Getting Some Action

I'm finally getting some action..... in the ovaries.

Today's appointment went well.  My lining today is 9 mm, which is great.  I need a minimum of 7 mm to sustain pregnancy.

So far, 9 follicles have responded to the meds.  They are now measurable, meaning they are 10mm or larger.
    Right ovary: 13, 12, 12,12, 11 & 10
    Left ovary:  10, 10 & 10
Looks like rightie is winning this race.

I am to continue my same dosage of meds: 5 units of Lupron and 2 vials of Meno.pur in the mornings, and 300IUs of Follis.tim in the evenings.  I am hoping that more follicles will grow within the next couple of days.

I go back on Sunday for another ultrasound and bloodwork. Because the clinic has very limited hours on weekends, the only time I am able to get in is 7 am in the morning.  7 am!!

Of course, we must not forget that this Sunday is the beginning of Daylight Savings Time, which means we spring forward one hour.  So, technically it would be a *6 am appointment.  Meaning I have to leave the house by 5:30 am!

Yikes!!  I am already so not a morning person, and having to be at a *6 am appointment really sucks!

I only have 3 cartridges of 300IUs of Follis.tim left, enough to last me through tonight, Saturday and Sunday nights.  Depending on how my appointment goes on Sunday, I may or may not need another 300IUs of Follis.tim for Monday.  Because the mail order pharmacy my insurance approves of is only open Monday through Friday, I would need to order more meds today, to get it in time for Saturday or Monday.  My nurse today advised me to refill my Follis.tim today.

While driving home, I thought why would I want to refill and pay for meds that I may or may not need for Monday?  At shots injection class, we were told that each Follis.tim cartridge comes with an overfill of 75IUs.  I have 3 cartridges of leftovers right now, and 3 more unused ones.  That means I would have enough for 300IUs from the overfills if I need it on Monday.  I wouldn't need my refill then.  I called the nurse and left a message, and she called me back later this afternoon.

She agreed that it would make sense to use up all overfill first.  I thought that we could withdraw all the overfills into one cartridge so we would only need to do one shot using the pen.  However, she was concerned about air getting into the cartridge and then the dosage might be off.  So she suggested using the the overfill first before using a new cartridge, meaning I would need to do 2 shots, one from the old cartridge with the overfill, and the second from a new cartridge, still amounting to a total of 300IUs.  I would need to do this 2 or 3 nights.

Two shots to save $100 in co-pay in meds I may or may not need?  I'm all for it.

We should know by Sunday the status of my follies.  If all goes well and I am ready, I may be triggering on Sunday night and egg retrieval would be on Tuesday!!

Again, we'll have to see how Sunday goes.  Will keep you updated.

Grow follies, grow!

Lazy Follies

I had my date with Mr. Wandy (ultrasound) and Helga (blood work) today, day 6 of stims.

My lining was 5mm, which is good.  However, my follies are lazy.  I have 10 small follicles on each ovary. 10 small.  Small.  I would have thought by now my follicles would have been at a measurable size, especially since we double the dosage of Meno.pur.  Dang lazy follies!

I suppose the one good thing is I now have 10 follicles on each ovary instead of 8 since March 2nd.  So I grew 4 more follies in 8 days.  Yay!!  Grow follies, grow!

I will continue my regimen of 5 units of Lu.pron and 2 vials of Meno.pur in the morning, and 300IUs of Follis.tim in the evening until my next appointment on Friday.  They will decide if anymore adjustments will be needed then.

I asked Nurse Amy when she thinks my egg retrieval will be.  Most people have the HCG (trigger) shots after 9 to 12 days of stims.  At the rate of how my follicles are growing, the nurse estimates that I would need 12 days of stims.  HCG shot is 36 hours before retrieval, so I am estimating that my ER would possibly be March 18th.  We'll see.

Helga drew my blood again today.  I'm starting to think that she is the only one that will be doing all my blood draws.  Not so excited about that.  I decided to switch and have my blood drawn from my right arm instead today.  My left arm was still sore and bruised from the last couple of visits.

As soon as I told Helga I wanted my to use my right arm this time, I started to panic!  It just occurred to me that I have never used my right arm for blood draws before this, ever!  I have always been so proud of left arm as I have never had any problems with it.  I noticed that my right arm does not have a nice visible vein that pops out a little, like my left arm does.  Suddenly horror stories of people being poked multiple times in the veins unsuccessfully came to mind!  Images of black and blue arms flashed by!

Argh!!.... what was I thinking?  Of course I was too embarrassed to switch arms by then.  Fortunately, Helga had no problem with my right arm.  I noticed that it hurt more after though, since I use my right arm more.

After the appointment, I called the pharmacy to refill my Meno.pur, plus I filled the rest of my prescription needed for the rest of the cycle:  Tetracy.cline, Va.lium, Endome.trin and Vi.velle.  Total cost: $296.95.  Again, thank you insurance company!

A side note: I have been experiencing headaches in the afternoons for the last couple of days.  I think it's the double dosage of Meno.pur.

I'm praying that my follies will behave and keep growing.

Come on..... Grow follies, grow!!

Stims-O-Rama

Sorry I've been MIA for a few days.  I have been feeling too lazy to write, been mostly lurking and reading blogs over the weekend.

I started my stims (stimulation injections) on Friday.  In the mornings I do 5 units of Lu.pron (reduced from 20 units), and one 75 IU vial of Meno.pur.  In the evenings I do 300 IUs of Follis.tim.  So 2 shots in the morning, and one in the evening.  I'm beginning to look and feel like a human pin cushion.  Luckily not too much bruising, yet.  Maybe I will take a picture of my tummy one of these days.

Lup.ron is simple, you draw out the 5 units, and then you inject it into your tummy.

Morning: Lu.pron with insulin needle

Meno.pur is little more "fun" as there are a few more steps to do.  There are 2 vials, the diluent (liquid) used for mixing, and the actual Meno.pur powdered medication.  Using a special cap called a Q-cap, the Meno.pur medication is mixed with the diluent before it can be injected.  There are a few more steps and switching back and forth between vials.  Injecting Meno.pur took a little more time than I originally expected, but I am getting better and faster at this.  It helps to take all the medication, syringes, alcohol swabs and cotton gauze out and lay them out in an orderly fashion the night before so everything is organized and ready.  I also found that Meno.pur tends to sting more, which the nurse at the injection class actually warned us about.

Morning: Diluent, Meno.pur powder, Q-cap and 27 gauge needle

Diluent and Meno.pur powder

I have taken Follis.tim before during my IUIs and previous IVF cycle, so I am quite familiar with it.  Follis.tim uses a special pen where you "dial up" the required dosage before injecting.  A nifty injection tool.

Evening: Follis.tim Pen and cartridge

So far, no real side effects worth mentioning.

If you are really interested in how these and other medication is done, check out the videos from Free.dom Pharmacy (if you get to a page asking for email, etc try copying and pasting this link to a new window instead: http://www.freedommedteach.com/player/Videos.aspx)

Today, I had my blood work done at the clinic, no ultrasound though.  That's for Wednesday and Friday.  I got a call this afternoon from nurse Jill.  They want me to increase my dosage of Meno.pur from 1 to 2 vials (150 IU) tomorrow and Wednesday.  My estrogen level is only at 68.  What does that mean, I ask.  I guess at day 4 of stims, they like to see the level close to 100.  If it is less than 100, then then increase the  meds.  If it's more than a 100, then decrease the meds.

I'm not sure how to feel about this.  Is it bad news, or just normal adjustments they make?  68 sounds kinda low to me.  I know in the past, I have had to continue stims for one or two more days than expected, so maybe it just means my body is not responding as well.  Still, it would be great if my body would be a super star and respond really well, or at least respond normally.  It just makes me nervous.

So the game plan for now is to increase my Meno.pur dosage to 2 vials tomorrow and Wednesday, and the Lu.pron and Follis.tim dosages stay the same.  I have another ultrasound and blood work on Wednesday and Friday.  They will be able to tell more then how my body is responding and if any more adjustments are needed.  It does sound like I will be needing a refill on my Meno.pur, which mean I will need to pay for another copay.

On another note, my MIL's birthday was a success.  It as a low key dinner at a local family restaurant and then we all headed to our house for cake.  Thankfully my Babe had Friday off, so he did an awesome helping pick up his crap stuff from the family room and did the vacuuming.  The house was clean (for the most part, minus the junk room, bedroom and office, which was off limits!) which was a good thing because Babe's 90-year Grandma joined us for dinner too.  She may be 90, but her vision is sharp and doesn't miss much.

We also talked about making a trip to Indiana for Babe's nephew's first communion and birthday, and his niece's baptism the fourth weekend of April.  I'm hoping that I WILL be pregnant by then!  It will make an interesting trip, depending on if I am truly since I WILL be pregnant, and if I have to deal with morning sickness, and hiding the news until the second trimester.  We don't plan on telling the in-laws until the second trimester.

p/s I updated the last part of my post to a more positive tone!  I have to believe I WILL be pregnant at the end of this cycle!

Show and Tell: Box O' Meds

It's Wednesday, which is also Hump Day, which also means it's time for Me'ls Show and Tell!

This week, I am showing my Box O' Meds that I received in the mail on Friday.  These are the injectibles that I will need for my IVF cycle, including:

• Lu.pron kit
• Follis.tim pen kit
• Follis.tim
• Meno.pur
• Generic HCG
• Various types of syringes and needles
• Alcohol swabs
• Sharps container

This doesn't seem like very much, because thankfully I am not doing PIO (progesterone in oil) shots.  If I did, there would be a lot more meds, syringes and needles.  Already with this, I feel like such a druggie.

As always, go check out what the rest of the class is showing at Mel's.

Thank You, Insurance Company

There are only a couple of mail order pharmacies that my insurance company will cover infertility meds through.  I just got done talking to the pharmacy a little while ago.

I ordered the all the injectable medication that I need for this IVF cycle:  Lup.ron, Follis.tim AQ, Meno.pur and HCG.

Grand total I had to pay?  A whole $240!!  OMG!

I almost could not believe it when the gal told me the amount over the phone.  This is approximately how much I would have to pay for one stinking 300IU cartridge of Follis.tim!

Thank you insurance company!

I will be receiving the meds on Friday, and start Lup.ron shots on Sunday.

A Good Couple of Days

Sunday was Valentine's Day and also Chinese New Year.  For my Babe and I, it was a fairly quiet day.  Though we don't really celebrate the much hyped Valentine's Day, we did have a small Chinese New Year (CNY) Celebration.  I am ethnically Chinese, so I was missing the CNY festivities at home.  After church, we met up with two other couples and their kids for lunch at a Chinese restaurant.  Being that it was CNY, we ordered a set dinner which included pork with watercress soup, Peking roast duck, pork chops in Peking sauce, steamed whole walleye with ginger and scallions, stir fried crabs with ginger and scallions, salt and pepper squid, chinese broccoli and dessert.  It's not often we get to eat like this!  Then my Babe and I came home and took a nap.  It was a nice way to just relax and eat.   Eating is a HUGE part of Chinese New Year.

Yesterday I got a call from Nurse Mary that did my annual exam.  The lab had found that some traces of blood and protein in my urine during my appointment last Thursday.  She asked me if I had experienced any increase in frequency in peeing, or any burning sensation, etc, symptoms of of UTI (urinary tract infection).  I said no, in fact I don't even remember if I've ever had UTI.  So she sent those my urine out to the lab to be cultured anyway, just in case.  So yesterday (Monday) I got a call from Mary, they found that I had a mild grade UTI or bladder infection.  She called in my prescription and I picked those up last night.  Talk about great timing, because by the time I picked up my drugs, I was starting to feel discomfort in pelvic area, nothing serious but just kind of an icky feeling.  I have been told that I am lucky that they found my UTI early and and did not have to suffer severe symptoms.  I am on antibiotics for 5 days.  I'm glad it was found now before I start my IVF.  What great timing!

Today, I had 2 appointments at the Dr. Hopeful's clinic,  a shots class and a nurse's consult.  There were just 2 couples, we first watched a video on how to do the shots for Follis.tim, Lupr.on, Men.opur and HCG.  Then the nurse went over our syringes and pens to show us how to do the shots hands on.  We didn't actually inject anything, but it was nice to be able to touch and feel the actual "hardware" before we got them from the pharmacy.  The nurse also showed us where to inject intramuscular (IM) shots so our hubbies don't stick us in the wrong spots!  The other gal that was there found out I am not doing progesterone in oil (PIO) shots, and using Endome.trin suppositories instead.  She was not happy, and wanted to switch!  I felt bad for her and I am so glad I am not doing the PIOs!  I guess she is planning to talk to Dr. Hopeful to see if she can switch too!  I have to say I think my Babe is kind of looking forward to the opportunity to stick a big-a$$ needle in my butt!  I am doing the rest of the shots myself!  We left the shots training with a Follis.tim pen kit.

After the shots class, we met up with Nurse Stacey who did our consult.  My Ovarian Assesment Report (OAR) results came back.  

• I had an Egg Retrieval score, or "chance of successful retrieval" of 9, which was "fair" .  This score indicates that there is a fair chance of obtaining 5 eggs or more through ovarian stimulation.
• Compared to other women 36 to 40 years old, my egg retrieval score is average.

I'm not really sure what this really means.  All the nurse would say is that they would not be changing my protocol.  So I'm hoping that this does not mean bad news.  Ughh.... I don't really like the sound of "fair" and "average".  Why can't it be "good" or "excellent"?

We then went over all our meds, dates of shots, ultrasound and blood work appointments.   I start Lup.ron on 2/21, Meno.pur and Follis.tim on 3/5.  Depending on how my stims go, I could have my egg retrieval on the week of 3/15.  We'll see how it goes.  We also went over instructions for HCG where timing is crucial.  And of course my Babe will make his "butt sticking" debut.  I am expected to do a Day-5 blast transfer and I am hoping that we will have some embryos to freeze for future use.

Before we were done, Nurse Stacey also gave me my "goodies" bag, a bag with 4 boxes of FREE 300 IU Follis.tim AQ samples!  Woo hoo!  Free meds!  That's about $1,000 worth of free meds!  I was so excited!

In a packet that was sent to me earlier, it was indicated on the drug list that it was possible to get Vi.velle and Endome.trin samples too.  Stacey said she would check into it as they don't always get those samples to give out.  I asked if I should wait to order those, to see if they get any in later since I wouldn't need those till later in my cycle.  She said she would check another spot to see if they had any.  She later came back with 3 boxes (6) of Vi.velle patches and 2 boxes (12) Endo.metrin samples for me.  Score!!  More free drugs!  My Babe was quite impressed with the way I was able to "finagle" more free meds.  See, I told him, ask and you shall receive!  And I did ask nicely =)

After the consult with Nurse Stacey, we met up with Melissa, our financial coordinator.  We put down our prepayment of around $7K.  We had decided we were not doing the shared risk program and would be paying by the cycle.  We thought we would be paying for everything out of pocket.  But there was a surprise waiting for us!  

We were told we had a lifetime maximum coverage for infertility treatment of $5K!  We will have out-of-network coverage of 60/40 for the actual IVF procedure (egg retrieval and embryo transfer), but the follicle monitoring (ultrasounds and blood work) will be covered by in-network 80/20 coverage.   Plus we also had a $5K lifetime coverage for infertility drugs!  Oh, such awesome news!!  Even though it is not a huge dollar amount, it makes such a huge difference.

We didn't realize that when I left my job last year, and switched our insurance to my husband's company, the benefits started all over.  We had maxed out our infertility coverage at my old company, but now we start afresh!  If I had not left my old job, we would be paying out of pocket for everything!

I am having a pretty good couple of days.  Early detection of infection, unexpected insurance coverage and free meds!   I am praying that this is a sign of more good things to come!

Making Some Progress

Today I received two packages from Dr. Hopeful's clinic in the mail.  The first was from Melissa, the financial contact.  Included in the packet were some brochures on how to finance the IVF, payment information, comparison between paying by the cycle vs. the AttainIVF (shared risk) program, estimate of charges, etc.  Boring but important stuff.  I can't believe we have to put down a prepayment of almost $10K by the middle of next month!

The second package was from a nurse, which included an IVF handbook, letter with list of testing required and estimated dates, consent forms for IVF and cryopreservation of embryos, a list of medications that I will be taking, and a prescription for my BCPs.  It's been years since I've been on any kind of birth control.  Hmm..... I have to take BCPs, which are meant to prevent pregnancies, to help me get pregnant.  Feels weird.....

I'm excited though, I found out I 'm getting Folli.stim, Viv.elle and Endome.trin free from the clinic!  I'm not sure how much this is going to save me yet, but either way, I'm pretty happy.  Anything free is super at this point!

Next step, research the cheapest place to get my meds.  Any suggestions?  I heard Freedom is the cheapest?

It feels good to finally be making some progress.

Confession and RE Update

Confession
First of all I have a HUGE confession to make.  For those of you that have been following or reading my blog I hope you understand why this is something I did not make known previously in my blog.  I will explain later.  So here goes.


This will not be my first IVF.  A year ago, we through one round of IVF overseas.  Unfortunately it was not successful.


I grew up in Asia and was home visiting family for a couple of months and decided while we were there, we'd try a round of IVF.  It was a lot cheaper to do it there compared to the US.  Only my family and a few of my close friends know we did this.  It's not something we like to share because some people frown on the idea of going overseas for treatment.  Plus we weren't sure if it was something we would share with our RE and if it would disqualify us from the IVF shared risk program.  Last night, DH and I discussed whether we should tell our RE about this.  Giving her this additional information may come in handy in her decisions on our protocol and procedures.   We decided it would be the best to be honest, even if it meant jeopardizing our chance at the shared risk program.


Overall we had a good experience doing IVF in this Asian country (due to the anonymous nature of this blog, I will not be disclosing the country).  I will write about it in more detail in a later post.


Now that you know the truth about our IVF experience, I will be updating my TTC history in this blog.


RE Update
Now, on to the part that you have been waiting for, the update on our appointment with the RE.

Last night, I again had a hard time falling asleep.  I think I got 4 hours of sleep, max.  I was tired, but felt pretty good at the appointment.  Since our last visit, the RE clinic had moved to a newly built and much nicer building.  There must be a huge market for the fertility business because the clinic was much bigger, fancier, and covered 2 floors.  The waiting room was twice the size of the old one and it was pretty busy, even in this sucky economy.  We found out later from our RE that the new facility included a new world-class IVF suite, with its own procedure rooms, andrology lab, embryo lab, incubators, recovery room, etc.  "The best that we could find", as she put it.

Our meeting with the RE, whom we shall call Dr. Hopeful, went really well.  She noticed it's been 2 years since our last visit so she asked us what we've been up to.  Right away, we were upfront about our previous IVF overseas.  I was worried about how she would react to it, but she seemed OK with it.  She was quite pleased with how I responded during that cycle, other than the fact it didn't work.  Our meeting lasted almost an hour and she gave me lots of information.   I was given the following handouts.

• IVF handbook
• Estimate of charges broken down into details by monitoring, IVF procedures, medication and additional charges.
• Statistics of IVF results for the clinic
• List of acupuncturists in our area.  Dr. Hopeful could not recommend acupunture medically (inconclusive research), but her thought is if it makes you feel good and help you relax, then do it.
• Comparison sheet for the cost of IVF by fee for service (pay by cycle) vs. share risk program.
• Classes for Mind/Body program, which she highly recommended.

In addition I found out the following:

1. Dr. Hopeful does not think a previous failed IVF necessarily means we don't qualify for the shared risk program, and recommends applying for it.  More details about the cost and payment of IVF will be discussed with Melissa, the financial coordinator.  In the mean time, we still have not decided if we will do the shared risk program.
2. Only 2 embryos will be transfered
3. Based on our fertilization success during our last IVF, we will not need to do ICSI.
4. There is an 18% change of miscarriage with IVF.  
5. I will be on Lupron, Menopur and Follistim.  I have had experience with Follistim, but will need to pay attention to researching side effects of Lupron and Menopur.
6. I will NOT need to do PIO (progesterone in oil) shots!!  The is the BEST news yet!!  I guess I will be on a suppository called End.ometrin.  I am so happy about this!
7. We will probably go in for a shots class so DH can figure out how to stick a very long needle in my butt.
8. I will need to do one IM (intramuscular) shot for the HCG trigger shot, most probably be done by DH.  I can handle doing one IM, but so relieved I don't have to do daily IM PIO shots.
9. The doctors at the RE office rotate through the procedures weekly.  This means Dr. Hopeful or one of the other doctors may actually perform the procedures.
10. We will need to do the following tests: 

• Ovarian Assessment Report -  to test the quality of my remaining eggs
• SIS (Saline Infused Sonogram) - check the uterus
• Trial transfer - measure the uterus prior to embryo transfer
• STD screening

It sounds like after my next AF arrives, I will start BCP on day 2 or 3 for 21 days, then start stims.  Today I am on CD11.  If AF is on schedule (which she probably won't be), I should start BCP on Feb 1st, and then we go from there.

In the mean time, I am waiting for a nurse to call to schedule a consultation and also for Melissa the financial coordinator to call to discuss costs and payments.  Actually someone from the clinic called this afternoon to discuss starting my IVF cycle but I was napping, thanks to only 4 hours of sleep the night before.  Tomorrow I will call the clinic and find out our next steps.

I'm getting excited about finally starting this, but at the same time I'm torn about the huge amount of money we are about to spend of IVF.