Saturday, January 29, 2011

11 Prescriptions, 4 Pharmacies (I need an IVF assistant)

It's been a long two weeks!  Work is not letting up at all, even though I've talked to my managers and business partners about needing to reduce my stress.  Perhaps I'm not being clear?  I've been "coming out" to work and other friends about TTC and infertility, which another post I need to write...  in the meantime, today is my first day off in the last 2 weeks.  I worked all last weekend and have been simply exhausted this week.

WARNING - Confusing Post:
First, the drug names are likely misspelled, I know that but I've never taken a course on medical terminology so it is what it is.  

Second, if you are still TTC, dealing with IUI or IVF and don't want to read this very confusing post, skip down to the bottom and read the Moral of the Story.

I've been so busy and tired I'd forgotten to order my IVF meds.  Seriously, the "Insurance" pharmacy called my nurse, Nurse A, who called me because I've not responded to the pharmacy earlier this week.  But as far as I know, I only need one Rx starting sometime late next week, the Estrace.  So what's the rush, really?  

Currently I'm in my pre-IVF cycle (CD11) using OPK to test for ovulation (which I expect around CD14).  My RE will bring me in several days AFTER a positive OPK to test that ovulation occurred and then start me on the Estrace, then I can expect a period.  Once my new cycle starts, that's when Stims will start.

As I dug into the Rx ordering process, it got very complicated (call the pharmacy, they have a question, I have to call the nurse then call the pharmacy, or a different pharmacy, and this went on and on).

List of Pharmacy's (and how I'll reference them)

  1. "Insurance" - a mail order pharmacy, the only one from which insurance will cover
  2. "Local" - the local pharmacy down the street
  3. "Random" - a random mail order pharmacy I've never heard of
  4. "Specialty" - a local specialty pharmacy
Initially I was under the impression that ALL prescriptions were called into pharmacy #1 "Insurance".  When I called "Insurance" on Wednesday they had a list of 9 prescriptions.  
  • They did not have the Estrace Rx, which is the Rx I need for next week.
  • They advised that the Lupron Rx was on a manufacturer backorder and I'd have better luck if the Rx was called to a local specialty pharmacy (Pharmacy #3) and the insurance coverage could be labeled "request override" - so hopefully it would be covered coming from "Specialty".
  • They had a Rx for PIO, which I wont use.  Instead I use the progesterone tablets inserted in my who-ha 3x's a day.
  • There was no low-dose HCG Rx which I had written down that Dr. T wanted me to use on this protocol
  • There was no Saizen Rx which I will also use, although I know it's not covered by insurance.
So I follow-up with Nurse A, by email.  The return email has comments to my questions and notes about where these prescriptions will now reside, hence I now have to work with 4 pharmacies to get all of my drugs.

So yesterday, Friday, the "Random" pharmacy called me stating I need to return their call ASAP because they were told I need their Rx starting Monday.  The Rx coming from Random is the Saizen, which is not something I need until I start Stims.  But I got that squared away because there is no shelf life concern on the Saizen (i.e. it lasts longer than 30 days so if I order it early, no concerns that it will go bad before I need it).

Then "Specialty" called me about my Lupron, stating they were told I'll need it right away.  Again, in my notes from my talk with the doctor I wouldn't start the Lupron until sometime during Stims because the Lupron suppresses ovulation.  Why would I need it right away?  It has a short shelf life (30 days) so I should only have it dispensed just before I need it.  I'm going to call the nurse back Monday and get this figured out, perhaps I start it with my Estrace and I just wrote it down wrong, but it wouldn't make sense to take a drug that suppresses ovulation, just after ovulation, would it?

So the prescription I know that I'll need as early as next week is the Estrace... who has that?  Oh, that's been called into Local, according to Nurse S.

In Summary (tracking for my own records):
  1. Insurance
    • Gonal-F (5-900IU)
    • Vicoden (5 tablets)
    • Methoprednozone (6 tablets)
    • Doxycycline (26 tablets)
    • Ovadrel (2 doses)
    • Daisopam (1)
  2. Local
    • Estrace
  3. Random
    • Saizen
  4. Specialty
    • Lupron
    • Low-dose HCG
    • Progesterone tablets

I've been through IVF once before... even though it's a new protocol, this should be old school to me... but it's a cluster of confusion because no one gave me a list of the drugs I'll need, approximately when I'll need them and where they were called into. It really doesn't need to be this confusing if the RE's office would just document and end-to-end cycle plan to provide to patients.

Moral of the Story
If you get nothing else from this random, confusing blog post, take this away...

  • TAKE GOOD NOTES ABOUT YOUR PROTOCOL when talking to your doctor.  
  • Don't be afraid to question your nurse if your prescriptions don't match your notes.  
I'm not an expert, my notes could be backwards on one or two things...  but I do remember the detail of that conversation with Dr. T (and documented on my blog immediately afterward)...  I know I got 95% of it right.


  1. It makes me think I might need to take a tape recorder with me when I start planning my donor embryo FET's. Yeesh! I hope it all gets straightened out and everything runs smoothly with really good results this time.

  2. Phew! you need an assistant indeed, I don't know how I'd keep any of this straight! Very best wishes with this cycle.

  3. I can see why you're confused. We just had our IVF consult and I know that I left there with my head swimming with information. I jotted down a few notes, but boy, this is confusing! The only thing I remember is that I have to call the first day of my cycle. That's it. And we were there for almost 2 hours!

  4. I don't know how you do it - I m sure most people must mess something up - I know I would! Makes me feel a little daunted just thinking about it. Looks sadly as though I am headed for IVF too!

  5. I wrote you a long comment that somehow got gobbled up before it posted! The gist of it was:
    1) I can't believe they expect lay people to manage complicated drug regimens without clear written instructions (and even then you expect mistakes)
    2) In NZ the fertility clinics dispense the meds directly as they are needed so you don't have to even think about it.
    3) I would have thought you'd take lupron first to down-regulate your ovaries and that the estrace would be to manage it's side-effects. I may be wrong of course as don't know your protocol.
    4) Why don't you ask for a written day-by-day drug protocol from your RE so that you know for certain what to take and when? It is their responsibility to ensure you are correctly informed.
    5) Good luck!!! Hopefully this will be the last hurdle xx

  6. I've always thought that all of this should come with a prescription for medical marijuana to help reduce the stress... ;)

    Good luck!!! The enormity of it all totally had me freaked out and I was so happy when it started to sink in and made sense in my head. You'll be there soon. Know I'm thinking of you!

  7. Good Luck with this cycle. I'm passing on a blogging award to you. Stop by my blog to check it out. And I'd never keep that all straight. I have a hard time remembering if I took my vitamins.

  8. It seems so overwhelming at first, but amazing (and a bit scarey) that this quickly becomes very routine.

    I hear you about the work stress. I wish I had a solution for that too- IVF is a second full-time job and managing them both can be so difficult.

    Wishing you the best- thanks for sharing your journey.

  9. I really can't believe you didn't have all this in writing for you to be able to follow. The meds themselves are confusing, but with all the different pharmacies that are involved??? The mind boggles.

  10. WOW this is impressive! I'm sure your kitchen table will soon look like a pharmacy now -complete with a sharps box :) Thankfully you are such an organized person. (a skill that will definitely come in handy when you become a mom!)
    Sending you lots and lots of positive baby vibes!!

  11. Just completed my injection class this weekend, and I'm right there with you. My head is spinning with the amount of injections I have to give myself. And let's not even get into when those meds will actually arrive. First, I have to get the pharmacy to actually call me.

    Sending you TONS of good baby vibes!


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