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.

Deposit Down!

Oh man, things are getting official! I finally sent in the contract and the deposit to SCRC. We are official SCRC clients and are cleared to start getting and filling prescriptions. One more thing checked off the list, but there's still so much more!

After taking care of the deposit, I started looking around for the best infertility pharmacies. The meds for my cycles are going to be REALLY pricey and we need to try and save money wherever we can. Right now I'm trying to decide if I should order from overseas, specifically ivfmeds.com. It's a little scary to consider ordering from another country but it could potentially save us a boatload. Right now the pharmacies on my list are:

• IVFmeds.com
• Walgreens Specialty 
• Alexander's Twin 
• Freedom Fertility
• Walmart Specialty 
• Kaiser 
• Roxbury Pharmacy 

I need to get prices on Menopur, Cetrotide, Omnitrope, Novarel, and Dexamethasone. Looks like I have a lot of phone calls ahead of me.

The Wheels of Infertility Turn Slowly

It feels like I've been playing phone tag all day long. Making calls, missing calls, no one is ever in the office when I need to speak with them and they only seem to return my calls when I have to pee. Still, I did manage to get a few things done today:

• Apply for Compassionate Care program and First Steps to get financial help.   
• We were approved for the minimum amount, 5% and 10%, but I'll take whatever we can get.
• Follow up with Reprogenetics. The billing manager needs a letter of agreement from Kaiser but the Kaiser lady has been on Jury Duty and then the billing manager went on vacation Friday to Monday. On Tuesday, both should be back in the office and I should get my letter. 
• Still no confirmation of the letter. I tried calling a couple times today but had no luck. 
• I need to order a very large amount of sperm. SCRC wants two vials, Reprogenetics wants two vials, and I'm thinking we should have another two on ice to ensure our donor remains available to us. That's 6 vials for roughly $5,000.
• Meet with the financial adviser at SCRC to officially sign the paperwork and pay the nonrefundable $18,230.00 fee for our two cycles. As the cycles progress, we will pay separately for medication, ICSI (which is required for PGD), PGD biopsy (which includes assisted hatching) and our FET. 
• I've got the forms mostly filled out, I just need to go over what is and isn't covered once more. They use really specific wording and I'm thinking they're going to make me pay separately for my two ultrasounds before stimms start, the mandatory ultrasounds that check if I'm suppressed and good to go.  
• Submit the paperwork to Reprogenetics. I've been waiting on the letter of approval so I know what my portion will be. I think we're going to pay for the additional chromosome testing.  
• I just sent off my paperwork. We decided to make up our minds about the additional chromosome testing once we know how many embryos we have. If we only get a couple, we'll skip it. If we get a bunch, like 10-14, we'll do it on the Fragile X negative embryos.
• Send DNA samples from myself, my mother and my sister to Reprogenetics for the creation of our probe.
• Hammer out a protocol with my doctor. Figure out what our plan of action is and decide how we're going to proceed. 
•  I spoke with the doctor today and we're going with a very unconventional cycle. Since I had such a nice response to my last IUI, we're going to try and repeat that success. We're going with an all Menopur cycle with some growth hormone and cetrotide thrown in for good measure.  
• Pay to have two vials of sperm shipped to Reprogenetics for the creation of our probe.
• Pick up and bring two vials to SCRC and pay the $500 storage fee to have them stored there. 
• Pick up and pay for my first round of medication.  
• I did some more research on this and it's going to be PRICEY. The Menopur alone will be $5k per cycle, plus the HGH, HGC, Anti-inflammatory and everything else. It's going to be at least $6k per cycle.   

There's still so much to do and a lot is hanging on that Kaiser approval. I can't send in any of my DNA samples or proceed with Reprogenetics until they have their letter. I also need to call my doctor back, get him a copy of a test that was left out of my file and find out what dosage of certain meds they want me to look for so I can get a better price quote.

Decision Made!

After going back and forth a million times, doubting pretty much every aspect of our decision making process, making up our minds and then doubting things again, we've finally made our decision. I'm still not sure this is the right move and I feel a little sick to my stomach over the money we're about to spend, but this is it. Without further ado, we have decided to pursue IVF with....

Southern California Reproductive Center

Ultimately, I think SCRC and HRC would both be excellent centers. A part of our decision ended up being that I can't seem to get the billing department at HRC to call me back to discuss our Kaiser PGD coverage. I really liked Dr. Kolb and I think he would have been a good doctor. However, our PGD coverage will save us about $8,000 and I can't work with a center that won't accommodate that.  They said they'd be willing to work with me, no problem, but then never called me back. That doesn't seem to be a good start to such an important relationship and it played a part in us ultimately choosing SCRC. Dr. Danzer called me after our consult to see if I had questions and has replied to every attempt I've made to talk with him. He's definitely got the personal touch down.

SCRC is also a lot closer to our home than HRC. It will only take us 10 minutes to get to appointments and the staff has been much better about getting back to me. They have an excellent success rate with PGD and are considered a top center here in LA. We're proceeding with the same plan we would have gone with at either center and I officially started the suppression phase this morning. 

Going forward, we're proceeding with:

- The first freeze all IVF cycle with biopsy samples sent to Reprogenetics

- A second freeze all IVF cycle with biopsy samples sent to Reprogenetics

- PGD at Reprogenetics on all embryos 

- A FET with either one or two embryos

I'm hoping against hope that we get lots of wonderful, healthy embryos and that our first FET is successful. In the meantime, there's still a ton of stuff for me to do:

• Apply for Compassionate Care program and First Steps to get financial help.  We were approved for the minimum amount, 5% and 10%, but I'll take whatever we can get.
• Follow up with Reprogenetics. The billing manager needs a letter of agreement from Kaiser but the Kaiser lady has been on Jury Duty and then the billing manager went on vacation Friday to Monday. On Tuesday, both should be back in the office and I should get my letter. 
• I need to order a very large amount of sperm. SCRC wants two vials, Reprogenetics wants two vials, and I'm thinking we should have another two on ice to ensure our donor remains available to us. That's 6 vials for roughly $5,000.
• Meet with the financial adviser at SCRC to officially sign the paperwork and pay the nonrefundable $18,230.00 fee for our two cycles. As the cycles progress, we will pay separately for medication, ICSI (which is required for PGD), PGD biopsy (which includes assisted hatching) and our FET. 
• Submit the paperwork to Reprogenetics. I've been waiting on the letter of approval so I know what my portion will be. I think we're going to pay for the additional chromosome testing.
• Send DNA samples from myself, my mother and my sister to Reprogenetics for the creation of our probe.
• Pay to have two vials of sperm shipped to Reprogenetics for the creation of our probe.
• Pick up and bring two vials to SCRC and pay the $500 storage fee to have them stored there. 
• Pick up and pay for my first round of medication. 

This is such a huge decision. After a lot of discussion we've decided to accept some of the offered financial support from our families. It makes me a bit uncomfortable but if it's what is necessary to have children, it's just something we're going to have to get comfortable with. 

Can you tell how nervous/anxious/ahhh I am? It's like a miniature tornado churning in my insides. I'm not actually worried about the process itself, I'm a pro at injecting myself and the retrieval is just another procedure for me, but I'm terrified that this might not work. I'm terrified we're going to spend $40,000 and not have any viable embryos to show for it. I'm terrified that E will get completely discouraged and we will be done. I'm terrified that maybe he's not ready after all, that he's feeling just some of what I'm feeling, even though we're in this together and he says he's okay. I'm terrified of failing and never having children.

The only thing I can do is cross everything I have, rub every lucky rabbit foot and Buddha belly I come across, project every good vibe/thought/energy I can muster out into the world and hope with everything I've got that my body cooperates and we are able to create healthy, viable, life.

Update: Freeway FAIL

My Sydney is finally home from the mechanic but she is sadly not whole. After googling around a bit, it appears she has fallen prey to what appears to be the curse of the Jettas (and other VW/Audi's). Sydney has been serving me faithfully since I bought her, yes with a few hiccups here and there, she is 12 after all, and it's crushing me that she might have a problem I can't have repaired.

The curse of the Jettas seems to start with, you guessed it, stalling on the freeway. It seems to happen to most people when they have less than a quarter tank of gas, as it did to me. The engine stalls, the power steering and breaking go out, and you have to hope you can coast to a safe place. People are usually able to restart the car, but it can take a couple of attempts. Some people see the battery light come on like mine did before it stalls.

The most successful fixes thus far are:

• Changing the Crank Position Sensor
• Changing the Fuel Pump
• Cleaning the Throttle Body
• Changing Various Filters 
• Cleaning the Fuel Tank
• A million other fixes from faulty ignition switches to bits of junk blocking filters

A fuel pump thing? I might need a new one of these.

Thus far, my mechanic has changed the Crank Position Sensor, changed the Spark Plugs, and cleaned the Throttle Body. The next stop would be changing the Fuel Pump but that is pretty pricey and at this point would be a shot in the dark since the pump appears to be fine. She isn't throwing any codes, there aren't any lights on, there's nothing to indicate what the problem might be. Some people have done all the above things and still have problems.

When I picked her up from the mechanic I was hoping she was fixed. I had asked the mechanic to double check the alternator again so she had a dead battery when we got back from Las Vegas. E and I jumped her and then took her on the freeway at night to try and charge up the battery. She was drinking along just fine, heading for PCH when E made the offhanded comment that he hoped she didn't stall. Not 30 seconds later and BAM, she starts dramatically slowing down despite me accelerating and I can tell she's about to stall. I pumped and pumped the gas and by some miracle the engine picked back up.

I don't want this to be me

I feel like I can't trust her anymore. I wonder when I leave the driveway or get on the freeway if she's going to stall. If I'm going to get stuck somewhere or worse, get in an accident on the freeway because the car behind me doesn't know my car just stalled and is going to stop. Inspired by my Williams and Sonoma trip, I thought about calling up my sister to head to the Pottery Barn Outlet but its an hour and a half away and I'm afraid of stalling out on the highway and getting stuck in the middle of no where.  What if she stalls on the way to my IVF appointments? On the way to my egg retrieval? Once I'm pregnant? There are tons of threads of people with VW/Audis stalling over and over. There's clearly an issue that should be recalled but nothing has been done.
 
I was below a quarter of a tank when I stalled both times so I'm hoping I can prevent the problem if I keep my tank mostly full. If it only happens with a low fuel tank, I think that points again to the fuel pump so I'll replace that next. My concern is that it's a flaw in the pump design itself, and that replacing it a million times won't fix the fundamental flaw.

I need Sydney to keep working. I just hit 70,000 miles on her so she's practically a baby, even if she's 12 years old. Our next big purchase was going to be a family car, but since we need to purchase our family first, the car is going to have to wait.