IVF Cycle: Stims Day 4-6

Day 4: Monday, September 12. Poke count: 13

I woke up feeling great this morning. Other than sleeping through my alarm and waking up 40 minutes late, I was good! My ultrasound and bloodwork went well. There are 11 visible follicles on my right ovary and 8 on the left. 19 follicles already! Ashley said that more could pop up in the following days since I've only been on meds for 4 days. They are still small, but that is to be expected at this point. They decided on no change in my meds for the next couple days.

I did wind up with a nice, dark blue bruise from where they drew blood. The vein in my right arm totally changes direction right where the needle goes for a blood draw. Either they can't find the vein, or they "kind of" find it and I wind up looking like a junkie.

Day 5: Tuesday, September 13th. Poke count: 15

I am starting to become increasingly uncomfortable throughout the day. There is a lot more pressure in my lower abdomen as the follicles on my ovaries grow. It hurts if my bladder is too full and it also hurts to empty my bladder! Pretty much anything that puts pressure on my ovaries hurts. The right side hurts much more than the left, but it hurts more to lay on my left side. I pretty much just want to wear sweatpants and lounge around the house all day.

My headaches are getting much more frequent as well. Instead of waking up with a headache and it going away quickly, I wake up feeling fine and it gets worse as the day goes on. I spend the majority of my day staring at a computer screen so I'm sure that doesn't help. I've been trying to stay hydrated to hopefully get rid of some of these headaches. So far all that has done is increased my trips to the bathroom!

I still can't really complain about the overall side effects of the medication. Everyone I have spoken to and everything I have read made this medication sound like torture. Even my mom said "Oh that stuff makes you crazy!" I have had a couple moments where I wanted to cry over absolutely nothing, but I hardly think I am crazy. The headaches and pressure are definitely tolerable. I just hope it stays this mild for the rest of the cycle.

Day 6 Wednesday September 14th: pole count: 18

I had an ultrasound this morning and everything is looking good. They only saw 16 follicles this time but they said sometimes you can't see the smaller ones. The ones we could see were definitely growing! They are actually visible and I can make out the individual circles on the monitor instead of just a blur of black. I was able to sneak a picture of the monitor. You can only see 3 of the follicles, but this gives you an idea of what they are looking for in the scans.

My estrogen levels from Today and Monday's blood work were good, so no change in the Menopur or Gonal- f for the next couple days. I will start the Cetrotide injections tomorrow morning, which will stop me from ovulating before they want me to. My next appointment is on Friday and hopefully the follicles will be big enough to plan my egg retrieval.

-Emily

IVF Cycle:Stims Days 1-3

Day 1: Friday, September 9^th. Total Poke Count: 6 (including previous bloodwork for IVF)

I started my medication today with 150IU of Gonal-F and 2 vials of Menopur. I got all my supplies ready on the bathroom counter and immediately had a little mental freak out. I have heard from so many other women that when they gave their first shot, they hesitated for a long time. My plan was to have the medication all ready in the syringes so when it was actually time for the shot I could just quickly get it over with. That didn’t work out so well. I had everything ready, but I still hesitated a little bit. I took the cap off the syringe and just stood there looking at the needle and said to Brian, “I don’t want to stab myself!” Brian was just standing there asking me what I wanted him to do.

“Do you want a hug or anything?”

 “No, don’t touch me!”

I finally started the first injection and didn’t push hard enough on the syringe.

“Brian, it won’t go in”

“Yes it will, just push harder!”

The whole conversation was quite comical. I eventually did get the needle to go in, but I was surprised at how hard you have to push to actually puncture the skin. The needle slid in and I kid you not I didn’t feel it at all, not even a little pinch!

“Brian, it doesn’t hurt at all! I didn’t even feel it!”

Brian looked over and saw the needle still in my belly, cringed and walked out of the room. I finished the first injection and went right onto the second one. The Menopur needle didn’t hurt at all, but the medication did burn a little bit going in.

Overall I was pleasantly surprised by how simple the injections were once I had everything situated. They didn’t hurt and I thought I had a pretty good grasp on the whole process. We went out to dinner for my mom’s birthday and I felt fine the whole night. I did have a little bit of a headache, but my head was hurting earlier in the day so I thought it was probably just stress.

Day 2: Saturday, September 10^th. Poke count: 8

I woke up with a slight headache, but nothing horrible. I took some Tylenol and it went away pretty quickly. I took Renly to the vet this morning after him waking us up several times the past few nights to go to the bathroom. He hasn’t been interested in his food, drinking a ton of water and has had loose stools. The vet agreed that she suspects a UTI, but we couldn’t get a urine sample. She gave us some antibiotics for him and suggested Imodium for the tummy issues.

Mid-afternoon I started feeling a slight pinching feeling in my lower right abdomen around where I assume my ovary is. I don’t know if this was from the medication or just in my head. It lasted the rest of the day though. 

We spent the afternoon at my mom’s, playing with my 2 year old niece and eating cupcakes I made for my mom’s birthday. I have felt mostly fine all day.

Look at all that red hair!! 

We packed up the dog and my medication and went to Fruitport for the night to celebrate Brian’s mom’s birthday. Yes, my mom’s birthday is on the 9^th and Brian's mom's is on the 10^th….and his uncle's is on the 11^th! It makes it super easy for us to remember birthdays.  We went out to dinner that evening, and around 6:15 Brian and I headed back to his parent's house for my medication. I was going to give myself the shots and then head back to the bar to celebrate some more. What should have taken 15 minutes turned into a 2 hour ordeal. I pulled out the bag with my medication and I HAD PACKED THE WRONG VIAL!!! Stupid! I thought I was super organized. I even have all of my non-refrigerated meds and supplies all situated in a shoe organizer. Apparently I’m not organized enough.

I like to pretend I'm super organized

I drove back to Grand Rapids, gave myself the medication while I was super flustered and drove back to Fruitport. Both of the shots hurt more this time, but I was kind of hurried so I wasn’t as careful as last time.

I had a slight headache by the time we got back to the bar around 8:30PM but I again decided it was just a stress headache. Tylenol took care of it quickly. We got back from the bar around 10PM and Renly’s Tummy problems had gotten MUCH worse. We keep him in the spare room when we stay at Brian’s Parent’s house and he is usually fine. There was poop by the door, the window, the wall and by the bed….he had exploded! It all cleaned up pretty easily and Brian’s parents didn’t seem too mad. We didn’t really tell them how bad it was at the time, although I guess they will know after reading this. :)

Renly got an Imodium, started throwing up and spent the night in the garage. Don’t worry, he had his bed, water, his bone and it was nice and warm.

Day 3 Sunday, September 11^th. Poke count: 10

I woke up with a splitting headache. The kind where you just have to close your eyes really hard and wait for the wave of pain to go away. Once I actually got up and got dressed it was a little bit better, but definitely still there. I am now convinced that it is the medication causing the headaches. I took more Tylenol with breakfast and it has been fine the rest of the day. The pinching feeling has continued today and gotten a little stronger. It is on both sides now. I don’t think it’s in my head anymore. I pushed on my stomach and it was a bit tender. Hopefully this all means the medication is doing what it is supposed to!

The Menopur burned a lot more tonight. It still wasn’t horrible, but noticeably worse. Overall I am pleased with how little the injections have hurt and how little side effects I am experiencing. The headaches and pinching feeling are obviously not pleasant, but they are definitely not intolerable. I have an ultrasound and bloodwork tomorrow at 8AM, so I’ll get to see how the follicles are growing at that time.

Renly seems to be feeling better too. I think the antibiotics upset his stomach more so we are putting him on a bland diet and giving him some pumpkin. He should be a happy puppy again in just a few days. 

Emily

IVF Update

Last week we got the green light from RGI to start our IVF cycle. On Monday I had an ultrasound and everything looked normal. There are no cysts on my ovaries and the follicles look good. They told me to take my last birth control pill on Tuesday and to start my injections on Sunday. They just had to schedule the embryologist to come take the biopsies. Later that day I got a call that the embryologist has another travel case around the same time so they will not be available. I was told to take another birth control pill and they would call on Tuesday with an updated plan. At the end of the day they still had not heard from RGI. I took another pill and was told they would call on Wednesday. Wednesday was the same story, nothing from RGI. Finally this morning I got a call from our nurse, Ashley, saying that they had heard back from RGI!

I will take my last birth control pill on Sunday 9/4 and start the injections of Menopur and Gonal-F on Friday 9/9. I will give myself those injections for 3 days and have an ultrasound and blood work Monday, Wednesday and Friday morning. Based off of how I am responding to the medication, they will adjust my dosage of meds. With the idea that I will be on the medication for 10 days total, my egg retrieval will be scheduled around 9/21.

I am incredibly lucky to have a boss who has allowed me the flexibility in my schedule to make this happen. Whenever I need to leave early or take a long lunch for an appointment, it is no problem. When we first started this process I told her how stressed I was about the whole thing. She reassured me that taking the time off from work for all of appointments was one less thing that I need to stress about. I told her today that Ill need to come in late after all my ultrasounds and she simply said :we will make it work". I couldn't ask for a more understanding employer.

Now that it is almost time to start everything I need to remind myself just to relax and take it one day at a time. We will be camping near Traverse City for the weekend and we are so looking forward to just relaxing and spending some time together. It will be nice to get away before starting our IVF cycle.

One last note:Today is Renly's first birthday and since we don't have human babies (yet!) we spoiled him rotten. I made him a pupcake (puppy cupcake) with apples, peanut butter and bacon and Brian got him a new rope toy that he absolutely loves. How did our little puppy grow so much in just a year?!

Giant Box of Needles

So my last post ended on a positive note. Our insurance had agreed to cover most of my medications and the total we paid was around $1200. We were happy with that and relieved to know that everything was set with my medication. Unfortunately we got a call at 7pm on Thursday from CVS and I've been too angry to even begin to write about it until now. Some new information had been sent through from our insurance and somehow we still owe over $6000 for all of my meds....what?!?! Needless to say I am not proud of the way I spoke to the woman on the other end of the phone. I still don't fully understand how we went from $1200 to $6000. They said the prices for insurance are different than out of pocket and I have $3500 max for all fertility meds. They must have forgotten to mention that. Anyway, we went back to mostly our original plan. I asked CVS exactly what meds I could get without going over the $3500 max, I was able to fill all 20 vials of Menopur and 2 vials of the Cetrotide. They threw in a sharps container and some alcohol swabs too. The rest of the meds we got elsewhere for a MUCH cheaper price.

We received the first giant box of needles from CVS yesterday.  I was surprised to see that the Cetrotide came in a cooler with ice packs. Apparently it needs to be refrigerated! We are still expecting 3 more boxes which should be here tomorrow. Brian convinced me to do an "unboxing" video because he says nerdy people like them. I probably should have gone through the box first though so I wasn't just guessing as I went along. I was totally wrong on the different needles! You can pretty much just ignore everything I say, its all incorrect anyway.

New Goodies 

Batman and Renly were more impressed by the box

On a non-med related note, we were expecting RGI to be done with our DNA probe last week. When I spoke with them last Tuesday they said it was on track to be done by the end of that week. On Friday our nurse, Ashley called and said that RGI had contacted her and it would be done the following week. I spoke with our genetic counselor, Divya, today and surprise...it's still not done! While the probe "might" be done next week, we did get the go ahead to start the next step with The Fertility Center. Divya will contact our nurse, Ashley, to give her the green light and hopefully we can get this thing moving. We are just hoping there are no more setbacks.

-Emily

Medication Update

In my last post I mentioned that our doctor had sent through an appeal to get my medications covered by insurance. 2 of the meds, Progesterone and Cetrotide, were initially approved, and 4 of them, Menopur, Gonal-f, hCG and Leuprolide Acetate, were denied. I called the specialty pharmacy department nearly every day to check on the status over the past few weeks. Every day I would get the same answer, “the appeal is still pending”. That is until Monday, when instead I got the answer I was looking for, “Approved!”

Menopur - Approved with just a $70 copay! Just this being covered will save us over $1500!

Gonal – f (Follistim) – Approved. The denied the Gonal-f, however they approved a similar drug called Follistim, saving us nearly $730. This medication seems like it will be more convenient for me. Follistim is injected using a pen like needle. I’ll just put the vial in the pen, twist the dial on the bottom for the correct dose, and use the teeny-tiny needle to inject the medication into the skin of my stomach. Seriously, this needle is tiiiiny! The dial on the pen will also be much simpler than drawing up into a syringe. We are planning a camping trip to Interlochen at the beginning of August, so if my timing is right, I’ll need to give myself injections in a tent. Not Ideal, but the Follistim pen will make this much easier.

Look how tiny that is!! 

Leuprolide Acetate – Denied again. We will need to pay full price for this one out of pocket.

hCG - Denied again. I will take the name brand, Pregnyl, instead which is half the price of the generic hCG. 

So they didn’t approve all of the medication, but 4 out of 6 is pretty good! We are celebrating this as a win. I ordered all the medication yesterday and I am expecting a giant box of needles and drugs to be delivered to my door on Friday. 

I have stressed out about every aspect of the IVF process and almost everything has worked out in our favor. This reaffirms our belief that we are doing the right thing, I received an email that RGI should be done with our DNA probe by the end of this week, my meds will be here on Friday and next week we will officially begin our IVF cycle. 

-Emily

Medication and Naughty Puppies

My last post focused on insurance coverage. They have approved most of the procedures I will need, but medication is another story. It is strange to think that they will pay for the procedures, but not the medications I will need in order to have the procedures completed. Our insurance company approved 2 of the 6 main medications I will need to take. We have prescription coverage through CVS Caremark, so of course we have to fill any covered prescriptions at CVS.

Cetrotide- Approved! Only a $70 copay on this medication. This would have cost us $1600 if we purchased it out of pocket at CVS.

Menopur - Denied - They denied this medication as I am under 37 years old and I have not gone through 3 failed rounds of Clomid (another drug that stimulates ovaries). I need 20 vials of Menopur, which would cost us $3,020 if we filled it at CVS. If insurance does not approve this after the appeal, I plan to fill the prescription through Alexanders Pharmacy in Portage. It is muuuuch cheaper there and we can get it for $1,538 total.

Gonal-f - Denied - This medication denied as our insurance requires the use of a similar drug called Follistim instead (they have some kind of agreement with the manufacturer). The Follistim however was also denied under the same reason as the Menopur. We can get Gonal-f from a pharmacy called Freedom Fertility for $954.50. We do however have a 20% discount card for any Sorono brand drugs so it will be $725.88.

Leuprolide Acetate- Denied - Our insurance will only cover this if it is needed to prevent premature luteinizing hormone surges. My grandfather actually to Lupron for this exact reason while he was fighting prostate cancer. CVS charges $445 for each vial and I need 2. Walgreens price is $325 so we can get all we need for $650 total.

hCG - Denied - CVS will only cover hCG if there has not been an inadequate response or adverse reaction to a similar drug called Ovidrel. The Fertility Center has a policy against prescribing Ovidrel. When I called Walgreens they told me that the generic hCG medication was actually over 2x the price of the name brands Novarel and Pregnyl. She didn't have an exact reason as to why, but she mentioned that most insurance companies will cover the generic version so they charge more for it...definitely not kosher. CVS charges $262 for the generic version and they didn't give me the price for the name brands. Alexanders charges $75 for the name brand and I will only need one vial.

Progesterone in oil- Approved With an $8 copay. This is on the cheaper side of the medication list, but every little bit helps!

I called pharmacies all over this side of the U.S. and even looked into pharmacies in Israel and England. The ones out of the country were a lot cheaper, but there is no way to tell how they are regulated. It would be hard to know how reliable the prescriptions would be. I had some prescription discount cards and coupons too so I had to take that into account. I made myself a nifty little chart so I could keep all of the different prices straight.

Isn't this a great looking chart!! :D

Renly apparently didn't like how the first one turned out. It actually made me laugh after a long day. I just wish I hadn't thrown my scrap paper with all the pharmacies and prices away...lesson learned. I pieced together what I could and called a few of them again.

Ashley, our nurse, said the doctor would be sending an appeal letter to our insurance company by Tuesday. They thought they might be able to get them to approve some of the denied medications. When I called on Thursday it had not been sent yet...maybe today. I am not expecting insurance to change their decision. I never thought I would be willing to pay so much only to stab myself over and over again! We will begin injections sometime in the next 2 weeks or so and I'm not expecting an appeal decision to be made by then. I will just keep price shopping for now. We have been surprised by how many things have worked out in our favor through this whole process, maybe this will surprise us as well!

On a more pleasant note, a good friend of mine made us this adorable bib :)

It may be a bit premature but she and her husband are moving to Canada (not because of the upcoming election) and she didn't want to to get lost in the move. Our collection of baby things has officially started.

- Emily

Insurance is a Beautiful Thing

Many of you have already seen my excited update on Facebook, but we got some amazing news last week! Probably the best news we have gotten ever in our journey towards a healthy baby.

We met with the billing department at The Fertility Center a few weeks ago. The woman who helped us seemed excited and told us we have great insurance that will cover most of our IVF cycle. This has happened a couple different times. They tell us nearly everything will be covered and then say none of it is covered when we remind them that we are not infertile. The billing ladies don't keep up on the medical side of things for obvious reasons, it usually doesn't change how they need to process insurance.  This time was different in that they had already sent the claim to insurance and it was initially approved. They did however still need to send in all of our clinical information. Our insurance company would review everything and make a final decision from there. She wrote out the total we would owe if insurance will in fact cover our cycle and the amount we would owe paying out of pocket...it was around an $8500 different!

We left the meeting expecting everything to be denied by insurance. Less than a week later, I got a call while I was at work...APPROVED! We will only owe around $500 for the rest of the IVF procedures. I normally don't answer personal calls while on the clock, but I recognized the number. I was so excited I had to tell the ladies at work. There were hugs all around. I realized then that everyone at work knew before Brian..whoops! This has lifted such a weight off of our shoulders and made this a much more pleasant experience. Insurance will unfortunately not pay for all of my injectible medications, which will add a pretty penny to our total, but we really shouldn't complain about that now. Our doctor is filing an appeal and we will see what they say.

Tomorrow will mark 4 weeks since RGI began working on our gene probe. We were told it takes 4-6 weeks for the entire process, meaning at any point in the next 2 weeks we will be getting ready to start injections. For now, we are celebrating insurance and counting our blessings! Good things are happening! :)

-Emily