13dp5/6dt - Woah Beta!

This mornings beta looked just fabulous! I was hoping for at least 800 with an optimistic 1200 but my HCG is officially 1642! Go little over achiever, go! My hormone levels looked good too, estrogen is 247 and progesterone is 24, and that's with just Endometrin, no progesterone in oil. Not bad for a natural transfer with no PIO!

I will never tire of peeing on these sticks #newhobby

The next check in is Saturday when they'll do another set of labs. The only bummer is that we've now officially completed our FET cycle so everything is charged by appointment again. Today's labs ran me $450 for HCG, progesterone and estrogen from today, and the Estrogen and Progesterone they added on to my last beta and forgot to charge me for. Going forward, that makes a regular appointment with labs and an ultrasound about $610 EACH time. Ouch. Still though, it's a really good problem to have. I'm going to see if I can have my labs run at Kaiser instead of the clinic since they'll cover 100% of them as part of my prenatal care.

As far as our ultrasound, it looks like we're going to have to wait a bit longer to take a peak at our embie baby. I had originally been told by a tech that we'd have one ultrasound at 5 weeks to confirm an intrauterine pregnancy and another between 6-7 weeks to measure the fetal pole, check out the yolk sac and maybe even see a heartbeat. Today the nurse said I'd have just the labs at the end of this week and then an ultrasound at around 6 weeks so it looks like we're skipping the 5 week one. I know it saves us a little money but it's a whooooole week longer I have to wait to lay eyes on this bub. It's crazy how we've been waiting so long for this and now 2 weeks seems like a lifetime away!

Nervous

Oh man, I'm feeling so nervous about tomorrow. It doesn't do me any good to speculate on the next ultrasound but that logic hasn't stopped me from running through all the "what ifs...?" in my head.

• What if we have even less follicles than yesterday? 
• What if the follicles aren't growing?
• What if all the follicles arrested?
• What if Dr. D wants to cancel the cycle?
• And in that vein, if he does want to cancel, how much will we be out?

I tried to talk over the possibility of having to cancel with E, just as a "what if" since he won't be at the appointment with me tomorrow but he didn't take it well. I was trying to figure out the numbers in my head and led with a figure waaaay higher than the actual amount, making him panic and freak out. Not at all helpful and not at all my intention. Crap.

I'm trying to be positive and hopeful that these 5 follies I have will look wonderful and mature and have healthy, perfectly fertilizing and growing eggs in them. That said, I can't not consider all the possibilities when the cycle looks so disappointing compared to last time. I think if Dr. D were going to cancel he would/should have done so already, instead of letting me stim for almost two weeks, so I don't see this happening. But, if we do have to cancel, the cycle rolls over and we are out the services/medications that we have already used. For this cycle, that would be:

• All monitoring appointments that I've had including ultrasounds and labs
• All medication I've used thus far 

This would leave quite a bit left to roll over:

• ICSI take two which we've already paid for
• Embryo Biopsy
• Egg Retrieval with anesthesia etc 
• Cryopreservation and storage
• Any unused medication, in this case it would be just the Novarel and a day of Menopur
• Any unused money ear marked for monitoring 

So really, it could be worse. If for some reason I walk in tomorrow and they say we need to cancel, we wouldn't be paying for the entire cycle all over again. It would just suck incredibly, but not as much as going ahead and getting no embryos.

Come on follicles. Come on eggs. I need you to be good and healthy in there. I don't think E could take cancelling a cycle and I couldn't handle giving up on getting more embryos to test. I've put too much of myself, my marriage, my heart, my hope, my love, my health, my body, into this to give up on one crappy cycle.

Disappointing Ovaries

Today we had another ultrasound and I'm trying really hard not to be super bummed. My right side, which is usually packed full of beautiful follicles, has basically pooped out in the most disappointing fashion. My left side is definitely more dominant this time and is picking up a bit of the slack, but not quite enough.

I was so bummed and distracted that I didn't take a legible photo of our sticky note to post. So, I decided to rewrite a more festive version to bring in some positive vibes. Last cycle we had 10 follies at this point and as you can see, we only have 6 this time and they're on the small and peaky side. My estrogen came in supporting their scrawniness at only 486 so we've still got a long way to go. 

Since the follies are coming along so slowly, I'm going to need to stim for longer than I'd planned. I bought enough Menopur for 11.5 days, through Saturday morning, and the nurse suggested that I'd need enough to get through the weekend. That means three more 5 vial boxes of Menopur from the Kaiser pharmacy for a total of just shy of $900. I was short on Omnitrope as well, I only bought enough for 8 days instead of 12 with the increased dosage, so I picked up a third cartridge of that which Kaiser was wonderful enough to cover for the second time. Small victories, I'll take them where I can get them.

Last night was also day one of Cetrotide and I'd managed to forget in the past 5 weeks how badly this stuff itches. It only lasts about 2 hours but my skin turns red, swells up like crazy and I feel like I need to scratch my skin off. I also hate the pre-filled syringes it comes with, they never prime properly and always leave a nasty bruise. Instead, I prefer to inject the liquid into the powdered vial, switch it out for a regular 3ml syringe, use the included mixing needle, and use one of my own 27 1/2 gauge needles to inject.  My 3ml locking syringes are always reliable, easy to prime, and the 27 1/2 needles almost never bruise like the too small 30 gauge or too long 27 3/4 needles. The smaller needles cut capillaries = bruise and the longer needles are the same thickness but go just deep enough to bruise too. Bleh.

I just finished injecting tonight's meds and I'm wishing, hoping, and praying that more follies pop up and that they all mature. I don't think the cycle is poor enough to cancel but I'm so worried we won't get enough mature ones to get our good embryos. Come on ovaries, you can go it. Grow follies, grow!

Easy Peasy Fix and Oodles of Follies!

This morning was my stim day 4 appointment and we got surprisingly good news all around! Since Friday and Monday seem to be the clinic's busy days, there was a decent line for ultrasounds and blood work and I decided to go up to the financial office first. I hadn't received a call back from my contact yet but when I went up to her office she had already listened to my message and was ready to help.

As I already knew, everything on the estimate was incorrect. She took the aCGH testing off first since we are paying Reprogenetics direct and then corrected the third cycle ICSI to the second cycle price. I thought she might go back on her earlier statement about only paying the biopsy fee once but she didn't! She looked up the payment records, saw that we'd already paid it once, and took it right off the bill. I have to admit, I was impressed. I was expecting a lot more push back for what turned out to be a 5 minute conversation. Basically, I was working myself up, worrying about nothing. Whoops.

I would have just paid for the ICSI today since I had the estimate in hand, but our credit card company has helpfully decided to replace my card due to "potential fraud". As one might guess, the potential fraud they're referring to is my charge to IVFmeds.com, a charge that I had already spoken to a supervisor about and approved. This still wasn't good enough for them so I'm now waiting on a new card to come in the mail, and my old one will only work if they're swiping it directly, which neither SCRC nor Reprogenetics would do. Given the hassle, I figure it's better to wait and give them a card they can actually run.

With that all sorted out for the time being, E and I went down to my ultrasound and even more good news. Both my left and right ovary each had 6 tiny follicles, for a total of 12 follies after only 4 (really 3.5) days of stims! The largest on the left was 8mm with the largest right following just behind at 7mm. This means the follicles are well synced and will hopefully continue to grow at the same rate so they can all mature together. If you recall, I wrote about last cycles stim day 4 ultrasound here and I only had 8 follies visible at that appointment. I did an extra two days of suppression for this cycle so I'm not surprised these follies were a bit smaller but I certainly wasn't expecting to have an extra four right from the get go!

What I'm wondering now, is whether or not I'll have to stim longer than last cycle to give these follies more time to mature their payload. Are two extra days of suppression enough to require an additional day or two of stims? I already have to order a third cartridge of Omnitrope, with the adjusted dosage the two cartridges I bought will only last about 8 days and I'm anticipating needing enough for at least 11-12 days. I don't know if I'll get lucky enough to have Kaiser cover this last vial like the did the other two, but it would be seriously wonderful if they could.

Please order more things. I don't have enough boxes!

My next round of ultrasound/labs will be on Monday so in the meantime, I'll try to send lots of positive, growing thoughts to my follies. We want to keep them all growing nice and evenly so they're perfectly mature and ready to be fertilized after retrieval.

The Financial Fuckery Begins

One of the main complaints I've heard about the IVF process is a distinct lack of communication between the actual IVF staff and the financial department. The financial departments of IVF clinics all over the country get slammed for poor billing practices involving incorrect numbers, screwed up payments and noticeably poor communication. Knowing this going in, I spoke extensively with the financial department for each lab/clinic we're working with and quadruple checked my numbers to try and head off any potential problems. I made a valiant effort but apparently it wasn't enough.

When I got home from work this evening around 8:15pm, I found this letter waiting for me from ART, the surgical center in my clinic.

Um, No.

As you can see, there are several mistakes. For starters, it lists my ICSI fee as being for a third cycle - this is only my second. I actually owe them $150 more than the bill says here.

Secondly, they want $3950 for aCGH testing. This is so far off that it's crazy. We did in fact decide to add aCGH testing on, but we're paying Reprogenetics directly and the fee is only $2,250. That's no where near 4 grand and there's no way I'm paying that to ART. All of our dealings with Reprogenetics have been direct, there's no reason SCRC/ART should have any part in fee collecting for them.

Their third and final strike is the $1650 for embryo biopsy. Here the number is correct, but we've already paid it. Before signing up with SCRC, I confirmed over and over again that the fee for embryo biopsy was once due once when purchasing their two cycle plan. As I've already paid them their $1650 when we did our first cycle, we will not be paying it again.

I'm hoping these were innocent mistakes but I admit it really cheeses me off. I went over this with all the different financial departments - SCRC, ART and Reprogenetics and I was so hoping we wouldn't get slammed with the usual financial fuckery. When our first cycle got billed correctly I thought we'd avoided any pitfalls but it looks like I got ahead of myself.  I left a voicemail for my financial contact at ART since it was way after business hours and I sent an email to my financial contact at Reprogenetics.

Your clinic and labs hold all the cards when you're doing IVF - they literally have your embryos, your potential children, the lab has my probe, and SCRC has over $20,000 of our dollars so it's not exactly like we can stamp our feet and refuse to pay if they won't fix the problem. With any luck, I'll get two satisfactory answers tomorrow correcting this estimate because there's no way I can give them another $6,600.

Lucky Break on Meds!

Unlike my last package of IVF meds, todays package came bright and early at about 10:30am! It had the remaining 43 vials of Menopur I'll need for this cycle, all well packed in bubble wrap. I even got an out for delivery notice from IVFMeds.com letting me know the package would be coming soon.

MeRopur!

I emailed their customer service Tuesday night asking about Meropur vs Menopur and their rep called me Wednesday morning. Instead of emailing, he wanted to explain to me personally that they were in fact the same drug by the same company, Ferring. IVFMeds sources their Menopur from several different countries in Europe and as I thought, this batch happened to come from Italy. Thus far, I'm once again impressed with their quality and customer service.

With my Menopur safely in hand, it was time to move on to my Kaiser order! I called them on Tuesday as well to confirm that my prescription was ready for pick up and got the all clear. So I climb in the car, battle through traffic, find a lucky street parking spot, and stand in line. I get up to the counter to pick up my "ready to go" prescription and surprise! it's not ready. The tech tries to tell me that he doesn't have it at all, I insist he does, and he agrees to get everything together if I don't mind waiting.

So I wait. And wait. And wait some more.

He finally calls me up to the counter only to tell me sorry, he doesn't have my Omnitrope. Le sigh. Again, I insist that he does have it, remind him that I got confirmation that it came in, and he's still insisting that he doesn't have it when another tech walks by and says hey, isn't that in the fridge? Oy. So he finds the Omnitrope, huzzah!, tells me he needs to write it up and I need to wait some more. Okay, I'm good with more waiting. And waiting. For another 20 minutes.

This time I get called up to the counter by a different tech, they go through my prescriptions and surprise! they don't have my big mixing needles. She can't seem to figure them out, apparently 22 gauge needles in the same quantity as the other needles is a complicated request, and she eventually decides to just make a new script for them. So again, I wait.

About an hour after I get there, the pharmacy eventually gets everything correct and ready to go! A third tech started scanning all my items, rang me up, and asked for my card to swipe at the station over so I didn’t immediately see the price. When she handed me the bill to sign I just about died - it was only $30!!! Whaaaaat???

My $15 Omnitrope!!

My last Omnitrope order ran me over $300. Whatever they did differently this time, my medication rang up as covered!  I kind of froze because it seemed too good to be true, I didn't want to draw attention to the price in case it was a mistake and I didn't want to pay more so ahhhhh I just signed the bill, took my bag and hightailed it out of there! I don't know how it happened but it was so worth the wait and I am so grateful to whatever they did to get my meds covered. This process is running us a small fortune and every little bit helps!

Cilly and Fuckie confirming via bodily inspection that I have removed all items from the bag

IVF Meds Package!

Look what finally arrived! My first batch of meds for this cycle :) I would have had them yesterday but it was Columbus Day and I completely forgot that there was no mail. Since I have to sign for the package or they won't leave it, I worked my schedule so I could be home today. Then I waited. 

And waited.

Annnnnd waited. 

All Day!

My other two packages from IVFMeds came at 10am and 2pm. This package didn't come until FIVE! I could have done a million other things not the least of which would have been to pick up my Kaiser order which is still sitting and waiting for me at the pharmacy.

This batch of Menopur came in blue boxes labeled "MeRopur". The last batch came in pink boxes labeled "MeNopur", the left overs are in the bottom right corner of the photo. A quick google search told me that it's the exact same medicine, by the exact same company, but its from the lot distributed to Italy where they call it Meropur instead of Menopur. Apparently the word or pronunciation of "Menopur" in Italian translates to something like "Not Yet" which Ferring thought would have a negative connotation. I opened each box to inspect them and make sure none broke in transit and the actual vials themselves appear to be the same vials, with the same med pellet but with different labels. 

The 5 Cetrotide were the exact same as last time, little kits with a vial of powder and a pre-filled syringe. The remaining 43 Menopur vials are on their way from London to New York right now and I'm curious to see whether they'll be Menopur or Meropur. I might call and ask but I don't think it makes a difference either way.

IVF Meds Take Two!

Now that the stim start date is inching closer and closer, I went ahead and placed my order for the next round of IVF! Since we had such good success with IVFMeds.com last time and the meds are SO MUCH CHEAPER, we went with them again. Even with the good amount left over from the extra we had to buy for last cycle I still had to order a tooooon of Menopur.

Thanks IVFMeds.com for saving me a ton!

Last cycle I had some extra Menopur left over from my second IUI and even with that extra, I still used a few of the last minute Menopur order. If this cycle is anything like last time, they expect me to use 90+ vials and stim for at least 11 days so I'm ordering over 80 vials of Menopur. Since I was one short last time, I also ordered 5 Cetrotide injections and hopefully that will be enough.

After the second batch of meds took a bit longer than was ideal to get here last time, IVFMeds.com offered to credit me the difference in cost for the extra vials I didn't use. I was skeptical because come on,  that's really excellent custom service, much more than I would expect from an online company based in another country. Instead of placing my order online, I rang up customer service and got the same wonderful rep that helped me last cycle. He remember me and my order snafu and in just a few minutes was placing my new order with a credit for the difference in the extra vials.  I'm still kind of shocked! It was all quick and easy, I rang them up, rang the bank to authorize the transaction since it got flagged again, and my nurse emailed me the new scripts to upload only minutes later. After all the calling and price checking and back and forthing of last cycle, I never knew the process could be so smooth.  

Impossible to beat these prices!

They're moving like ninjas this time and have already shipped out the first batch of my order, 40 Menopur and 5 Cetrotide. Like last time, I ordered so much Menopur that their pharmacy can't fill it all at once from in store stock so they're shipping it in two separate batches. This order went out on Friday so I'm not quite sure when to expect it. Priority Mail Express International does a lot of things regular Priority doesn't do, it's even delivered by a separate branch of USPS. If the package moves on Sunday, it should arrive in New York tomorrow and will probably be delivered by Monday. If it doesn't travel on Sunday, it'll hit the big apple on Monday and I'll get it Tuesday.  I also have to call Kaiser to authorize them ordering my Omnitrope and needles/syringes. The order was called in on Friday but from past experience I know they won't actually order it until I ask for it.

It doesn't make a difference protocol wise if the Menopur arrives on Monday or Tuesday since I don't need it just yet, but since I have to be here to sign for it in person, I have to plan my schedule around the delivery. Kind of a pain but well worth the savings!