3 Day Transfer & Protocol Answers

The embryologist called this morning to say that all three embryos are dividing, we have two 3-cells, and one 2-cell. We are on for a 3-day transfer tomorrow. Hubby and I have to make the big decision as to how many to transfer. He's thinking percentages and odds, I'm thinking of avoiding complications of multiples. Hopefully we can come up with a compromise that works all the way around.

A couple commenters asked about the protocol I've been on. I don't know the exact term, as I'm really bad with keeping terms straight, but here are the meds I've been on:

DHEA, 75 mg, since 1/10/09
Bravelle, 300 IU, day 3
Menopur, 300 IU, day 3
Saizen, 0.8 ml, day 3
Ganirelix, 225 IU, day 5
Dexamethasone, day 3
Folic acid, 1 mg, day 1
Multi-vitamin (not prenatal) day 1
Prenatals up to day 1

Since trigger on Friday, I've added:

Medrol, 64 mg (the nastiest tasting pills I've ever taken)
Doxycyclene, 2x day, for 5 days, including day before ER and starting again day after ER
Baby aspirin
Folic acid
Multi-vitamin
PIO, 50 ml in a.m.
HCG booster on 5/26, and 2 other dates I don't have in front of me right now

I hope this helps the other poor responders out there.

Ganirelix

I add this tonight. I'm to do the shot in my thigh, but I'm not sure exactly how I'm going to do it. Between my boobs and my tummy, it's kind of awkward to do it. I could have Hubby do it, but I need to do it tomorrow night anyway as I'll be at a function, so I need to figure out how I'm going to do it. I tried finding videos online, but wasn't able to.

If anyone has any tips, please share. Thanks!

This is what $507.10 looks like

Isn't it ironic

As of today, I am 19 or 20 days away from AF. I am actually looking forward to AF. Only those with IF look forward to AF (well, and those stupid teenagers who have unprotected sex).

Between now and then, I'm going to minimize the contact with the in-laws (too many babies for me right now).

But, how ironic is it that tomorrow morning I am participating in the March of Dimes March for Babies? By the way, I surpassed my goal!

I'm skipping Mother's Day weekend and am instead going to my 20th class reunion. From what I've read, most of my old classmates' kids are 10 or older, although I certainly don't have the 411 on everyone.

Tonight I'm having a virtual martini party. Darya is riding the blues, and the best way I know to get rid of the blues is to drink a virtual martini. Anyone who wants to join in, please do so. Mine will be appletinis. Oh, and I'll be drinking these appletinis during a church dinner and pie auction. Suh-weet!

I told my acupuncturist today that I try to stay away from medications (specifically allergy meds) as much as possible, yet I'll have a big-ass box of meds coming in next week. Just say no?

Alanis Morissette has nothing on me, baby.

SHG tomorrow

Tomorrow I go in for my SHG (to make sure that the fibroid my old RE saw hasn't decided to become a concern) and my face to face consult with the A guy. He just wants to look at my airway, to make sure that there won't be any problems during the retrieval.

I have to be up by 5 am, so I can be on the road between 6:00-6:15. I see A guy at 8:15, and my SHG is at 9:00.

Really not looking forward to getting up that early.

On a different note, I have noticed that my AF, since being on the DHEA, has shortened to about two days. I'm wondering if this is normal.

~ Whoosh ~

Did you feel that? That's the ball rolling even faster.

• Telephone consult with anesthesiologist earlier this evening
• Saizen will be ordered in the morning
• TET & face to face meeting with anesthesiologist - Wednesday
• SHG - Thursday
• Nurses consult - Thursday
• Embryology consult - Thursday
• Business office consult - Thursday
• Possible SA for Hubby - Thursday

I was supposed to have the face to face with the A guy (easier to type than anesthesiologist) tomorrow morning, but a huge snow storm is moving into the area over night, and luckily we were able to do a phone consult this evening and will meet face to face next week. He needs to be able to look at my airway to make sure that there won't be any problems during the retrieval.

My pregnyl came in today. All my other meds will be shipped at the end of this month.

This might just happen, huh?

One AF down, one to go

AF is here today. I'll be scheduling the trial embryo transfer (TET) and the SHG for next week.

Next month's AF will begin my "IUI convert to IVF" cycle (actual name of the cycle - assuming I have a minimum of four follies, we'll do IVF, if not, it will be IUI).

Saizen wasn't approved by insurance so I am getting prices. If anyone has some suggestions, please leave a comment.

My drug dealer called this morning

We were able to go ahead and use Pregnyl rather than Novarel. Same same, just different manufacturer. It's being shipped out this week, so I should have it by Friday.

Whew!

Problems filling Novarel Rx

Has anyone else had problems getting their Rx filled for Novarel, or even the generic HCG?

My insurance company's specialty pharmacy is out of both. They said that the manufacturer has them on back order for two months now.

They gave me the name of another place (Apothecary by Design) and they too are out of Novarel and HCG, but do have Pregnyl. I've got an e-mail in to my nurse to find out if Pregnyl will work or not. They don't want me using Ovidrel.

What are you doing to get your hands on Novarel, or do you not have this problem?

I do have one vial left over from my attempts last year, and the vial expires 05/09. I'm wondering if I should use it or just go ahead and try to get fresh. I will need two vials, so I've got to find more anyway.

Thank God for insurance!

I went online to check to see if my insurance company had processed my medications (not actually expecting them to yet). Low and behold, they have! And I about choked!

My medications (not including the Saizen, as it hasn't been processed yet - needs pre-authorization because it is a growth hormone so it may not actually be covered) cost $5,899.88. My copayments total $154.98. I am so thankful to have this insurance. My ART benefit is $10,000 lifetime maximum, but I have found that things like my medications, u/s, and b/w do not apply to this maximum. It is only the actual ART procedures that apply. I just called Hubby to give him this figure and he said that if insurance didn't pick it up, that we wouldn't have any kids.

The list includes:
Drug name - total cost - my copay
Medrol tab - $45.82 - $40
Bravelle - $2,649.14 - $25
Dexamethason - $4.98 - $4.98
PIO - $64.32 - $10
Ganirelix - $391.04 - $10
Climara - $45.44 - $40
Menopur - $2,674.14 - $25

It seems funny that the most expensive of the medications falls under the preferred drug list, which has the $25 copay, and some of the least expensive medications fall under the non-preferred drug list with a $40 copay. Doesn't really make sense, other than the insurance company must have some really good contracts with the pharmaceutical companies for these to be preferred.

On a related but different note, as many of you know, I'm in the insurance industry (I'm an agent - I sell insurance). One of our larger clients is currently putting together the specifications for their insurance plan for 2010 that we will be bidding out. One of the things that we will be getting pricing on is infertility services. I hope that I'm able to negotiate a good price for them so that others can be helped. Colorado doesn't have mandated IF coverage, and I don't see that happening any time soon, especially given the fact that our budget is so tight and we're struggling to provide coverage for those without insurance, much less adding additional mandates which increase the cost of insurance. We'll see how it goes.

Ball is slowly rolling

I finally heard back from my IVF nurse. Dr. S received the consult note from Dr. M (the peri).

They've submitted everything to the insurance company, but haven't heard back from them, so I'm following up to make sure they have everything they need in order for them to pay!! :-)

I'll call when I start AF in April to schedule my TET (trial embryo transfer) and SHG (not the HSG), and then have the consult with their anesthesiologist.

Should then be able to schedule my IVF consults. Dr. S's office did go ahead and fax in my Rx.

They also want to know if I'm going to be pursuing acupuncture with this cycle. I've started placing phone calls to some acus here in town, to see if any of them specialize in infertility treatment. The last hottie I used, while really nice, just didn't seem to provide the same type of services that I've read others receiving. So I'll check around and see. It does mean that it will be out of network (meaning self-pay) but I'm okay with that. Actually, it would be subject to my out of network deductible, which actually also applies to my in network deductible, so it'll be okay.

On a different note, I think I just recently ovulated. Again, I had some pain with it, so I really do think that the DHEA is working. It is certainly making an oil field out of my forehead, especially if I don't wear my foundation that helps prevent shine. Good thing I normally wear bangs!

Unfortunately, due to reasons I won't disclose to protect someones privacy, we weren't able to capitalize on ovulation this month. In my head, I rationalized and okayed this, thinking that if we did BD, I'd have too many eggs and it'd result in HOM. So, we're okay. (Does anyone ever do this, rationalize these things in your head so that you're basically forgiving yourself for not doing something? Am I even making sense?)

Lingering effects of Octomom

My MIL asked me the other night if the medicines I'm taking will cause me to have eight babies, like that "woman in California?" Um, no.

I went on to explain to her what happened with Octolina (heh! a new name for the octomom Angelina wanna-be), how her doctor was very unethical, didn't practice wise medicine, etc. Yeah, there will not be eight babies residing in this uterus. Not all at once nor scattered over time.

Speaking of MIL, please say a prayer, think good thoughts, etc., for her. They cut short their annual vacation to Yuma, AZ due to her finding a lump in her underarm. It's her lymph node. She's scheduled for surgery March 6. I think she is very scared as her mom died of breast cancer, so I'm sure that's in the back of her mind.

My body is jacking with my mind

So, AF should be here any time now. Last night, I thought she showed up. However, it seems like it was just enough to be noticed on the TP, as today there is nothing.

I don't normally spot first with AF, it's boom, she's here. Then after a couple of days, it dwindles to spotting. This is my second period while I've been on DHEA, and I'm wondering if maybe the DHEA is effecting my period? Or is it something else?

It can't be implantation spotting, could it? It'd be way too late. Even if it were late implantation, this would still be way late.

See what I mean? My mind wants to believe this crap. Or maybe it's my heart. Actually, it probably is my heart, cause I know in my head that this has to be AF, she's just teasing me (torturing me). Stupid AF. Stupid clomid. Stupid heart. Stupid DHEA.

Damn this emotional roller coaster. Last night I blew up (well, self-imploded, really) because I didn't get anything for Valentine's Day. I said something about it and Hubby responded, but he thinks it's okay in his head. However, to me, it's like a slap in the face. I made him a homemade Valentine's coupon book with a few lovey dovey coupons, and the other ones were like "F-bomb free day" or "grumpy free day" coupons. Plus I gave him a couple of little boxes of chocolate, one was a bear holding a baseball saying "You're a good catch" and the other was a fish saying "You're a keeper." Nothing extravagant, nothing expensive, but from the heart. What did I get? Sex, but only after I initiated it. He thinks that that was enough. Whatever. I'm sure I'll hear about it as he reads this, but good. He needs to know how I feel, as I don't do a very good job of verbalizing it. I didn't want jewelry, or expensive roses. But even just a little bouquet, or a card. Instead, he bought yellow roses from a corner street vendor and gave them to the f'ing hoochie mamas that work for him. Oh, I'm about to explode again. I've got to get back to work.

Mucinex does wonders for CM

TMI Alert!

During the height of my cold, I was taking 4 Mucinex D tablets a day to try to clear the gunk from my lungs and sinuses. It finally did work, as I am feeling better, although if I talk too much I get short of breath and my throat gets scratchy.

During this time, I was also doing my clomid challenge. I've taken clomid before, and remember the havoc it created with my CM. Well, I did not have that problem this time.

If you've taken clomid, you have probably heard about taking a teaspoon of regular Robitussin as it helps to thin your body's mucus. Regular Robitussin has very little of the Guaifenesin medicine in it compared to Mucinex. I'm talking 100 mg in a teaspoon vs. 600 mg in one tablet. I was taking 2400 mg a day for about a week.

This weekend, I had what felt like PMS cramps. First in my abdomen on Saturday, then they moved to my back on Sunday. In fact, at one point Sunday I went to the restroom thinking I had started my period (which by the way isn't due for two weeks). No, it wasn't my period. Let's just say I ended up needing to change my underwear. Holy crap! I've never seen that much CM at once. Never.

Let's just hope that this is a good sign. Hubby and I definitely took advantage of it. Maybe that clomid and the DHEA I've been taking will pop an egg out. Stranger things have certainly happened.

TMI over.

We go tomorrow for our regroup session with the RE. We'll see what he has to say about everything. Keep your fingers crossed for us that we get a chance. That's all I'm asking for is a chance. That's all we ever want, isn't it?

Assvice needed

Okay, so I take my last Clomid tablets tonight. Get my blood work tomorrow. No ultra sounds though.

My question to you. Knowing that most likely I won't produce any follies with eggs, but knowing that things sometimes happen, what are your thoughts on BDing during my possible "O"?

I'm sure that if I were to produce any, it would be very minimal (one, maybe two). But most likely none. However, considering my feelings from my previous post, I certainly wouldn't want that to happen.

By the way, my RE didn't say anything about not BDing. He actually didn't even mention it. I'm thinking that there should be no problem. Like my ovaries are going to respond to a measly 100 mg of Clomid. Sure.

Eight is enough

My jaw hit the floor this evening as I watched the 10 o'clock news. A lady in Southern California delivered octuplets. That's eight babies, my friends. EIGHT!

Damn! The funny part (if there is a funny part) was that they only thought there were seven originally. Hmm, I wonder if they knew that there were eight if it would have made any difference (such as in selective reduction)?

For now, the babies and mom are fine, but I wonder what their long-term prognosis is.

I truly hope that all are well, but you know, this really pisses me off. Stories like this gives fertility treatments a black eye. Many women, such as myself, try for years to have a baby. A baby. As in one. If we get so lucky, we may try for a second or even third down the line. We all know that with the procedures we go through, there is a chance for multiples. But when doctors and the couple allow for a woman to carry that many, it just really puts both the mom and babies at such high risk. I have a hard time understanding why a woman would want to do this.

What are your thoughts? If one of your treatments was "successful" and you ended up pregnant with more than, say four, embryos, what would you do?

Wow, blood results already!

I got the call with my blood results today before I even got back into town. That was fast!

FSH 5
LH 3
E2 74

So the FSH looks good, not sure about the LH, but the E2 while under 80, is still lots higher than 40, the ideal number. The AMH results won't be in for 10 days.

Hubby went in alone for his SA while I had my blood work done. That was a mistake. Unfortunately, he got a cramp in his side right as the goods were being produced which prevented him from getting all the sample in the cup. I'm hoping they have enough to test. If not, he may have to repeat it. Next time I'll be there to catch it! :-)

Oh, and a NP did my ultrasound, rather than the doctor. She didn't indicate how many antral follies were there. As usual, my left ovary was hiding behind my uterus, and while it was very uncomfortable, I got through it.

I'm good to go to start the clomid on Friday.

Regroup is set for February 3.

Weekend review

I live such an exciting life that I have to review my weekend with you. LOL Yeah, right.

Friday night, went to dinner with the in-laws. MIL had a cold, so I tried to steer clear from her. It didn't work. Woke up Saturday morning with sore throat and stuffed up nose. I didn't let it stop me from enjoying the sun, and went for a walk around the riverwalk. It was such a pretty day. I soaked up extra sun, just for you Dagny. ;-)

Sunday, despite ingesting a variety of cold medicines, was worse. I had to get a spackle just to get the gunk off and out of my nose. Had a fever. Had chills. But like a good wife, went to the store and got the makings for dinner as well as stuff for later this week to fix. I made white-girl chile rellanos.

I got to watch my Bahama-mama (as I like to call Troy Polumalu, #43 of the Pittsburgh Steelers) intercept the ball away from the Baltimore Ravens and score an awesome touchdown! I have his jersey, by the way.

Then, got ready for bed, and lo and behold, AF arrived. It was 10:45 pm by that time, so I think I'm safe to assume that today is CD 1. Which means I get to call for my CD 3 u/w & b/w & 10 b/w, then start the clomid on Friday. Joy.

Now, I'm at work and between my fever (was sweating like a pig) and the cramps (thanks Aunti), I feel like crap. Oh well, I'll just suck it up since I'll have to take this Wednesday and next Wednesday mornings off to get my blood work done up in Denver. Joy. I just love getting up early.

So, would you give my weekend five stars?

DHEA is in

My DHEA came in the mail this afternoon. I'll start taking it tomorrow. I could have started today, but didn't want to take the two dosages very close together.

If you've ever taken this medication and have any input you'd like to share, please feel free.

Thanks!!

Additional details

I thought I'd post what the plan is if we are able to pass our tests and actually go down the IVF road with Dr. S.

As I mentioned last, I'll start taking the DHEA, probably on Monday or Tuesday, when it comes in. I will call on CD 1, go in for CD 3 blood work to test FSH, LH, E2, and AMH (ovarian reserve test).

I'll then take clo.mid 100 mg CD 5-9. Test FSH, E2 on CD 10. I'll also have another blood test 10 days after I start the DHEA to test my levels for that.

After we regroup, if, as I said above, we get the green light to proceed, here's the plan:

• 300 units of Menop.ur (he uses this rather than Repr.onex as it is a pure rather than synthetic med)
• 300 units of Bra.velle (again, he prefers this over Fo.llistim as it comes from the real deal rather than fake stuff)
• Gani.relix (an antagonist) when my follies get to be about 14 mm
• Growth hormone (Sai.zen)
• Dexamet.rason (sp??) - actually not sure what this is for
• Optional acupuncture
• ICSI

It is somewhat ironic that all the meds he plans on using I have zero of. If you recall, I have left over Foll.istim and Re.pronex. I guess I will continue to save these for possible donor, however, since we may have to wait a year for that and the meds may expire before then, I will be donating the meds to a person in need (well, I'll ask that they reimburse me for my copayments, which is still CHEAP compared to what they could pay cash price).

I almost scared myself this afternoon as I went online to check my insurance benefits. I tried searching for some of the meds, and they weren't coming up, when they had before. However, I did go on our internal website and found our outline of benefits and it does say that IF treatment is still covered. Phew! I just need to figure out why it isn't pulling up the drugs. I'll have to contact customer service to see what's going on with the online system.

I did have to pay out of pocket for the DHEA, which considering, is nothing compared to what others pay. I'm not in the least bit complaining. My benefit summary did state that it doesn't reimburse for meds filled by non-participating pharmacies, which this one isn't. Oh well. I'll just make sure that all future meds are filled by my insurance company's specialty pharmacy.

Did I ever tell you how I came to have IF coverage? My employer was purchased a year and a half ago by a much larger insurance agency based out of Chicago, IL. Illinois has a state mandate for infertility. So when we moved over to their insurance, poof! I have IF coverage, which was perfect timing. My old insurance carrier would diagnose IF, but didn't provide any coverage to treat it. My coverage isn't a lot. I have up to 6 attempts at IVF, which may sound like a lot, but it's a $10,000 lifetime maximum benefit. I'm very fortunate that the blood work, ultrasounds, medications do not apply to the $10,000. Only actual retrieval, the ICSI, the fertilization and growing, then transfer are applied to that amount. So I figure I probably have about 1.5 - 2 IVF attempts worth of coverage.

Now that I've written a short novel, I'll go watch Desperate Housewives. I tried watching it Sunday night, but the digital signal for ABC was jacked up, and I was unable to sit through the jumping, skipping and still frames. I'm going to go online and watch it.