binder was by my side the entire trip!
~ Travel in Costa Rica! See the sights and really enjoy all it has to offer while you are there. We went to Arenal, Monteverde and Manuel Antonio.
~ Rent a car in Costa Rica. Many websites have scary stories and people seem reluctant to rent a car there, but we had a great experience. It was so nice to be able to stop on a whim and go where we wanted.
~Get a vacation rental in Panama. We used http://www.vrbo.com/, and it was so nice to have an entire apartment to relax in for the week. Find somewhere close to the clinic...it's in the middle of a nice area with a huge mall so there is a lot going on.
~Bring your own progesterone if you can. I'm still a little iffy on the progesterone they give you. I had a hard time finding information about it online (it's not used in the US) and I ended up switching to endometrin because I started spotting through the progesterone.
~Bring a video camera to ET. You can video your embies while they are on the computer screen and get pictures.

I think that going to Costa Rica and Panama for IVF was a great idea for us. Even though it was unsuccessful, I wouldn't change it. We were unexplained and told we had a 70% chance of being successful with IVF. Going to CR/Panama allowed us to do our 1st cycle, spend less money, and get a great vacation. For our situation it was a good fit.

I hope that this gives you a better idea of how this works, and the pros and cons. If anyone has any specific questions, please don't hesitate to email me at chefbud10@gmail.com.