Embryos: Day 3Enbrel 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.

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.

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.

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.

OMG. OMG. OMG.

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.

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

Cleaning House

Moving to NYC in a few weeks and I really don't want to try to transport all of my IF meds through the airport.

Need something?

I've probably got it.

Reasonable $$ too.