IVF Update

Alrighty. Sit back with a cup of something, and get ready to read! This one is a long one.


I want to update everyone on our IVF progress, as well as provide insight for what the journey looks like – in detail. One thing that has driven me the most crazy over this time so far, is the lack of true detail for each step.

Like, when someone says you’ll have to go in for bloodwork to determine medication protocol – okay…what labs do they draw? What are they looking at?

Why would that level of detail be important?

Well, if you’re like me, and have no infertility coverage, you’ll find that most of the process is not covered by your insurance, but sometimes SOMETIMES little random things in the process are. Like certain labs. Not all of them, but some.

If you are married to a finance guy, you’ll understand and appreciate his desire to know exactly what gets covered, and what has to be paid out of pocket, as in advance as possible.

The only way you’ll know that, at times, in this process, is by having as much information at hand as possible, while calling your insurance company yourself.

So, hopefully this overload of information will be helpful, if you’re looking for the most detail you can get ahead of your first cycle.


From the top!

The first thing that happened, after we decided/knew IVF was right for us (I have no fallopian tubes – see here), was pick when we’d like to start.

For us, it was both a financial planning decision, but also, a personal one.

See, throughout these five years of infertility, I’ve been driven nuts by people who easily got pregnant when they wanted to. I always heard “I didn’t want to be heavily pregnant during summer” and so on.

Well. Heck. IVF put the ball back in my court, so I chose spring, for the reason I just listed, actually!

I can’t stand heat and summer, and I know I’ll probably be grateful to myself for picking spring to get pregnant, so I can be nice and huge during wintertime. If it works, that is.

So, think about when you want to start, based on things like that.


Big Picture

After deciding we wanted to try in spring, we phoned the doctor and asked what steps needed to take place to make that happen.

For us, it was the following:

  • IVF consultation with the doctor
    • He told us what exactly happens during a cycle, medically
    • He gave us a general idea of the timeline
    • He gave us a general idea of which meds I’d probably be on
    • We asked lots of questions
  • I was already on birth control, but this would be when you would begin, if you weren’t already taking it
    • The reason for the BC is to begin suppressing everything, so they can control control control.
  • Scheduled lab work and a sonohysterogram for me (did these on different days)
  • Scheduled lab work and a semen analysis for Sean (done on the same day)
  • After protocol came back, scheduled injection class at clinic

Now, let me break down these bullet points…


IVF Consultation

The IVF consult cost us money. Of course. It isn’t covered by insurance, so it was a few hundred dollars. It’s unavoidable, but annoying.

As I mentioned above, this is when all preliminary questions are asked and answered. Here are a few I had written down ahead of time:

  • What medications do you typically prescribe?
  • What is the general timeline for everything?
  • What are your clinic’s success rates?
  • How many embryos would you put back? What’s the most?
  • What can we do to begin preparing our bodies?
  • Does your clinic do ICSI?
  • Are you a 3 day or 5 day transfer clinic?
  • What happens with extra embryos?
  • What would be a reason you would cancel a cycle?
  • How can I prevent OHSS?

I would encourage you to Google “questions to ask at an IVF consultation” to build your list. That’s what I did, and I’m glad for it!


Birth Control

Ironic, right?

If you aren’t already on it, they’ll prescribe it for you now. This lets them shut you off, so they can turn you back on again when it’s time.


My Labs

My lab work was timed specifically. I was to continue BC until I finished my current pack. This way, my body would start my period (I’d been taking continuous BC so that I wouldn’t have a period).

On the first day of my period, I had to call the office so they could schedule my Day 3 labs.

Here are the labs they asked for:

  • AMH or anti-mullerian hormone (1 week for results; all others were back the next day)
  • DHEA
  • Testosterone
  • Prolactin
  • Prenatal panel which is
    • HIV, Hepatitis B, Hepatitis C, RPR, Blood Type, CBC

I took this list, and called my insurance to find out which they would cover.

Those labs filled about 9 vials. I felt totally fine afterward, but it was irritating to have the needle in my arm that long! Started itching. Nothing was wrong, my skin just didn’t like it.

***It was at this time that I really began to realize that IVF is a PROCESS, not an EVENT.***

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Sean’s Labs

For my husband’s labs, he was tested for:

  • HIV
  • Hep C
  • Hep B

I guess it’s just standard protocol for them to look those over. It only took 1 little vial for them to test all that, so tell your husband it isn’t too bad! 🙂


Semen Analysis

This is when the man is asked to produce a sample on site, and then the andrology lab looks it over to make sure all the little spermies are happy, moving quickly, shaped properly, etc.

The setting is a tiny room with a comfy chair, TV, vials of oil for lubrication, sterile cup for the sample, cabinet w/sink, clock. It’s super clinical, and not romantic AT ALL. Fluorescent lights and everything. So, wear something cute, be aware ahead of time that it’s super unnatural, and do your best.

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My husband and I feel strongly that no other woman’s body needs to be involved in our baby-making process (non-traditional as it is), and thus, I went with him for this step. Together, we got what was needed, and that was that.

Some couples don’t feel as strongly about this, and husband goes in himself, watches a dvd they provide (or magazine, etc.), and does it alone.

Not happening over here.

Something I’ve learned through this step (which we also had done after our first year of infertility, five years ago), is that sometimes the room will have materials on the wall (pinup photos, calendars, and so on) when you enter. That INFURIATED me the first time.

The second time we did it (for IVF), those weren’t there at all, and were in a cabinet, out of sight unless you wanted them.

So, if you’re sensitive to that type of thing, ask the nurse before you enter the room if it’s going to be visible immediately. I asked this time, and she let me know in advance that they had moved those materials a few years back, and now store them in a cabinet in the room.

The other thing I’ll mention is this – lubrication is limited to canola oil, which they provide in little vials. No saliva or anything. So, just be aware that they’ll have it there for you.

Oh! One more thing.

They left a clipboard in the room to have us write the time ejaculation occurred, whether any was lost (didn’t make it into the cup they give), and so on. Little awkward questions that made me feel very sad for us, but whatever. The lab just needs to know so they can account for certain things.

The nice thing is that the room you’re in is locked, and inside another, larger area, which is also locked. So, NO ONE can hear, see, etc. anything. It’s at least private, in that sense.


Sonohysterogram

Ya’ll. This one is not very fun.

Mercifully, I had temporary memory loss about what exactly this procedure is, and literally went to the doctor that day thinking I was having a transvaginal ultrasound. That’s it.

The reason that was silly of me, is because I’ve had an HSG before, and knew that HSG’s and Sono’s are very similar. One pushes dye through the fallopian tubes (HSG) and one pushes it through the uterus (sono).

Both do not feel good AT ALL.

The benefit for my ignorance that day is that I wasn’t stressed at all going into it.

The downside is that I hadn’t taken any advil ahead of time, as a precaution (like I did for the HSG).

So, I’m warning you and not allowing you to be ignorant, and I know it might stress you out, but I did not like being surprised.

Let me rewind to the specifics of the procedure, though.

Basically, you’ll be taken to the ultrasound room of the office, and the doctor, tech, and medical assistant will all likely be there.

I had my husband sit in a chair near my head, for support.

They get you to undress from the waist down, then put a sheet around you. From there, you get to lay on the bed with your feet in the stirrups. Blehrughahhhihatedoingthis

Next, the doctor will use the speculum thing, to open you up. This never hurts me, it’s just cold.

From there, he locates the cervix, so he can insert a small catheter type thing, which he’ll use to pump the fluid through to your uterus. They can then see the shape of it, whether there are fibroids or cysts, and so on.

For me, the catheter placement and fluid pumpling was AWFUL. Because I was unaware of what was happening even at that point, the shock of the pain make me scoot all the way up the bed, and they had to pull me by my legs back to the edge of the bed. Yikes!

It’s over within a few minutes, and I survived, but it just really really didn’t feel good at all.

At this visit, they also will do endometrial scratching, which I think is even more painful. I say “I think” because he had such a tough time getting into my cervix, he didn’t do the scratching. Apparently everything is rather tilted in there!

After this part, they removed all the tools and replaced them with the ultrasound wand and finished up by looking at my ovaries.

Then it was over. Ahhh, finally.

They gave me a feminine pad, and I took about 4 advil. The pain subsided gradually over the next couple of hours.

I am still bleeding / basically having a period, and it’s been 8 days. Supposedly that’s okay, but I just want to warn you that it might trigger you to get one, or at least spot a bit.


(In the meantime…)

In the meantime, and between all these appointments and procedures, my bloodwork came back, and gave them the information they needed to determine my medication protocol (what to prescribe, how much, etc.).

With that information in hand, I began hours and hours of research calling different pharmacies around the US for the best prices.

One of the main meds most women will take during IVF is called Gonal-F (Follistim is the other brand, and each pharmacy will sell one or the other at a reduced price, based on their contract with them). It is the big guns, in terms of stimulating the ovaries to grow eggies.

The manufacturer of Gonal-F is called EMD Serono. EMD Serono has a savings program called Compassionate Care.

Compassionate Care allows patients to save money on EMD Serono meds from 25, 50, up to 75% off.

It’s SO easy to apply for. You just need your prior year’s tax info, and ten minutes at a computer. You’ll apply on their website, upload that tax document, and within a day or two, they’ll send you an electronic savings “card” for you to use when ordering from participating pharmacies.

Worst case, and you don’t qualify for even the 25% off – they still have a 10% off mail in rebate. We qualified for 25% off, and you can’t combine them, so we went with that.

Now, pay close attention to the “participating pharmacies” part.

Compassionate Care’s website allows you to search for participating pharmacies by state, or you can have them list EVERY participating pharmacy in the US.

So…that’s what I did. And I called all of them.

I learned SOOOOO much through those phone calls, too. Let me tell you.

For one, I learned your FIRST question should be: Do you ship to _______ (your state)?

If they don’t, make a note of it (so you don’t forget you’ve already asked), and call the next one.

If they do ship to your state, your next question should be to verify they are part of the Compassionate Care program.

If those answers are yes, here’s what I would do:

  • Create a little spreadsheet like I’ve pictured, where each page is a pharmacy.

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  • Title the sheet by the pharmacy name, put their phone number in the corner, and leave room for any notes (shipping fees, are needles included?, etc.)
  • Any time I called a pharmacy and they didn’t ship to me, I noted it, and “hid” the page, so I could always double check the name of the pharmacy in future, but not have to have it in my face all the time.
  • In each page, have the same layout, with the meds you’ll be taking, the dosage, and quantity
    • When you speak to each pharmacy, get their quotes and put them in your categories
  • Then, when you’ve called everyone, make a master comparison table (pictured) so you can see who won in each category.
    • My nurse was AMAZING and totally didn’t mind sending scripts to different places. She thought it was pretty funny I did all the research to begin with

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Let me tell you – we saved close to $2,000 by comparing like this. So, if that seems like a lot, I encourage you to put the work in.

One of the cool things I learned from calling around, too, is that despite the fact that my nurse ordered me two, 900 unit Gonal-F pens, I could get that same amount of medicine by ordering three, 450 unit vials because the 450 vials are actually over filled to about 600 units and are hundreds of dollars cheaper! I’m saving about $5-600 by using three, 450 vials instead of two, 900 pens.

One other money saving thing I learned is that for the progesterone suppositories (if that’s what you’re being prescribed), you can use either Crinone (name brand) or Endometrin (generic). The difference, is the Crinone is applied once a day, and Endometrin twice. So, you need twice as much Endometrin. HOWEVER! Even at twice as much, by using Endometrin, I’m saving about $300. So…worth asking the pharmacies about brand vs. generic!

When I asked my nurse if this was an okay cheat, she was all for it. Her main concern is the medicine and dosage, not the method of packaging. Does that make sense?

The bottom line takeaway is this – ask questions! There are SO many brands of the same medications out there, that by switching to a generic, you can save SO much money.


Financials

One big thing for us in all of this was funding. The journey, out of pocket, is so expensive, that we had to use a loan.

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Getting our loan! This is Ryan. He’s our new best friend!

Timing wise, though, this was frustrating to go into blind.

Why?

Because you won’t know how much it will cost until you know which medications you’ll need, in addition to the actual IVF procedure.

Well, you don’t know the meds you need until you get those labs done.

All of those steps required spending non-loan money, as well, and that wasn’t fun.

So, the way the timing worked for us was this:

  • Meet with bank to discuss viable options when we found out our protocol
  • Had labs drawn
  • Received results and protocol
  • Researched med prices
  • Went back to the bank with the medication and procedure total, thus knowing a good ballpark for our loan

We borrowed a few thousand more than we estimated, so we aren’t up a creek at any point. I’d recommend this. There’s always a chance you’ll need a refill, or they’ll add something once monitoring begins.

Stress is such a huge no no during all of this, that once financing is figured out, the not thinking about it afterward is a huge gift. You know?

So, at this point, all testing had been done, and I’d told my nurse where to send prescriptions for meds.

Each pharmacy then called me to confirm shipping address, etc. and to take my payment. That’s how simple that part is.

Now, a couple of my meds require refrigeration, which means overnight shipping, and that can cost between $10 and $40 (it did for us, that is). Just be aware of that.


Injection Class

At the injection class two days ago, we met with our IVF nurse, and another couple who are starting at the same time.

We began by going over an enormous packet of consent forms, and then an enormous “book” with all the IVF steps laid out, for reference. It included medicine overview, written instructions for mixing meds and administering them, and so on.

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Note the nurse and some meds she’s already showed us how to prepare and administer.

She then went over each medication, with demonstrations, and how to draw meds, administer them, and what to expect.

When she was done, the head Embryologist came in and gave a presentation on the science behind the lab stuff at retrieval and transfer.

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Embryologist on the right. He had a presentation which walked us through EVERYTHING, including the average outcomes and ballpark numbers to expect

Now

It is now Monday, and I’ve given myself my first three injections (painless!!! Seriously, not even a “pinch” – I’m so relieved!) of Lupron, to suppress suppress suppress. No ovulating allowed! That would defeat the purpose.

On March 8th, I’ll begin to give myself a second injection, of Gonal-F and Menopur, mixed together. So, at that time it’ll be Lupron in the morning, Gonal/Menopur in the evening.

After a few days of having that second med in my routine, I’ll go in for every other day bloodwork and ultrasounds so they can see how my ovaries are doing, and make any med adjustments they’ll need to.

The plan is for our retrieval to take place sometime during the week of March 19th, or possibly the weekend before that. Then, 3-5 days after retrieval will be the transfer.

I bought a few organization drawers for all the supplies, as the ease of access cuts down on me feeling like a crazy person. The alternative was to leave everything in their boxes and bags, and search for what I need each time. Doable? Yes. But, come on. Plus, I love organizing things!

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The folders have all of the medication label information stuff, receipts, instructions, and so on!

I also made this silly little calendar, which is a complete overview of the cycle, and which I can update as we go!

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My head right now…

In an attempt to prepare myself for what is coming, I’ve been doing research (go figure). Not too much, as I don’t want to stress out. Just a little.

Like, did you know all these meds can make you pretty constipated? So, I’ve learned it’s a good idea to include benefiber in your daily routine.

I’ll also be pretty crampy and miserable leading up to, and after, retrieval. So, I’ve got my heating pad on standby.

I also learned that one way to help prevent OHSS is to drink gobs of Powerade Zero, stick to a no sugar/carbs, high protein diet. Therefore, I’ll be having a protein shake daily, with benefiber mixed in.

Also!

Apparently it is a good idea to really take care of your gut when using all these meds, so a daily probiotic is on the list.

A cute piece of advice I’ve read, and will follow, is to buy “happy” bandaids, so they at least make you smile when you see them. I chose Disney Princess bandaids 🙂

A random thing I’ve learned is that, generally, when you do a fresh IVF cycle (no embryos were frozen between retrieval and transfer), you will likely only need progesterone suppositories.

When doing a FET (frozen embryo transfer), say a fresh cycle didn’t work, or you are opting for genetic testing first, (which requires freezing), you probably will have to do progesterone as an injection. Up to ten week of pregnancy! Ya’ll. That injection is with a big honking needle, in the but, daily. It’s huge because the progesterone is in oil, which means the needle needs to be big to get it out. Ugh!!! Fingers crossed my fresh cycle works!

So, that’s where we are! Keep us in your prayers. I’m battling a cold – epically bad timing – and really working on taking in ONE DAY AT A TIME. That’s such a common phrase, but so very applicable to me right now.

If I start thinking too far in advance, or dwelling on how much worse I might feel, what might go wrong, etc., I just stress out. Not good. Not allowed.

If you’re going through this too, I’d loooooove to hear from you!

If you’re about to go through this, I’d also love to be of any help I can. Feel free to email me (see contact page), and I’ll answer any questions you have!

If you’ve already been through this, ah! Tell me all about it!

If you don’t fall into any of these boats – congrats! Thank you for reading. I hope this helps you understand that friend or co-worker a little better.

More in a few days! I’ll update on any side effects from the Lupron, particularly.

Have a great day!

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Some of my “prep” items!

Preparing Lupron for the first injection!

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I especially chose Belle for this moment 🙂

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2 thoughts on “IVF Update

  1. This is so wonderful! I still cannot believe you’re here. You’re definitely right about it being a process. You’re doing so well with it all, (and also, I can’t believe how much money you saved with all the pharmacy calling and research. That’s so awesome!) and I cannot wait to see and snuggle this beautiful little angel baby.

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