Endome.trin

I was prescribed Endome.trin, a vaginal suppository instead of PIO (progesterone in oil) shots this cycle.  This is used to prepare the uterine lining to nourish and support a fertilized egg after egg retrieval during an IVF cycle.

(image from http://www.ferringfertility.com/medications/endometrin/)

I am grateful for Endome.trin instead of PIO.  But I was directed by the doctor to continue to use this even though my transfer was cancelled.  According the nurse, they want my body to continue mimicking the luteal phase.  I am to continue for a total of 10 days then stop.  I should expect AF a 3 to 5 days after that.

Endome.trin can be messy, but nothing a panty liner cannot fix.  But it can be a real pain, literally.  I've had daily uterine cramps, sometimes mild, but other times intense.  I've also felt cramps like I'm severely constipated, but I'm not.  It feels the worst in the mornings when I first wake up, and I feel the intense need to pee first thing in the morning.  I've already been woken up in the middle of the night with these cramps more than once.  These are normal side effects of Endo.metrin.  During my last IVF cycle, I used Crino.ne gel instead, which is had some side effects, but I don't remember it being like this.

I can handle all these side effects.  The physical discomfort is no big deal.

The kicker about this though is that thanks to these side effects, I am reminded daily and constantly that my transfer was cancelled.  That I should be PUPO (pregnant until proven otherwise), that I should be in my 2WW.  Instead, I am waiting to hear if I can see my RE before May 5th.  And yet, I have to experience these side effects.

Thankfully, I only have a few days left to take it.  My last dose will be on Tuesday..... please come soon.

On a positive note, I am feeling better.  I have not cried in bed the last couple of nights now.

Today

Today.

Today would have been my embryo transfer day.

Today I would have been PUPO - pregnant until proven otherwise, a term used for women waiting to find out if their IVF cycle worked.

Today, I would have been on bedrest, relaxing, laying around on our bed or the couch reading, watching movies, or catching up on people's blogs.

Instead, today the lab called to confirm what we already know, that my only 2 embryos have arrested.

Because Dr. Hopeful is currently on vacation, one of her partners, Dr. K called today to follow-up with me.  There wasn't too much more information he could offer me from this cycle.  I will need to follow up with Dr. Hopeful when she gets back from vacation on April 5th.  I will have to leave all my questions I have until I see her face-to-face.

Of course the first available appointment to see her is over a month away on May 5th.  But the receptionist said she would leave a message for Dr. Hopeful and they will try to squeeze me in as soon as possible.   More waiting ahead.

Also, I was told to continue my Endome.trin suppositories for a total of 10 days.  Then I should expect AF to show up within 3 to 5 days of stopping.  Just in time for Easter.  Great.  Such a waste of meds  and effort for nothing.

My sister reminded me last night that around this time a year ago we had been dealing with the disappointment of the BFN from my first IVF.  I looked back at last year's calendar.

March 19th 2009, I found out that we had a BFN from my first IVF.

March 19th 2010, I had my egg retrieval for my second IVF.  It was also the day I found out we could retrieve eggs from the left ovary only.  From there on, things kept going downhill.

I know this may sound silly, but I want to remember today.

Today, March 24th 2010, would have been the day we transfered my embryos back.  It is not to be.

But I want to remember today anyways.  I don't want to forget.

Box O' Meds, Part Deux

Guess what the UPS guy dropped off today?

My box of meds with my Meno.pur refill and meds for the 2nd part of my IVF cycle.

From left to right:

• Vi.velle (estrogen) patches
• Endome.trin (progesterone) suppositories
• Diaze.pam (Va.lium)
• Tetracy.cline (antibiotics)
• Refill of Meno.pur

Notice there are no PIO meds.  Yippee!!

I am hoping this is the last of the meds I will be needing until I get my BFP!

Today, my friend E and her 2 1/2 year old daughter went out for our monthly girls' lunch out.  We always go to this Sushi and Chinese buffet place.  It's a great place for $9.99 a person, and we also have a coupon for $5 off for 2 people.  But the kid eats free.  How can you beat that?

I pretty much stuffed myself silly.  Not such a good idea as I am already bloated from the stims.  Well, this was possibly the last time I could have sushi with raw fish for a very long time.  Nine months, and most probably longer.  I'm praying that this is the case, of course.  We'll probably still come here for lunch every month after my BFP, but I will just have to avoid the ones with raw fish.  But oh, I sure do love the ones with raw salmon!

Today was also fun because E and I were able to talk about baby and pregnancy stuff (She knows about my upcoming IVF).  Like how she would pass down some of her baby clothes to me (her youngest is almost 9 months), and how I may buy some of her baby stuff like the jungle gym play mat, breast pump, bouncer, etc.  All this contingent on me getting a BFP, of course.  But it was great to be able to actually talk about baby stuff, morning sickness, and maternity clothes, and know within the next month that it is a very real possibility that I could actually use all these stuff.

Today, I feel bloated.  My ovaries feel "heavy" and there are some small movements and twinges in there.  It feels like my ovaries are having a party down there, and I'm not invited.  I'm hoping that this means my follies are actually finally getting off their lazy butts, and starting to grow. We'll find out more tomorrow at my appointment with Mr. Wandy and Helga.

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!!

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.