Follies Ahoy!

Day 4 of stims and my ultrasound showed at least EIGHT follies! This is the best start to a cycle we've had yet!  And although I'm not getting my hopes up, the tech actually wrote 4-5 for each ovary, but I could only see 4 on each when I looked at the screen with her. Maaaaybe 5 on the right side, but she went pretty quickly. They don't measure each follie individually until they're bigger, mine were all under 10mm. They did all look about the same size though which is wonderful, I didn't see any lagging behind or pulling ahead. I forgot to ask my nurse what my estrogen level was since I missed her call and she left a voice mail, but I will definitely remember to ask next time. Until then, my marching orders are to continue with our existing protocol.

I didn't realize E had snapped this photo :) There are my 8 lovely follies, and my lining is 7.7!

I had the same phlebotomist this time as my last appointment, but I decided not to mess around and went straight for the hand. I told him about the bruising from last time and he agreed he'd rather go for the vein he knows he can get in one go, rather than poking and jabbing and bruising me again. It stung again but didn't leave a bruise and it didn't hurt nearly as much as being repeatedly poked.

Our next appointment for ultrasound and labs is Monday morning when I also do my blood draw for PGD and bring in my donor vial to be sent to Reprogenetics. Our clinic's lab guy said he'd rather all our genetic material go out at once so he asked me to let the clinic send the vial instead of having the cryobank send it directly.

Tomorrow I'm expecting my second package from IVFMeds.com and I NEED that package to come on time. Thus far it's mimicked the same delivery movements as the first package and it should be right on schedule for tomorrow morning. I've posted signs on the door for our postman to Not Leave without delivering the package, and there should be someone home all day. If the package doesn't come, I will be completely screwed and will have to rush to a pharmacy and get vials for the weekend. I don't think the Kaiser pharmacy is even open over the weekend so that package has to come on time.

Thinking positive, I'm so excited for those 8 follies. Sticking myself at least 3 times a day will be all worth it if this works!

Vials Ordered!

Today we were able to check off another thing on our IVF checklist - we officially ordered our donor vials! The doctor in charge of PGD at SCRC has started coordinating with Reprogenetics to get our genetics package ready to go. I was going to ask for a blood draw for PGD tomorrow when the phlebotomist is already doing a draw for estradiol but the PGD doc said no. He'd rather send all our genetic material at once, and since he doesn't want to ship our package on Friday, he asked me to come in and get it done on Monday. 

He's also ready for our donor DNA so we went ahead and placed an order for 5 vials. We're going to pick up 3 of them on Monday morning and hand deliver them to SCRC ourselves when I get the draw done. That way he can send our vial and my blood sample in the same package - I might even try to get my mother and sister's saliva samples in the same box but I don't know if the kits will come in time. The other 2 vials will be stored at CA Cryo in case we need them.

I realized I never got a good shot of the EU Menopur mixing needle so I snapped another shot this morning. This was the first batch I'd mixed entirely via needle and it did take longer than it does via Q-Cap. It also seems to get more bubbly which means I spent more time tapping out bubbles and waiting for each vial to settle. 

EU Menopur and mixing needle

The EU Menopur vials are the slightly larger vials with the blue caps. From left to right, you have the 3ml syringe, the mixing needle and the little injecting needle. The mixing needle is really flexible which means you can get into those corners to get every drop, but you do have to do a lot of wiggling and sucking to get everything.  More than once I ended up with bubbles on the bottom and had to empty the liquid back in, swirl and tap out the bubbles, and then draw everything back up. It takes awhile to mix a lot of vials. 

As for the HGH, I had good luck with the Omnitrope last night and managed to not bruise myself! I did my injection a little closer to my belly button and aside from the heat and soreness that night, there's no other sign of injection besides the tiny pinprick. I'm about an hour away from prepping this evenings injections and will hopefully continue the good luck!

Day Two of Stims!

Today was day two of my stim injections and I think I'm finally getting back in the swing of things. The first day was a little tough, I felt unexpectedly nervous and my heart was pounding in anticipation of the Menopur burn. It was pretty much exactly as I remembered it though, and by this morning it felt routine again.

Now that I've tried a few of the new medications for this cycle, I'm starting to get a feel for how everything works in practice. Thus far:

• Omnitrope (HGH) - this is one bubbly sucker. The solution is really fragile, you're not supposed to shake it and it bubbles at the slightest provocation. This can be a pain in the ass but since I got the cartridge vials and not the 5.8 vial I'd have to mix like the Menopur, I'm not complaining. I have to draw it back and inject it with the same needle which does dull it slightly, and I do have a small bruise at my first injection site. I also have some heat and soreness at my injection site this evening but I can't tell if its from the Menopur or the Omnitrope since I injected them on the same side. I do morning injections (4 Menopur) on the right, and evening ones on the left (4 Menopur and 0.25 HGH). I might switch things up tomorrow and inject the Omnitrope on the right to give my left side a break.

The cartridge vial is so skinny, but you can still draw pretty well from the rubber stopper at the top.

• European Menopur - I decided not to use the glass ampoules that came with the EU Menopur since I have a ton, like 5 boxes, of the sodium chloride vials left. I tried to give the Q-caps a shot and they do fit on the EU vials, but the rubber stopper in them isn't ideally shaped to extract all the liquid. I have to use the big mixing needles to get every last drop and it takes a bit longer to do. I also had a nervous scare when I combined cold sodium chloride with room temp EU Menopur powder and it turned instantly cloudy. Cloudy Menopur is supposed to be bad Menopur but since it cleared up after about 30-45 seconds, I deemed it okay.

You can see the hole in the rubber stopper is only in the center of the stopper, which means liquid can pool around the sides. The US vials have a long slit to better capture liquid from all sides.

I can already tell my belly is going to be bruised and poked and sore once this cycle is over. Three - four injections is a lot for a day and I'm going to run out of places to stick the needles since they all have to be injected in the same area. I can't rotate between belly, thighs, butt, etc, they all go into the same section of my lower belly. Owie. 

IVFMeds.com had good news, my second package finally shipped! It ended up going out two days later than it was supposed to which necessitated 2 more phone calls to customer service asking why I hadn't received tracking info yet. I would have liked it to go out sooner but if it travels like the first one did, I should have it in time. The customer service rep also said that if my medication didn't come in time, they'd reimburse me the difference between their cost and the cost of the vials I'd have to buy locally. It was a really nice offer but I'm hoping I won't have to take them up on it.

I also got a good convo in with Reprogenetics and they've put my blood and saliva kits into the mail. I have to send in a vial of my blood, a saliva sample from my mother and my sister, and a single premium IUI vial of our donor. They were originally requesting two vials (~$2,000) but their lab agreed we could go with one since these are really high yield vials instead of the low yield kind they'd usually be sent for PGD. That saves me an extra $1000 which is excellent, every little bit helps!

IVF Protocol a bit Clearer

Today I picked up my Omnitrope, needles, syringes and Dexamethasone. Kaiser is usually great about prescriptions but this time they were way off - they gave me Omnitrope cartridges in a weird dosage without the pen to inject them, they forgot my injecting needles and only included the mixing ones, and they only had half the needles and syringes I needed. I ended up spending 30 minutes at the counter while they tried to sort everything out and I still ended up without the pen for the Omnitrope. When I called my nurse to talk over it and find out more about my protocol, she had never worked with Omnitrope in this form before and had to sort out how it's going to work. It looks like I'll have to draw it up and inject it with the same needle, which is going to blunt the needle and make it hurt more -_- I'm not excited about that part.

Although I was hoping for only a couple days with tons of injections, it looks like I won't be that lucky:

CD 1: Nothing
CD 2 - 14: BCPs
CD 15 - 17: Nothing
CD 18 - 25:  2 injections of Menopur (4 and 4), 1 injection of Omnitrope and 1mg Dexamethasone

At some point I'll add in an injection of Cetrotide for 4 days, bringing my injection total to 4 injections per day. My little belly is going to be so, so sore! I have to go in tomorrow morning to get the small needles and syringes I'll need for the Omnitrope so I think I'll ask the nurse if I can inject the Omnitrope into a different place. If I'm already doing two injections into my belly each day, I'd really like to not have to add two more to the same place.

I was going to insert a photo of my new supplies in here, but I'm too lazy to take one right now. Just picture lots of needles and syringes, including big mixing needles, and I'll post one tomorrow when I'm less lazy.

Cleared To Stimmmmm!

It's official! I have been cleared to start my injections on Tuesday. They're going to start me off with the same 8 vials of Menopur per day, split into two doses. I think they might also want me to start taking the Dexamethasone soon as well, so I'm going to pick up the bottle, my needles/syringes, and the Omnitrope tomorrow.

Thus far, I think the protocol will look like:

• CD 1: Nada
• CD 2 - 14: Birth control pills
• CD 15 - 17: Nada
• CD 18 - 21 : 8 Vials Menopur + Dexamethasone?
• CD 22 - TBD

The Menopur makes two injections, the Omnitrope a third, and the Cetrotide a fourth. I think I only need to take the Cetrotide and Omnitrope for 3-4 days though, so there won't be too many days with four injections. I'll take any silver linings I can find lol.

The Omnitrope, a brand of Human Growth Hormone (HGH) is a bit of a gamble. For a group of women, usually those with poor egg quality or diminished ovarian reserve, adding HGH can really improve egg quality and fertilization rates. It can sometimes contribute to higher egg quantity as well so I've got everything crossed that I'm one of the women it helps. With 7 antral follies on the ultrasound, I would do anything to turn as many of those as I can into healthy embryos.

(Source)

Come on Yoda, I need the force to be with me!

First IVFMeds.com Package!

My first package from IVFMeds.com arrived! And it was, surprisingly, right on time. I know I've already admitted that I was really nervous ordering from overseas - if you google IVFMeds.com there are a couple reports of people complaining about problems with shipping speeds, packages getting stuck in customs and trouble getting refunded. They all made me pretty uncomfortable but since my nurse had never had a problem with them, I ordered anyway. 

.....And then called their customer service line about 10 times. Asking about their process, asking about their shipping methods, confirming the order, confirming the prescription for the order, asking about when the package might be here, asking about when the second package should ship - you get the point. I called a lot.

Each time I rang, a customer service rep answered quickly and courteously. I had no problems getting through, they were helpful and friendly, and more importantly they gave me correct information. The British gentleman who answered my last call about the estimated delivery date and the second package shipping was spot on - he told me the package would arrive Saturday (today) and that I needed to have someone home to sign for it. If there wasn't anyone home, he promised me the package wouldn't have any identifying information on it and suggested I leave a note for the postman and ask a neighbor to sign for it. Since they had to split my order into two shipments, the second would be going out Monday and should arrive Thursday.

Excellent packaging

 

The postman pulled up right on time Saturday afternoon. I almost missed him because he heard my dogs bark and decided to just drop the note in my mail slot and run without ringing the doorbell. I'm so glad I had the heads up from customer service or I wouldn't have been lurking around waiting for him. This one didn't exactly have nerves of steel.

On to the package! The order came in two envelopes - an outer poly bag with no identifying marks and an inner padded envelop. Each box of medicine was wrapped in bubble wrap, and since this order contained 32/72 Menopur, my two individual vials of Menopur were bubble wrapped and then placed inside a separate small box. I opened each package to inspect the vials and every one of them arrived safe and sound.

As I expected, the European Menopur comes with glass ampoules of Sodium Chloride instead of glass vials. You're supposed to snap the tops off at the marked weak point and draw up the liquid with a needle and syringe. The US Menopur comes with glass vials and Q-Caps - these little plastic caps that snap onto the glass vial and allow you to mix the Menopur without a needle and syringe. It doesn't look like these ampoules would be terribly hard to use, but since I have tons and tons of Sodium Chloride vials left over from my IUIs, I don't think I'll need to use these. I will probably just use the American Sodium Chloride vials with a Q-Cap and a European Menopur vial. The European Menopur also comes 10 vials to a box, while the US version comes 5 vials to a box.

The European Cetrotide is something I haven't used before, but it looks fairly easy to use as well. The packages came with a syringe pre-filled with a liquid, a vial of Cetrotide powder and two needles - a large one for mixing and a small one for injecting. It looks like much the same process as the Menopur and I assume it's similar to the American version of Cetrotide. Inject the liquid, mix it around, draw it up, swap the needle and inject.

Thus far I'm really pleased with IVFMeds.com - their service has been great and as long as my second package comes on time and the medicine works as it should, I will have no problem recommending them to anyone else going through IVF.

Ultrasounds and Shitty Labs

This morning was my first IVF appointment. It was a quick one, just a pop into the office for my pre-cycle ultrasound and labs.  I've done this routine a million time for my IUIs so I wasn't too nervous about going in.

The first stop was the lab for my estradiol draw. I asked the phlebotomist for a butterfly, warned him that I have difficult veins and pointed out the exact spot on the vein that would be easiest to draw from. He seemed really nice, confident and I thought he'd get it in one go.

Boooooooooy I was I wrong.

The first stick brought no luck, so he tried again. He wiggled the needle a bit here and there, tried to poke it in at a different angle, moved it a bit more and then tried again. I know I'm a difficult draw but at this point I couldn't help but compare him to the nice Kaiser tech in the infertility lab who always got my vein on the first go and used to chat with me about his weekend plans. Another wiggle, an under the skin angle adjustment, another poke, a particularly painful jab and the phlebotomist gave up. I was already bleeding, starting to bruise and he seemed no closer to reaching my vein than he had been before he put the needle in.  I was seriously unimpressed at this point and starting to sweat, which is my go to physiological response whenever I'm in pain and nervous. Ugh.

This one still hurts. That's all blood underneath the bottom tape.

After conceding defeat, he announced that he'd have to draw from my hand. Um, what? He promised it wouldn't hurt more than a bee sting (last I checked, bee stings aren't fun), had my flex my wrist and make a fix, and then stuck the needle into the top of my hand. He was right, it did in fact hurt like a bee sting, but since he'd finally struck blood I decided not to complain so I could get the hell out of there. Two cotton ball and tape band aids later I was free.

I've never had a hand draw before. I see many more in my future :(

The next stop was the ultrasound, which went off as it usually does. The tech was nice and efficient, sympathized with my many cotton ball bandages and didn't have to push hard in any direction to get a clear view. My ovaries are nice and suppressed from the birth control with seven little antral follicles snoozing away. The teensy simple cyst is still there on the left side but doesn't seem to be hurting anything. My estrogen eventually came back at 20, confirming the suppression.

The next decision is what to do about stims. I am clear to stop the birth control today, wait two days, and then start stims on Saturday. However, they only just shipped my Menopur from the UK. I'm supposed to have rush shipping but I have a hard time believing they will be here that quick. I have 15 vials of Menopur left over from my last IUI but that's one short of two days. If today is the last day for birth control and I bought one more vial of Menopur at Kaiser, I would have meds for Saturday and Sunday but my package would have to be here Monday morning for my morning injection. I don't see that happening.

The nurse said I'm clear to stay on the birth control pills a few more days if I want. She said I could easily take them through the weekend with no problem and not be over suppressed. I'm thinking maybe I'll split the difference, wait to take them until I hear more about my shipment. If it's coming right on time, I'll stop the pills on Friday or Saturday, and if it's running late I can get some Menopur from Kaiser or stay on the pills till Sunday.

Owie :( Nasty bruise is already forming

 

IVF Medication Costs and IVFMeds.com

Anyone going through the IVF process knows that medication pricing is a super aggravating, time consuming process. Every pharmacy has different pricing and everyone you "know" who has done IVF purchased their meds from somewhere different. To find the best price, you need to make a whole lot of phone calls.

I began my search with my IVF clinic - who do they recommend, where do they usually send people. They, predictably, recommend the pharmacy across the street from them. They have a good relationship with them and they always have the meds they prescribe in stock. They're pricing wasn't bad but it certainly wasn't the best.

The next stop was google -I read through pages and pages from different forums cataloging the experiences of other women. From that, I picked out a handful of other pharmacies to check out, in addition to my standby pharmacy, Kaiser. They all had different prices and not all of them stock all my meds so it was pretty obvious I'd have to order from multiple places to get everything I needed.

As of this week, this is the pricing I got:

	Walgreens	Roxbury	Walmart	Kaiser	IVFmeds.com	Alexander	Freedom
Menopur per vial	75.5	76.95	140.17	57.19	38.5	74	78.9
Cetrotide 0.25	175.05	104.95	224.24	142	69	159	99.5
Omnitrope	335.89	377	378.44	357.48 (3)	N/A	N/A	N/A
Novarel	87.95	89.95	282.54	281.06	N/A	90	89.9
Dexamethasone (30)	N/A	20	14.32	Ins? 18.73	N.A	7	N/A

Surprisingly, Kaiser still beats out the usual US pharmacies for Menopur. I'm shaky on the Omnitrope because  I'm not sure if I've been asking for quotes on the right stuff - I was asking for a 5.8ml multi dose vial from other places, and Kaiser is the only pharmacy that actually received the prescription which states that I need three of "some dosage" of Omnitrope.  They're way off on the HCG though so I'll have to order that from somewhere else, and none of the Stateside pharmacies can hold a candle to IVFmeds.com in the UK for Menopur and Cetrotide.

I went back and forth a couple million times about IVFmeds.com. My nurse said they used to order from them all the time, but had to stop recommending them because the practice decided it didn't want to recommend pharmacies outside the US. They never had any problems with them and the nurse said she'd be happy to write me a RX to send over to them if I wanted. The thought of ordering medication, especially such important and expensive medication, from another country is nerve wracking. I'm already spending so much on the IVF, do I really want to cheap out on the drugs necessary to make it work? Is it safe? The savings ended up adding up to at least $3,000 over the two cycles so with the nurse's blessing I went ahead and placed the order. I'm still nervous but thus far their customer service has been great and the first box of my meds is already on the way.

Thus far, I've ordered:

IVFmeds.com

• 72 Menopur
• 4 Cetrotide 0.25

Kaiser

• Needles and syringes 
• 3 Omnitrope ?
• 30 Dextamethasone 1mg

The Novarel I'm going to have to order from either Walgreens specialty or Roxbury which is across the street from the clinic since Kaiser charges so much. I'm also going to try and get insurance to cover my Dextamethasone so I'll run that through Kaiser first and see what they say. Maybe we'll get lucky.