And Then There Was One

So today's appointment showed that I'm down to one good follicle. The opaque or weird follicle on my right ovary was actually a collection of small follicles grouped together so they looked like one larger follicle. There are now 3 follicles on the left ovary, but only one is growing and developing while the other two aren't really developing at all.

The big follicle, the one with baby potential, is about 15mm which is a decent size for CD8.  My estrogen was 185pg/mL so it is going up, but still isn't ready to go. I think each mature follicle produces at least 200pg/mL of estrogen so my labs confirm just the one viable follie. I go back in for more labs and another ultrasound tomorrow morning which should give me an idea of when we're doing the actual IUI.  I'm pretty sure Wednesday is now off the table and we're looking at Thursday or Friday.

One thing that's concerning to me - I ovulate by myself every month. That's one egg developing each month without help from fertility drugs. It takes a little bit longer, I don't ovulate till day 16ish, but I do ovulate. Now I'm injecting 6 vials of Menopur, like $300 into my belly every day, and I'm still only developing one egg.

Does this mean I'm technically not responding to the Menopur at all? What does this mean for us if we need to do IVF? If I can only get one egg off of this many hormones, how am I going to get enough for IVF with PGD?

Hopefully we won't need to go there. This cycle is going to work. I'm going to get pregnant with a healthy baby from that lovely little follicle on the left. This is going to work.

Jinx

At my ultrasound appointment yesterday, the nurse asked me if I was having any side effects from the Menopur I've been taking. Apparently it can cause cramping and a whole lot of other unpleasant side effects in many people. I was happy to report back that I felt just fine, no cramping, and the injections *didn't even hurt OMG yay!* as long as I did them slowly! I felt like I could ride off into the sunset on a rainbow shitting unicorn on because I felt great! *insert some rainbows, sunshine and glitter shit here*

Ha Ha. Not.

Yeah. Because that's not painting a big huge target on my back for fate.

So, naturally, the second I left the doctor's office I started to feel sick. Then I remembered that I had had some digestive upset when I woke up that morning, but I'd attributed it to nerves. I sucked it up, blamed nerves again, and went to my acupuncture appointment. I told my acupuncturist, S, all about the insurance woes and my low estrogen and she told me she'd already received a call from my RE, Dr. K, that morning.

Dr. K actually called S, personally, because she believes in what she does. Even though S sees Dr. K's patients and is a Nurse Midwife at Kaiser, S said she's never had a doctor personally call about a patient before. Dr. K asked her to please do whatever she could to help me, to try and get as much blood flow to my ovaries as possible because we have to help my follies develop and get my estrogen up or this wasn't going to work. This really choked me up, I don't know how my chances are looking for this cycle but I really love my infertility team. I couldn't ask for better, more supportive doctors.

With specific marching orders in hand, S began my treatment to clear out the cold and phlegm and get my blood flowing. I also told her about my weird stomach pain so she added on a stomach treatment for that. And for the first time ever, those needles hurt. She put the first one in my foot and my leg nearly jumped off the table. "I'm sorry," she said, "you're much more sensitive today. The Menopur can do that, make your skin much more sensitive". Ow.

This was the 4th time I've done acupuncture and the first time it's ever been uncomfortable. Each needle hurt a bit going in and was sore during my hour, although I was able to ignore it and focus on visualizing all my energy going to my ovaries. S strongly believes that you need to put positive energy out there so I'm sending every positive thought I've got down to those follies. Afterwards, the points in my left wrist and left foot were actually too sore for me to put my watch or sandals back on, another first. I usually feel relaxed and refreshed after a session, not sore.

Before I left S also told me that she had a patient who might have some extra Menopur. She had been planning to donate it to another woman who ended up not needing it so it might be available for me! This would be so, so wonderful, with the increase to 5 vials a day, I don't think the stash I just bought is going to get me through this entire cycle. I might also be one of those people who are slow to stimulate and require a couple extra days of injections, which would mean I'd definitely be short.  I should know on Monday if she still has the Menopur available.

As for the side effects, they continued for most of the day. S's stomach treatment worked for a couple of hours, but the general stomach pain eventually came back. I didn't feel nauseous, crampy, and I didn't have ovarian pain, my stomach just hurt. The injection was also much more painful last night, the needle itself was really uncomfortable for the first time and it took me a good 5 minutes to inject all the liquid. Even though the acupuncture hurt, I somehow wasn't expecting my injection to hurt and was completely surprised when I stuck the needle in and my skin went OWWWW. I hope this is a temporary side effect because I have at least 5 more injections to go.

E2 Labs and Ultrasound

I had my ultrasound and labs this morning and the results were mixed. The good news is that we saw at least two little follies growing, one about 12mm and the other around 11mm! Two potential chances, I'm over the moon. There was also another follie that looked a little bigger but it wasn't quite right, the opacity was somewhat off or weird, so we're not holding our breath for that one. Two is still awesome even if its not the 4-6 we would have liked.

The not so great news is that my estrogen is still low. It was only 68 on Stim day 5 so I'm upping my dose of Menopur to the even more impressive, dun dun dun! 5 vials per day. We didn't start off on the max dose so we could move up if needed and that's what we're doing. Unfortunately, the initial egg recruitment is already done so we aren't likely to get more follies than those already there. She did see 4 more smaller follies on one side, but it's unlikely they'll grow big enough to ovulate for our IUI. The med increase also means we probably won't have any left over for IVF if this doesn't work. Fingers crossed it works!

5 Vials of Menopur is $287.60 per day. Ouch.

E and I also went ahead and ordered our vial of premium IUI quality sperm! I'm pretty excited to actually have a chance at getting pregnant this month since it will be our first opportunity to really have a shot. We pick up our swimmers on Tuesday in preparation for our IUI on tentatively Wednesday or Thursday if everything goes okay.

The next ultrasound is Monday so I'll have three days of 5 vials per day under my belt by then.  Please send all good vibes, thoughts, energy, etc to my little follies. In the meantime I'm going to acupuncture today and will ask her to do everything she can to get my lining thicker, my estrogen up and my follies healthy. I need those babies to grow!

$2,000 down and 4th Injection Done

Since it's become apparent that the insurance company has no intention of honoring their original medication coverage, I bit the bullet today and paid for my meds out of pocket. It was painful.

My first stop was Kaiser. I got the Menopur there for $57.52 per vial which is an excellent price as far as I can tell. I should have also purchased my Endometrin there, but there was a minor miscommunication with the other pharmacy I was purchasing from. They quoted me a cheaper price than Kaiser, but neglected to mention that my RE had ordered two boxes of Endometrin, not one.

When I checked out, the pharmacist said he'd never rung up a bill so high in the 6 years he'd been working there. He'd never seen anyone pay 100% OOP for fertility drugs, the most he'd encountered was 50% and he was astounded that we had literally no coverage for the meds. He actually wasn't sure the system could ring up a bill that high and it did decline my card the first time I swiped it. The second time it worked, with extra authorization, and I left with my $1725.80 worth of Menopur.

The next stop was Northridge Plaza pharmacy, which had my Orvidel for around $77, which was great, but my Endometrin was over $200 for two boxes. I ended up checking out at around $295 and here my card was declined again. I ended up having to call my credit card and assure them it wasn't fraud before they would allow me to make the purchase. They promised it wouldn't happen again and I let them know I'd be making another $800 purchase in the next few days.

While I was waiting on the phone, a woman came up to purchase her trigger shot. She's doing her IUI on Saturday and was thanking the pharmacist for running her Menopur through her insurance. Apparently her Menopur was only $30 and she was so happy she almost cried. I wished her luck, looked down at my $1725.80 worth of Menopur (I was afraid to leave it in the car) and hoped/wished/crossed everything I had that this cycle yields a healthy baby.

On the way home from Northridge, the wood inset on my driver's door handle literally fell off on my foot. It felt like the universe was just rubbing salt in my wounds. I know my car is over 10 years old but I can't pay for insanely expensive fertility medication and a new car at the same time, so she's just going to need to hold herself together. I super-glued the panel back on with some Gorilla glue and I hope nothing else decides to fall off my car in the meantime.

Finally, today was CD4 and injection number 4. It burned like last night but I didn't have any problems with bubbles so the entire process went a lot faster. My routine takes about 15 minutes, I turn on my music, sterilize everything, mix up the injection, put it away, go pee, sterilize everything again and give myself the injection super, super slowly. I could probably shorten the process but it seems to be working for me and there are a lot of vials to sterilize :/

Tomorrow is my next ultrasound, please let there be lots of little follies growing in there!

Injections Day 3 and OOP Expenses

After crossing everything I have and holding my breath and arguing and hoping that my insurance would come through and pay for my meds, they have predictably decided not to cover them.

E and I were not expecting to be shelling out this much for a week's worth of medications, but since we have no other options, I called a every promising pharmacy I could find and comparison shopped. I think I've got the best prices I'm going to find between two different pharmacies so I'm heading over tomorrow to pick everything up. I still need to get 30 vials of Menopur, one Ovidril injection and 30 Endometrin capsules.

Today was also day three of my Menopur injections and this one was probably the most physically uncomfortable. There was a bubble that was a huge pain in the ass to get out and then the liquid burned like hell going in. It's still uncomfortable now and I'm starting to think my left side might be more sensitive than my right. Bleh.

Positive thoughts. I'm thinking positive thoughts.

Insurance Run Around and the Second Injection

Today I woke up a little sore. I was expecting most of the uncomfortable feeling from last night's injection to fade but it has stayed with me pretty much all day. It's not awful, just noticeable when I move around or bend over,  like some kind of tender heaviness in my stomach.

I spent pretty much all morning on the phone with insurance companies (aka on hold). My first call was to Kaiser, who reiterated that I should have coverage but oh wait, apparently I don't. The service operator at the Kaiser payment assistant center is also undergoing fertility treatments so she was sympathetic when I asked about discounts for cash customers, but she couldn't help. Her supervisor suggested I call Medi-Cal, which was just laughable.

Next I called our health plan provider, who said we have a separate prescription plan independent from Kaiser. This is news to me, considering that we've been getting all our prescriptions at Kaiser without issue until now, but okay. I rang them, they said hmm I don't think it's covered but it's on the list for injections so they transferred me to a different company that handles injections.  They said sorry, we don't cover infertility meds and transferred me to Freedom Fertility. We still have no idea if we have any kind of insurance for our prescriptions but my RE faxed over my scripts and we should have an answer tomorrow. Either way, I'm running out of donated meds so we'll have to get some in hand soon. Please keep your fingers crossed.

(Batiuk)

After my gym class today, I took my second Menopur injection. It was much less eventful than the first since I think I got out most of my internal despair yesterday. I didn't burst into tears at the sight of the syringe and I was able to psych myself up for it fairly quickly with some good music and a few deep breaths. This shot also burned a bit less so I'm hoping the injection site is less sore tomorrow morning when I have my next gym class. It still hurt to bend over and squish my tummy, but again it's really not that bad. 

My goals for the rest of the week are to sort out the prescription debacle and stay positive. We still have a 50% chance for a healthy baby if this works and stress will not do me any favors.

The First (Injection) is the (Hardest), Baby I Know

After the disaster of an afternoon, I was hoping to relax, take my amazingly donated Menopur and lay low. I laid everything out as instructed and began mixing all my vials.

One dose of Menopur

Since my ovaries are unlikely to respond well to stimulation, I'm taking 4 vials of menopur in 1cc of sodium chloride. The Menopur comes with this awesome little Q cap that allows you to draw up the liquid, inject it into the first vial of powder, mix it up, draw up the liquid, inject it into the next vial and so on and so forth. I'm taking 4 vials, so I do that 4 times.

This process I'm very comfortable with.  I've worked in several different labs and I mixed everything up methodically and with little thought. Sterilize the tops, mix the liquid, prep the syringe and pop on the needle. It was a perfect syringe, no bubbles, precisely measured and ready to go. Except this time, I wouldn't be injecting a mouse or one of my cats, I'd be injecting my own pinched belly.

I took a breath, moved the needle close to my sterilized skin, counted 1, 2, 3 and Lost. My. Shit.  I deal with our infertility by intellectualizing it, researching, and telling myself we'll be a positive statistic. After today, all my emotions were lurking just below the surface and I couldn't distance myself. I looked at that needle and the full weight of everything we're going through, the very likely possibility of having to terminate the baby conceived with some other woman's generously donated Menopur, hit me smack in the face. I completely broke down, started sobbing, and had to put the cap back on my injection.

Teensy needle, why do you (emotionally) hurt so much?

I texted E, who was wonderfully sweet and supportive, but who wouldn't be home from work until after 11. I paced, I cried, I tried to settle myself down with some music, but nothing was working. The first IUI appointment, the pharmacy problems and my mother's questioning weakened my barriers enough for one, tiny little needle to break down my carefully built walls like a bulldozer.  It was bad.

I'd say it took me about an hour to stop crying, pull my shit together and just give myself the shot. Four sequences of sterilizing, uncapping, pinching, recapping, crying, and attempting to process what this little shot symbolizes before I could take control and do it.

Realistically, these Sub Q injections aren't bad. The needle is so tiny and sharp that you barely feel it going in. Actually injecting the liquid is fairly uncomfortable, you have to go really, really, really slowly, and it dose burn a little as well. Overall it was slightly physically uncomfortable but not horrible, and probably wouldn't be too bad emotionally if you aren't brutally shoving your feelings down in an attempt to cope. The spot is still sore a hour later, so I wouldn't go to the gym right after, but it's nothing terrible.

Advice for those just starting out: The shot doesn't hurt badly, but if you're not emotionally coping with your infertility, have someone help you with the first injection.

IUI: The Disasterous Beginning

So after years of trying, we're finally starting a process that just might work. Today I went in for my baseline ultrasound that gives the RE a starting point for my IUI. This was the hopefully beginning of the post that I wrote this morning before I went to my appointment. It's not the opening I would have chosen afterwards. That would probably go more like:

I went to my first IUI appointment today. The ultrasound went great but the latter half the day was a complete and utter disaster.

I got to the hospital on time, with the 15 minutes to check in I always seem to miss, and after circling a couple times I lucked into the best parking spot. 2 hours of free parking? Yes please! I thought this was a sign our IUI was off to a great start and gave myself a mental fist bump. 

I met a new OB/Gyn and some really sweet nurses who were great company while they checked me in. I couldn't pee right away for the pregnancy test we all knew would be negative, even though I'd guzzled water, so the nurse let me proceed and said I could pee later. The ultrasound itself was a little uncomfy (as if a wand going up your girly bits could ever be anything but uncomfortable) and I had 9 antral follicles! That is AMAZING for me,  I've never had more than 7 follies. I would have danced on the table but the OB still had the wand so I settled for telling her how pleased I was with my body and how acupuncture seems to be working. 2 extra antral follies after only 3 acupuncture sessions and a week and change of herbs? I'm sold.

(I love your comics Phoebe Potts)

The nurses have the routine down, so after my ultrasound I went over my treatment with the OB and discussed the massive amount of meds I'm going to be taking. She was nice, was familiar with my file and we joked about the insane prices of donor sperm. There is always a long line at the pharmacy, so the nurse had me go down and put in my prescriptions before getting my injection training. I went back up, watched the nurse mix pretend Menopur, she told me how easy it would be to inject myself and then sent me on my way to go pick up my meds. I still hadn't peed yet.

As predicted, that pharmacy line was LONG. It took me about 30 minutes to get through, standing behind a high school student hiding a pregnancy test against her leg and hoping no one would notice. I felt badly for her and hope she got the negative she wanted, she was clearly terrified and wishing to be anywhere else.  It's nice to know I'm not so dead inside that I would resent the fertility of a scared teenager, though I did resent the lazy father telling his 2 year old he was going to tie her up (stroller) if she didn't sit still and be quiet. She's 2 asshole. 2 year olds aren't designed to sit still and be quiet, with no entertainment, for 30 minutes.

Finally I get to the front of the line and the pharmacy assistant starts pulling out box after box of drugs. There's a crap ton of menopur, my ovidrel trigger shot, progesterone, needles, and syringes. She starts ringing them up:

Her: Wow, this is over 1000 just for this? 
Me: Yeah, fertility treatments are expensive :/
Her: This is expensive, over 2000!
Me: You mean before insurance? Cause we should have 100% coverage
Her: Uh, no...you pay 100% All of it. $2000 please.

SCREEEEEEEEEEEEEEEEEEEECCCCCHHHHHHHHH

We are NOT supposed to pay 100% out of pocket! The whole reason we switched around insurances and paid a fortune to the union was so we would have infertility coverage! It's been confirmed numerous times by different people and now they're telling me to fork over $2,000 for a weeks worth of meds?????? I explain all this to the assistant, she enlists another assistant and freaking out, I head back upstairs to go pee in my cup and panic. 

I explained the whole thing to my nurse, and then to my doctor, who also insisted we should have coverage. When my nurse called for help, the pharmacy services insisted we had no coverage and hung up on her! I couldn't believe it and I kept trying to get ahold of E to ask if I should go back down and spend $2000 on the meds since we can't not have them. While I was doing that, the nurses were angels and scoured the office looking for donated Menopur for me. I was so thankful I almost cried, they found 4 boxes, which is 5 days for me, and told me to call back in the morning to see if we can fix things. If not, my doctor said she'd put in a prescription at a cheaper pharmacy for me and we'd just have to pay out of pocket. The nurses kept saying they hoped the donation would pay off with a baby, and I didn't have the heart to remind them there's a 50% chance I might have to terminate if it works. I almost cried again.

With donated Menopur in hand, I went back to the pharmacy and paid for my needles and syringes. They were really apologetic but I had to leave without the rest of my meds. I drove home somewhat shell shocked, where I met my mother who wanted to talk to me about my premutation. Apparently, although it's insanely rare, my premutation was passed down by my father, not my mother. She wanted to talk, discuss options, make me an appointment at UCLA and offer us money we're not sure we're comfortable taking. I wanted to scream that I've been over the options and back over them a million times, but it's not something we feel comfortable discussing with her. My defenses were low and I explained more than I wanted to, when I really just wanted to go cry in a corner.

Why are you so expensive???

I really hope we can get this prescription problem sorted out. I need enough Menopur to stimulate a large horse and it will be insanely expensive out of pocket.