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.

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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: J3590
Follistim: J3590
Lupron: J1950

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.

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. :-)

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.

Poignant Paragraph

I picked up a copy of the Winter 2009 Resolve publication for the North East Region. Usually these pamphlets speak on a really top level, noobie level. I don't tend to find much that resonates for me anymore in these materials. I kind of feel like I've "read it all". But, surprisingly, a particular article jumped out at me, "Pregnancy Between Infertility Friends", by Anne F. Malave, PhD, p. 6.

This one paragraph really grabbed me on an emotional level (I hope they don't mind my including a paragraph here):

"The experience of infertility plunges people into contact with the outermost reaches of their humanity. Infertility is a profound crisis that threatens identity, relationships, and continuity. It threatens one's sense of the world, it disturbs beliefs and assumptions, and it belies safety and security. It is an emergency that uses up coping skills, and depletes resources; people start to run on empty as their chronic stress levels move into the area of trauma. Infertility can shut people down emotionally, it necessarily limits and narrows; people are functioning in "emergency mode", a black and white vantage point that oversimplifies for the purpose of survival. This is not the best place to understand the complexities of human interactions, or the perspective of the "other": this is a time to survive, and everything else may feel inessential, a luxury."

I don't think that there is any more clear way of expressing how infertility has made me feel. My beliefs and assumptions about getting pregnant, of being a mother, have been ripped to shreds. There have been times in cycles that NOTHING ELSE MATTERS. My eye is so "on the ball" that I turn totally inward, tunneling into doing everything to cycle.

That article expresses my innards so well. I can't read it without tears.