Update and More Waiting

As I mentioned in a previous post, I had been instructed to call the clinic with the first day of my period. So when I finally got my period I called the clinic to report this and assumed that I would soon be told to start taking birth control pills in preparation for the stimulation. (Birth control pills are often used prior to the stimulation phase in order to “rest” the ovaries and reduce the chance of ovarian cysts.) Imagine my surprise when I got the call back from the clinic that this time, I would be doing a “no pill” cycle and that I would need to start doing the stimulation injections on the second day of my period. Of course this involves now waiting for my NEXT period before starting because it was already Day 4 of my period by the time I got the call back with this information.

During my first egg retrieval cycle, I had a lot of trouble with the HCG trigger shot (see previous post) so I asked if I could have Ovidrel this time instead of generic HCG. I had trouble getting all of the HCG medication out of its vial and into the syringe. Ovidrel comes in a pre-filled syringe so it would eliminate that problem. (I learned about Ovidrel from reading other people’s egg freezing blogs.) The doctor agreed so I am relieved that it should be an easier trigger shot this time.

When I got the prescription list, I saw that my doctor is making some changes in addition to switching to the Ovidrel: Last time I was on 75 IU Follistim + 75 IU Menopur for the first 8 days of stimulation, before moving to 150 IU Follistim + 75 IU Menopur for a couple of days, and 75 IU Follistim + 150 IU Menopur on the last day of stimulation. This time, I will be on 150 IU Gonal-F and 150 IU Menopur from the start, so double the dose of what I was on for most of my first cycle. And it will be Gonal-F instead of Follistim.

I am very lucky to have insurance that covers the medications. However there is a lifetime limit on fertility coverage of $15,000 and the medications count against that limit. So I decided that it would be a good idea to find out which pharmacy had the cheapest medications so that I would not use up more of that lifetime limit than necessary. This turned out be an exercise in frustration. I called my insurance to confirm that its preferred pharmacies had not changed since last year. They are still the same--one mail-order pharmacy plus the Walgreens Specialty Pharmacy. I asked the insurance guy if I could compare the prices of the two pharmacies for certain medications, and he said I would need to call the pharmacies to do that. I called up the first pharmacy and they said that they could not tell me the prices that would be charged to my insurance plan and that I would need to call the insurance in order to get that information. Of course, when I had called the insurance, they said I would need to call the pharmacies to get pricing information. Frustrating! I did not bother calling the second pharmacy since I would be unable to do a price comparison without any information from the first pharmacy. So my attempt to be a good consumer and find out all the prices was a bust, and I ended up going with the mail-order pharmacy because that seemed more convenient. When my packages of medications arrived, I looked through all the paperwork to see if I could find out the cost of the medications, but all it told me was my copay amount, so I still have no idea how much is counted against my lifetime limit.

I have an ultrasound scheduled for around the time that my next period might start. I explained to the coordinator doing the scheduling that my periods are irregular and that I could not be certain that it would have started by the time of the appointment. She said that was ok and that basically they try to get the ultrasound within 5 days of my period, so even if it hasn’t started yet, I could still go in for the appointment. So my next step is that appointment, and to notify the clinic (again!) when I get my period. For now I’m waiting.

First Egg Freezing Cycle: Preparing for the Stimulation Phase

I called up the Stanford clinic and let them know that I wanted to go ahead with the egg freezing. After some phone tag, the nurse and I finally connected and she set me up for several appointments including a baseline ultrasound, a class to learn about the medications, and a day 5 ultrasound. I drove to the clinic to pick up a schedule showing me when I should start taking birth control pills (which are used prior to the stimulation phase to rest the ovaries), when I should start the stimulation meds, and the tentative date for my egg retrieval.

My first task was to start birth control. I also had to order the medications necessary for the stimulation phase. I learned that getting fertility drugs is not the same as getting most prescriptions. I had assumed I would just be able to use my normal pharmacy, but in fact you have to use a specialty pharmacy that has the special fertility drugs. First I had to call my insurance to learn which specialty pharmacies I could use under my plan. I ended up using Accredo mail order pharmacy though I also had the option of going to a Walgreens Specialty Pharmacy in town.

My meds arrived via overnight fedex, in 3 boxes each filled with a foam ice chest and numerous cold packs. I put all the meds in the fridge and set out the sharps container, syringes, alcohol pads, and needles on a side table. Wow it was a lot of stuff! The clinic had given me a list of all the meds and supplies they had ordered, and advised me to double-check that everything had arrived. I had a hard time doing the inventory because it was all so unfamiliar to me--how was I supposed to know what a 27 gauge needle looked like? I fumbled my way through the inventory as best I could and discovered that the Menopur was missing. I called up the pharmacy and they had no good explanation for why the Menopur hadn’t been shipped, but they shipped it overnight so luckily it arrived in time for the start of my stimulation protocol.

I had my baseline ultrasound after being on birth control for 9 days. I know Dr. Westphal was checking to make sure there were no ovarian cysts; not sure if she was looking for anything else as well. Anyway it went fine. I had my IVF orientation class the same day.

Most of the people in the class were going through regular IVF as opposed to egg freezing. Many women were there with their partners, and one couple even brought a (noisy) child with them. I guess they are struggling with “secondary infertility” which is the term for when a woman already has a child but is having trouble conceiving another one. There was one other girl just doing egg freezing, but I think she was doing it for medical as opposed to elective purposes. She was very young (probably high school age) and had her mom with her, and she only had one ovary. So I suspect that I was the only one there for “elective egg freezing.” I was surprised by how young the women going through IVF looked. Most appeared to be in their thirties, not even necessarily their late thirties.

The class covered a lot of information very quickly: showing the names of all the clinic staff, talking about the different kinds of stimulation protocols, going over what would happen at egg retrieval, talking about semen sample retrieval (since most women were going through regular IVF), what happens post-retrieval for the women going through regular IVF (embryos grown in lab, transferred back into uterus), the wait for pregnancy test after the transfer.

The real meat of the class was the injection training. All the stimulation drugs are injections, so we had to learn how to give ourselves shots! And how to mix up the medications. There are a lot of steps to mixing up Menopur, which comes as a powder and must be mixed with a liquid and put into a syringe. I had trouble keeping up and had to keep looking over at my neighbor to copy what she was doing. We struck up a bit of a conversation. She asked me if I had done any IUIs first. I didn’t know at the time what an IUI was, or that it was something that was frequently tried before moving to IVF. I just said no. I didn’t let on that I was only there for egg freezing because I thought it would be insensitive to mention that to a woman who was clearly there because she was having trouble conceiving.

We practiced giving the shots on oranges. I knew there was no way I would remember all the steps, but luckily we were given a step-by-step instruction sheet to help us. I left the class feeling excited, like I was taking on a new big project.