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Surrogacy Blogs:
Part of a Miracle
Bump Fairy
Our Surrogacy Adventure

Working on it:
Mad Hatter
Chick N Chicken
Ambivalent Womb
Stirrup Queen's List of Blogs
Delinquent Eggs
Life and Love in the Petrie Dish
Life in the Infertile Lane
Hell Hath No Fury Like a Woman Barren
Everyone Else But Me
It Takes a Village
Stella Part 2
Music Maker Momma

On other paths:
Fertile Soul
MLO Knitting
Out, damned egg! Out I say!
Holding Pattern
Hummingbird Chronicles
Velvet Cage

Adventures in Baby Making
Barren Albion
Barren Mare
Dead Bug
Due Dates
Fertility Shmertility
Fumbling Towards Eggstacy
Great Good Fortune
Healing Arts
Hopeful Mother
I Can't Whistle
IF & the City
It Only Takes One Egg
Waiting for Baby Orange
Jenny From the Infertility Block
She's Back!: Manana Banana
Smarshy Boy
Stella and/or Ben
Tinkering with the Works
Twisted Ovaries
Wishing For One

Other Good Reads:
Dr. Licciardi's Infertility Blog

Mc Gill Reproductive Centre - Montreal
Georgia Reproductive Specialists
Jinemed Hospital - Turkey

Cooper Center - NJ
Conceptions - Colorado
Red Rock Fertility - Dr. Eva Littman
Pacific Fertility Center
Zouves Fertility Center"
Nova IVF

IVF Meds - UK
Free Garage Sale
Flying Pharmacy (IVIg)

Blastocyst Grading Criteria
How much hCG is Left After Trigger?
POAS Ratings
More POAS Ratings
The Beta Base

Sunday, February 28, 2010

6DP5DT: This Party Might be Over

Couldn't sleep - it's 5AM and I woke up feeling really warm, overheating despite having the window cracked open (there is snow outside folks), and then I started to THINK. That always does me in. Thinking.

It's early Sunday morning, 6DP5DT. Two nights ago (4PD5DT), on Friday, I had some very familiar cramps - deep stabbing uterine cramps just above my pelvic bone, that lasted all of 10 seconds. They were much like those I felt during my first IVF cycle on 4DP3DT (7 day old embryos). This cycle and that cycle are the only two times I've felt this particular type of uterine pain in my entire life and let's say that it was so intense that it's not something one would easily forget. That first cycle my beta was 2. My RE at that time said I might have had very early implantation failure. I'll never know for sure if he was trying to give me SOME sort of hope with that comment or what but it was potentially my only close call with a possible pregnancy in the years I've been trying.

I recall reading from Dr. B's notes (my Reproductive Immunologist) that he felt that this deep stabbing pain is often a symptom of the body attacking an embryo that has or has tried to take root.

On part of Thursday and all Friday I felt crampy like AF was coming. My uterus felt heavy, crampy, I had sore breasts, and since late Friday night, it's all disappeared. It's all gone. Yesterday, Saturday, not a twinge. Nothing. It's as though this cycle never started.

It's weird, but I think that this cycle with one blast nearly worked...I truly believe it tried to implant...but I feel that it is now gone. I think that something seriously happened on Friday night. The timing was right, too. Transfer was Monday, hatching would have happened Tuesday night or Wednesday morning and implantation should have happened shortly thereafter. The timing was spot on.

Just in case, just last night, I added in another 200mg of progesterone to give whatever might be there a last chance help. I think I should have done this Friday night, not last night, but I also didn't want to mess with my lining just yet.

My RE only has me on 50mg of PIO plus another 50mg in a supp (along with 50mg of E2). 100mg isn't much at all (my RI insists on 200mg MINIMUM) so I don't feel I'm being the least bit risky pushing this to 300mg a day or higher. 400mg would do me just fine too.

Anyways, I hate to be such a pessimist, and I know that you'll yell at me to wait for my beta before reserving judgment but I think that this cycle is done for. I'm not even going off of anything I've seen on a HPT either. I know it would be too early for anything to show there. I'm just going on what I feel.

I know it sounds crazy, but I am really in touch with my body's little quirks and symptoms. When I've had ovarian cysts, I've known it before the U/S found it. I can feel when I ovulate (mittleschmirz). I know when I have a cyst at the beginning of a cycle. My nether regions are really sensitive, unlike my mother's, who swears she didn't have a clue she was pregnant with me until she was out of her first trimester.

I'm bummed. I'm going to keep taking my P4 capsules (200-400mg/day plus the 50mg P4/E2 supps) but I think that I'm taking enough this that I can just skip the 50mg/day of PIO now. My hips hurt really bad from the shots and just last night I read about a gal over on FT.com who developed CYSTS in her bumm from the damned shots. Apparently the oil never absorbed in a few spots where her hubby shot too deeply (how the hell can you shoot this stuff too deeply? The freaking needle is ONE AND A HALF INCHES LONG!) and it just sat there forming pockets of old oil. Ick, ick, ick. I have to say I AM NOT SURPRISED. They found the cysts on an U/S after she complained of pain. They drained them under ultrasound guidance. I think she had at least 6 of them.

So I'm not concerned about flying at this point. I laid low Monday through Friday last week - actually did bed rest on Monday and near bed rest the next two days. I'm hopping a plane to California tomorrow morning and I'll do my beta there (and dollars to donuts it's LOW, really LOW). My new job starts on the 8th and I'm going to take a week off to see my friends and my mom.

Peace out.

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Friday, February 26, 2010


Another snow day...woke up to a veritable winter wonderland outside of our apartment. I love how the snow envelops the sounds of the city and everything is quiet. For once. I sleep so good when it snows because the sound of the light rail at the end of our block is muffled.


I'm not sure about these POAS that I bought off of Amazon (manufactured by WongFo - 20mIU/ml sensitivity). Tried another one this AM and the same faint line persists, hasn't changed for two days. I am certain it's just an evaporation line as it's too early for it to be picking up anything. I just wish that the test area was completely "white" so that there would be no mistake. (For you newbies: it's an area on the stick where the reagent is located that picks up the hCG. In the right light you can see it and be fooled into thinking it's a BFP).

I'm 10 days past trigger at this point, so the damned stuff should be completely gone by now. Maybe I'll get the boyfriend to pee on one tonight so I can use him as a baseline for what NO hCG looks like with these sticks? Or maybe one of the cats?

Here kitty kitty...

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Thursday, February 25, 2010

3DP5DT: Snow Day

We've got big snow here today. It just keeps falling out of the sky. 4-8" due this afternoon and another 5-9" this evening. If I weren't in my 2WW I'd grab my board and go board in the park until someone stopped me. :-)

My two cats are interested in the snow but have no idea what it is. They occasionally jump into the window to check it out and just stare at it all. My bigger girl, Gigi, is the bolder of the two. Coco is a meek chocolate point Siamese mix - scared of the TV and her own shadow. One day I'll post a picture.

I put a collar on Gigi and attached a leash. When she wakes up I'm going to see if I can walk her downstairs to frolic about in the snow for a few minutes. If she'll stand for that. My cats have NEVER been in snow. This is the first year they've actually SEEN it, in fact, but from the safety of the double paned windows of our apartment. Gigi's bold. I imagine she'll dive right into a pile until she realizes how cold it is!

On the IF front:

After a number of emails back and forth between myself and Dr. Italian, I finally got to the bottom of the miscommunication about my "blasts".

Apparently the nurse (or office person) who conveyed the information to me was incorrect about BOTH being blasts. One was a grade 3 blast, the other was a cleaved embryo (he used the word "cleaved" which I was unfamiliar with - I had to look it up to basically determine that it's an embryo that hasn't gone blast). How she got so far off track is beyond me. So the end result wasn't as good as I'd hoped for...but still one good blast.

Aside from that, I got up at the crack of dawn, 3:30 or 4:00AM to take the boyfriend to the train station so he could get to Boston for two days of meetings. I POAS about 4AM then went back to bed for 15 minutes. I POAS again at 4:30AM just to see if these cheapo things test consisently. One looked liked yesterday's, a very very faint line that is still trigger HCG and one showed nothing. So they're close. FRER showed nothing yesterday morning when my trigger HCG would have been stronger, so they're a POS compared to the cheapos. 50 cheapos that test 20mIU for $11 is a great deal in my book.

I spent a bit of time reading a number of different IF sites last night. Most women who get a BFP after a 5DT saw a positive line no earlier than 5DP5DT and 6DP5DT, so I won't really start to pay attention to anything on the tests until about then. Until then, I love seeing the trigger disappear.

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Wednesday, February 24, 2010

2DT5DT: Yes, I'm POAS!

It's only 2 days since transfer but I peed on a couple sticks today to see if my trigger is all gone.

First Response can't see a thing (25mIU) and my new ones from WondFo (20mIU) have a very very very light line, might be a evaporation line - who knows. So the trigger is pretty much gone. At least I'll know if anything turns up in the days to come and I won't have to ask the question, "Gosh, I wonder if that's still my trigger?" I like having a "baseline" pee stick to base other pee sticks on. Must be the scientist in me.

So the other embryo didn't make it.

Dr. Italian wrote and said the following:

The second embryo was cleaved (i.e. never made it to blast) on day 5 and never changed therefore it was discarded.
The blastocyst that you had transferred had no deeper grading; it was grade 3.

OK. This is a bit of a contradiction to me.

The nurse wrote to me on Monday and said:

"You have one non-expanded and one compacted, both grade 3. There will be one last update right before transfer.

Grade 3, in reference to an embryo that is "non-expanded" or "compacted" means that they are "blasts".

Cleaved means an embryo that is not yet a blast.

So which was it? Was it a grade 3 blast? Or was it a cleaved embryo?

It can't be both. It is so frustrating when people aren't clear. Maybe I just don't understand something about embryo or blast grading, but I wish they would educate me on this. I emailed Dr. Italian asking for further clarification and haven't heard back from him.

I hate being "that patient", that irritating "has to ask every question" patient...but I think that's me ... despite my trying so hard to not be irritating.

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Tuesday, February 23, 2010

And Then There Was One

Yesterday was transfer day. I arrived early to inquire about a $517 bill from the clinic for services that should have been paid, to do a progesterone test, and for my pre-transfer acupuncture session.

It was my first meeting with the acupuncturist. He was charming and really quite good placing the needles. I really appreciated being able to do my acupuncture session inside my RE's office - a huge stress reducer.

As I laid there with my needles in, I tried to visualize myself in a safe place, white light, and becoming pregnant. It was strange but something about the experience brought forth lots of really vivid visuals. I found myself wiping a unexpected few tears away.

He took the needles out at 4:45, which is when my transfer was due to happen. I guzzled down a bunch of water since I'd forgotten to drink anything but luckily my bladder was already moderately full. I was whisked into the transfer room and waited just a few minutes until Dr. Italian came in.

"We have one embryo today."

My heart sank. We had two blasts earlier in the day. What happened? He explained that the one that was "non expanding" was doing quite well (a grade 3 in terms of "blast" grading, not embryo grading - so very very good). The other one was not compacting well and hadn't formed the appropriate junctions between the cells. He said that they would watch it til the next evening. If it came around they'd freeze it for me. I suggested why not just put it in? But he said, "Well, that would defeat the purpose of doing a 5 day transfer."\

True. But it DID make it to blast. It's past that 3 day mark. So why not just put in back

I guess one thing is that it's safer in the lab under constant conditions if it's fragile. My uterus is a fairly hostile environment given how many embryos HAVEN'T made it there.

But he did say something that made my heart jump:

"This one may very well get you a baby."

So they washed my insides with water, blotted, and then rinsed out my cervix with blast culture so that there wouldn't be anything to "shock" the blast.

And in went the one little blast.

My post-transfer acupuncture would be done in the same room, so I just laid back and relaxed as best I could with a bladder that was near to popping. I really get freaked out peeing after transfer - worrying that I'll push out the embryos. The nurse could tell I didn't really want to get up and when I joked about getting a bedpan, she dashed off and brought me one. She is an angel. OMG. All I know is that with the bedpan and the acupuncture being done ON THE TRANSFER TABLE I was able to stay stationary for about an hour and a half before getting dressed to leave. That, in my book, makes me feel a LOT better about transfer than just about anything. (Well, that and the lovely valium that they gave me before I went in! ;-)

Progesterone levels are at 68 which they said was good. They said they want it to be over 17 or 18. They asked if I was taking extra on the side. Hell no. I wouldn't dare mess with my lining. There are somethings that I will tweak: antibiotic duration, lupron/ganirelix dosaging...but progesterone before transfer is definitely NOT among them. I would add in extra progesterone well after transfer (maybe 4 or 5 days out to support a potential pregnancy, but not before).

Anyways. That's it. 1 very good blast, one is struggling in the lab today.

Taking it easy today...riding the couch with the cats.

Beta is on March 2nd, but I'll be POAS with abandon the entire time.

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Monday, February 22, 2010


I'm one of those infertiles that has absolutely no issue with POAS from the day of transfer. My reproductive endocrinologist (who has passed away) told his patients that it was actually a good thing to POAS every day starting with transfer.

Yes, you'll have some residual hCG in your urine from your trigger. But that's fine. You POAS every day. You watch the trigger disappear. THEN if anything REAPPEARS, you are nearly 100% certain that it is because of implantation and NOT the damned trigger.

Why is this important to know?

Well, for an immune patient such as myself, I'm supposed to get an infusion of intralipds the first second I know I'm pregnant. I'm also supposed to double my lovenox injections. Both help to support the attached embryo. The sooner you know, the sooner you can act. Also, from an insurance standpoint, some benefits are better once you are pregnant. So if you test +, then get immediate blood test confirmation, many prescription drugs that aren't covered for the infertile might suddenly be covered for the pregnancy. One such drug that comes to mind is IVIg. $2500 for a cash payer without coverage. Reason enough in my book.

So knowledge is power in the hand of an infertile immune patient.

I've done a bit of reading online about which POAS are the best. Many seem to test at 25mIU of hCG. Some require as much as 50 or 100, which is crazy in my book. There used to be some POAS made by Inverness labs (So Cal) which measured amounts as low as 10mIU but they only seem to be available in the UK or EU these days.

One I found that has great reviews is made by WondFo of China. It says that it measures to 20mIU of hCG but tests have shown that they pick up hCH as low as 10 to 12mIU.

I bought a lot of 50 on Amazon for less than $12 and will be POAS with abandon.

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Day 5 Embryo Report

I was a bit nervous this morning as I only had Saturday's day 3 report to go on. I sent in an email to the office. A prompt reply came back:

"You have one non-expanded and one compacted, both grade 3. There will be one last update right before transfer"

OK. I've not been to a day 5 transfer before. I'm in the dark on these things. I found this great description of how blasts are graded here which helped a lot but I still asked for a bit of clarification. She wrote back right away. Thank god. As I am a bit nervous.

"The best case is an expanded blastocyst, the non expanded and compacted. The non and compacted are just embryos that haven’t totally expanded. You will be able to get a better explanation at transfer from Dr Italian or our embryologist."

So I am wondering about the grading now. I had 2 7-celled grade 2 embryos on day 3. But now they are blasts. Blasts tend to have their own rating scale (esp if you look at the link above). Are my blasts still being graded on an embryo scale (and have thereby slipped from grade 2 to grade 3) or are they onto the Gardner blast grading scale which makes them a 3 and is actually quite good?

Well, I guess I'll have to wait til I get to the lab to know for sure.

All I know is that I am grateful, elated beyond belief, that this 45 year old has produced two living blasts for my 5 day transfer. I know that I have beat the odds: only 50% of embryos apparently make it to day 5.

This can happen. I believe this can happen.

Touch wood. Throw salt. Spit. Make sign against evil eye. Anything I'm missing in my ritual?

I'm doing pre and post acupuncture at the clinic (thank god it's all done in house) which should bump my odds a bit higher.

Now if I can just remember to breathe!!!!

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Sunday, February 21, 2010

Day 3 Embryo Report

Just received an email from Dr. Italian's office entitled "Day 3", so the observations were from yesterday (Saturday), not today:

"Embryos look good. You have 2 – 7 cell, grade 2. Good luck Monday ;)"

I wasn't sure exactly what "grade 2" meant. At first I assume that grading was on a 1 to 3 scale, but I just found an article on www.sharedjourney.com that discusses grading in much greater detail. Apparently the scale is 1 to 4, 1 being best. The doctor in this article said that grade 1 and 2 embryos often grow to the blastocyst stage. Fingers crossed that this is true of mine.

7 or 8 cells on day 3 is right in the ballpark - neither growing too slowly or too fast (both of which indicate problems).

Cell division is regulated from the maternal (ovum) genetic instructions up til day 3, then the genetic instructions of the "embryo" take over on day 3. As such, I still don't quite know if my embryos are in the safe zone because they were likely "viewed" before this transition happened.

So...it's good news, but it's not as "specific" as I would have liked to have had.

I realize that they don't like to look at the embryos often as it can disturb them, so I won't ask them to look a 2nd time for me today but I would love to know if they've made it to day 4. It's another hurdle for my little guys.

Hang in there....oh please, please, please. One more day.


Tomorrow is transfer. On the bottom of my "day of transfer instructions" is a notation:

"Please remember to have intercourse the night before your transfer".

Fun little twist on the typical IVF cycle. My clinic believes that there are prostaglandins in semen (not sperm itself) which help prepare the uterus for the embryos. Incredibly awkward, talk about a scene for performance anxiety:

"Sweetie, I need you to have sex with me tonight."

Well sex can mean any number of activities to my other half.

I needed to clarify what needed to be done.

In. Very. Precise. Terms.

I hope he recovers from the clinical nature of this request. I hate feeling this awkward.

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Saturday, February 20, 2010

Embryos: Day 3
Enbrel Anyone?

Still no word from Dr. Italian on how my 3 day old embryos are doing. I sent him an email a few hours to inquire, but nothing. I know he's not at work today, so I hope that it's because he's busy and not for other reasons.

On another note: if any of you ladies use enbrel for immune/infertility related issues, I have 2 prefilled syringes that I am not going to use. Leave me a comment if you'd like them and we'll find a way to get them to you. I think they expire in a month or two so I'd like someone who needs them to use them. They're great for RA in case you know of an elderly person w/o insurance that can use them, too.

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Thursday, February 18, 2010

They're Alive!

I just got the call from Dr. Italian's office.

They both fertilized and both are normal!

Thank you universe!!!

I am to email the doc Saturday morning around 11AM EST to confirm that they have made it to day 3. If yes, transfer is on Monday at 4:45PM EST.

Please, oh please, survive.

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Wednesday, February 17, 2010

2 Outta 2 Ain't Bad

2 follicles and 1 cyst yielded 2 eggs. So I am hopeful. 100% retrieval and fertilization rates are more the thing I am used to. I hope these little guys are normal and fertilize. Grow! Grow! Grow!

[Note: Dr. Italian sent me an email a few hours after this post to tell me that both eggs were mature!!! I am so happy!]

On another note, I found a study that is being done out of UCSF's IVF program where they are finding success with doing an hCG trigger WITH 450iu (6 amps) of gonadotropin (ie, Gonal-F). There initial study write up is here. Yes, it's a double blind study...all good protocols followed. :-)

They have preliminary data in and it was published in Fertility & Sterility, Vol 90, Suppl 1, September 2008 which you can get online at Elsvier for $4.95. Roughly, the findings are that IT WORKS.

hCG trigger + 450iu FSH:
Fert Rate: 79.2%
Clinical Preg Rate: 60.0%
Ongoing Preg Rate: 45.7%

hCG trigger + placebo
Fert Rate: 69.6%
Clinical Preg Rate: 47.1%
Ongoing Preg Rate: 38.2%

I brought Dr. Italian a copy of the study and he agreed that if we do another cycle that we'll do a Gonal-F/hCG trigger next cycle.

I am praying that I don't need another cycle to test this out on.

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Tuesday, February 16, 2010

Night Before Retrieval

Interesting tidbit of information from the altar of reproductive immunology @ AEB:

Stop lovenox 48 hours before retrieval and start up again 12 hours after retrieval.

It keeps changing but this is the latest.

As for me? I'm feeling typical cramps...left arm hurts pretty good from last night's trigger. I'm getting a free acupuncture consult tomorrow before my retrieval - if I like him he'll do my acupuncture before/after transfer....of course that is if there is anything to transfer. (I always feel I need to throw that caveat in there).

I also got on the phone with Dr. Persian at Stanford and have a lap surgery ready to go if this cycle busts. Points at which it can bust?

- No eggs retrieved (Wednesday)
- Nothing fertilized (Wednesday)
- Nothing makes it to day 3 (Monday) or day 5(Monday)

So the earliest I'll know if I'm doing a lap is tomorrow - the latest, Monday. I'll call Dr. Persian by Thursday and schedule my surgery. You know me: I ALWAYS have a contingency plan.

Dr. Italian in NYC said he doesn't think I should do a lap and that it could ruin what I have left. He said one of his patients did a lap and her FSH went from 10 to 17. Well, OK. I'm willing to bet that she didn't see Dr. Persian though.

I don't know if I believe him. I just don't know. I weigh it in my mind as: "What benefit could it be to him if I do or don't do a lap?" Time spent healing from a lap is time I'm not doing an IVF...which is time I'm not spending money in the clinic. I have a hard time thinking any physician would be so shallow as that. But maybe he's right? Or maybe he's only familiar with hack-endo-surgeons that aren't on the same level as Dr. Persian? I wish I knew the basis of his beliefs.

At any rate, it warrants a flight to the SF Bay Area to meet with the god of endo laps and see what he has to say.

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IM Deltoid Trigger

OMFG...just did my first HCG trigger IM in my arm. I have never injected myself IM.

I nearly bit through my lip doing it.


I am going to have to do some progesterone shots before my man gets home. I don't know how on earth I am going to do it myself.

IVF keeps pushing me beyond my limits.

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Trigger Night with the Thickest Lining on the Planet

It's a dismal cycle.

2 follicles and a cyst on the left. Nothing on the right. I was right: the RE's initial Dx of 9 follicles was way out of line. Do I know how to read an U/S by now or what? H-E-L-L-O????? I can tell the difference between a fluid filled follicle and a blood filled one (endometrioma). Why can't my RE?


And get this. My lining is at 14mm. No, that was not a typo. FOURTEEN. Holy crap. I know it is because I didn't get a full menstrual cycle last AF and so what was left in there has been built upon. I have never had a lining this thick. My gawd. If there is anything to put back in there, it will sure be cozy!

Left side:

1 @ 17mm
1 @ 22mm
cyst @ 23mm. We doubt that the cyst will have anything in it, but you never know.

Lining 14mm, triple striped

Right: NADA!

So I'm trigger tonight at 3AM - retrieval is on Wednesday at 2:30PM.

I am going to do a 5DT no matter what I have. I know that research is now saying that if an embryo can't make it to day 5, they're simply not viable to begin with. I'm not sure it's true, but enough REs are saying this that I am going with the crowd on this one.

I don't want to endure the 2WW and progesterone shots for nothing. The 2WW is hell. Progesterone shots are hell. So, we'll let them grow and see what we have in the end.

What would you do? Grow them 3 days and stick them back in the oven? Or go for 5 days?

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Thursday, February 11, 2010

CD7: Living Life Without Regret

I saw the best quote over on Endo-a-Go-Go:

Regret for things we did can be tempered by time;
it is regret for the things we did not do that is inconsolable.
--Sydney J. Harris

That is precisely why I keep doing IVF. I cannot bear the thought of what it is to reach my golden years and wonder: what if I'd done one more cycle while I had that darned IVF benefit? I know that I would torture myself with that guilt, that heart break.

I also cannot imagine what it would be like to reach my golden years without a child.

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CD6: Aching Ovaries

It's always sorta amusing in a cycle where one second you feel nothing, and then moments later you feel a twinge with one ovary, then the other, then you realize that the gonadotropin juice is working. Mine just kicked in during the last hour.

I'm hoping that my right ovary is actually producing SOMETHING this time 'round, as the doc suggested with his follicle count of 4 or 5 on that side.

Anyways, first monitoring ultrasound in two days and an intralipid infusion following immediately afterward the U/S. I am guessing that my trigger will probably be next Tuesday or Wednesday with retrieval on Thursday or Friday. This time I am going to make DAMNED SURE that my follicles are BIG ENOUGH before I trigger. I hope my dates get pushed out a bit more so that transfer happens by the time my other half is back at home. He's out all week from Monday to Friday - horrible time to be by myself during a cycle, but at least I'll have lots of "calm" while I'm alone. I can do my own trigger shot in my tummy, but no way in hell I am going to do the P4 in my own hip. No way in hell. I don't know how some ladies can do that. I think I'd pass out from fear of hitting my sciatic nerve. Oy.

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Monday, February 08, 2010

CD4: Outta drug money

I knew it would happen, but not that it would happen so soon.

I've exhausted my IVF drug benefit. Holy crap. Somehow I've blown $25,000 worth of infertility drugs over the last 3 cycles plus the one that I'm currently in. Really? How can that be? I guess it works out when you figure what a single Gonal-F 900iu pen goes for.

But STILL!!!

So rather than this cycle's meds costing me about $450, it'll be $1050. I was within $1200 of maxing out the benefit but still needed 8 Gonal-F 900iu pens (valued at over $8000, according to the insurance company). They somehow figured that if a patient is within $1200 of their maximum benefit that the patient only needs to pay a portion (they said 30%?) of the remainder. Well somehow that 30% winds up being $791 to me. I don't know how they figure their math but 791 is NOT 30% of 8000. It still is a good deal for me, obviously, so I'm not griping, but I am shocked that this much money has been spent.

Now, by comparison, I've used $7900 of my $50,000 IVF benefit during the same time.

So $25,000 on drugs, and $7900 on 3 IVF cycles.

How can drugs cost 3 times more than the actual procedure?

It just doesn't make sense.

So on my call with the prescription drug carrier, they suggested I call my insurance company and ask if future drugs could be paid for through the major medical portion of my insurance company...that sometimes insurance companies will do this. It seems that I have a benefit for a procedure which requires medications, but no medication coverage. It's a conundrum.

My next call was my insurance company. I explained the situation to them and they said that they needed the "J codes" for my medications before they could tell me whether they'd be covered under major medical. It also might be that the drug money would come out of my remaining $43K benefit. OK. That works for me. I know that I can get meds for 4 cycles with $25,000 and that $7900 will do 3 IVF procedures. That's $33K total. I'm sure I could get 4 or 5 full cycles done for $43K. Maybe I need to negotiate a "frequent flyer" discount card with my RE? Buy 3 IVFs get one free?

I quickly fired off an email to the IVF clinic asking for the J Codes but it's after closing so I'll just have to call in the morning.

The craziness of IVF never seems to end.


Endnotes: J-Codes are for injectible meds only (not oral). Here are the J-Codes for infertility drugs (all are "Status F", whatever that means) or you could look here.

Gonal-F: S0126
Ganirelex acetate 250mg: S0132
hCG 10K iu: J0725 (Novarel, Ovidrel, Pregnyl, Profasi)
Menopur: J3490
Follistim: J3590
Lupron: J1950

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Sunday, February 07, 2010

CD3: Bring on the Gonal-F

It's a typical cycle, although not the same one I did last cycle. 5 days of femara, added in Gonal-F, ending with ganirelex...and a trigger. Tonight's the first night of Gonal-F - I'm doing 450iu this time whereas last cycle (which was dismal) we did 600iu. There's a axiom that "less is more" when it comes to IVF. Hitting your ovaries with big guns of gonadotropins can, and often does, shut them down. So we're back to 450iu, which is what I did with my first IVF back 4 or 5 years ago. (God, it's been that long?)

I was doing a bit of reading last night about when to start lovenox. It's not a huge deal if you start it earlier than you should, but starting it later means that you might form micro clots in your endometrium that can cause failure of the embryo to implant or thrive. I was also reading that lovenox, taken early, can help calm the immune system for folks like me whose immune systems run amuk with elevated APAs. So rather than wait til my stim day 2 (which would be Monday night), I started mine last night (Saturday). A few days earlier can't hurt, and might actually help.

So I finally buckled down and ordered my meds today, due to arrive on Tuesday. I've got plenty of back up drugs to get me til then...actually enough for the entire first week, but one can really never have enough Gonal-F is my thinking.

One thing that is sorta worrying me about this cycle is my lining. I started to bleed, quite a bit, about a week before my last BCP. So the day after my last BCP I let the clinic know that my period had started. I went in the next day for my baseline. This was Friday, two days ago. But despite having bled for a week solid, my lining was still at 11mm. THICK as all hell. Some women would slice off their little pinky for an 11mm lining. But that night the doc started me on my Femara. Since Friday, I haven't bled much more so that lining is probably still up in there. I'm starting stims tonight, first shots in half an hour. So once we start the Gonal-F, my lining isn't going anywhere. I'm worried about putting embryos into a lining that's been hanging around for a good month and a half (I was on BCPs since late December for this cycle).

Anyone know if I should be concerned about this lining situation? The doctor didn't seem concerned and I'm not seeing him again until next Friday. I'm going to fire off an email to him to ask...but if you guys have any ideas, please pipe in.

Peace out.


Friday, February 05, 2010

CD 2: Owwwww

I went to the clinic today for my baseline U/S and bloodwork. I had a thirty-something millimeter sized ovarian cyst on the left side. We already knew I had a cyst there, but it had grown since the last ultrasound.

So he tried to aspirate me on the table. No anesthesia. But it was just too painful to have forceps, an ultrasound wand, and the needle holder all crammed in there. I was recoiling in pain. He said that he felt we should do this under anesthesia. Yep. I quickly agreed ("Just get that stuff out of me already"). So I went and busied myself for 2 hours while the anesthesiologist showed up for the day's retrievals.

It was a fast procedure but I feel a bit torn up down there. I have clear vaginal tears, both inside and out. They burn. Owww. My skin is thinner down there with age, so tearing happens more often, but this just smarts.

So I'm riding the couch tonight. Got a few movies on the DVR and I'll just drink my nettle tea and cozy down with the cats. I start taking femara today (5mg/night) and on Sunday the Gonal-F starts. Following Friday I do an intralipid infusion after my first monitoring ultrasound and then we inch closer toward retrieval.

But the good news I've saved for last.

The results of my baseline U/S showed 9 antral follicles. 4 on the left (where the cyst was) and 5 on my crappy right ovary that had all the endometrioas (that were removed by needle aspiration/sclerotherapy in December).

9 is amazing for someone my age (45). I think he might have been looking at the same ovary twice though: my ovaries tend to get stuck next to each other behind my uterus. It wouldn't be the first time someone did this.

But even if there are only 4 or 5, it's still not that bad.

My vote's for the 9 though. :-)

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Thursday, February 04, 2010

CD1: Welcome AF

Took my last BCP yesterday. I'm supposed to call them when AF comes, but she's been here since last Saturday or Sunday...so that makes today CD1 by my reckoning. (U/S and bloodwork scheduled for tomorrow. Yippee.)

I have an 11-13mm cyst on my left ovary that will need to be aspirated before I start meds. Otherwise we saw 3 follicles on the left. Dr. T said that he saw "maybe" 3 on the right, but I've seen enough ultrasounds to know that they weren't follicles....just his wishful thinking to keep me from throwing in the towel. More reasonably, I think that they might have been remnants of the small endometriomas that he drained in December. They certainly weren't follicles.

I think it's time to call Dr. Persian on the west coast to schedule a lap. I have a hunch that this cycle isn't going anywhere. I haven't even ordered my meds yet, if you can imagine. I'm not being reckless here....I have enough Gonal-F and Ganirelex to get through half the cycle, I just need femara to get started and that is easily available in any pharmacy worth it's salt.

Dr. T advised against a lap, but my right ovary is toast. It's just dead. Nothing's happening there. I had 4 follicles on that ovary month after month until recently....and the last two months, nothing. So what damage is a lap to look at it going to do at this point?

Probably very little.

So here we are, February 3rd. I have $50K in IVF coverage, $25K in infertility meds. I've used up only $7K of the IVF coverage over two cycles (amazingly) and my insurance runs out the last day of July. I don't see that I'll be able to use all of my coverage. I am currently interviewing at a company that has $20K in IVF benefits and no cap on medications. They're listed on the 50 top companies to work for in Conceive Magazine. Fingers crossed that there aren't age limitations for IVF with them and that, after I turn 46 (the cap that most clinics have) I can switch to this new clinic that I discovered where a woman got pregnant with her own eggs at the ripe old age of 49. It's a world record so that should tell you the clinic if you Google it. I'll just refer to him at Dr. Amazing to keep things straight. ;-)

So there's not much hope for my right ovary, but there IS hope that I can keep on trying.

Now, off to call Dr. Persian and get that ball rolling.

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