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.

Let's Do It, Again, Differently

I hadn't been to the RE office since December 22, my beta BFN.  It's been the longest time away from what often feels like my "home away from home"... the longest break in visits since I started back in April 2010.

As I was in the waiting room, a man came in and said his wife and triplets were downstairs.  They wanted to see if it was okay to bring the babies up to see the doctors & nurses (I'm sure because they made them).  All I could think is.... get me back in an exam room before those babies come through the door!  And my nurse called me back and just as I was walking by the door, in come the babies... I glanced for a microsecond and hauled it back to the safety zone behind the door.

My favorite nurse, S, greeted me and when she got me back into the room she hugged me.  Tears were hard to contain, on both of our parts.

As I waited for Dr. T I wrote down the most important question I knew I should ask:  "How much more aggressive can we get?"

Dr. T came and got me from the exam room to join her in my office.  She seemed affected when she was talking about how much she wishes the IVF worked for me.  They all know it's taking a toll on me and I can see that they truly want me to succeed!


My Fertility In General

• My FSH is consistently very good, especially for a "woman my age"
• While my AMH is on the low side plenty of women still get pregnant with lower AMH's than me (one of the doctors in the group studies AMH closely and my AMH shouldn't be a factor, especially given my good FSH)
• I absolutely should try again (they will tell women when it's not advised to try again)
• Regarding my 'aggressive approach' question, the most aggressive approach with the best odds for success is donor egg however she does not recommend this for me yet (and I'm not ready to go there at this time)

IVF#1 in Review (Ganirelix Antagonist Protocol)

• I responded well to the meds, 6 mature eggs (the 7th was almost mature)
• Everything went well except it took 13 days of Stimulation to get to retrieval, she'd like to reduce that (it's unknown that if it takes longer to get to retrieval if that compromises the eggs - or something like that)
• The embryos just didn't mature at the desired rate between day 3 and day 5
• My progesterone (using the suppositories instead of PIO) was excellent, at 45 on transfer day - see the BIG shot in the A$$ is NOT the only option for progesterone!  Note, I did take my suppositories 3x/daily religiously!

New Protocol (Luteal Estrace/Microflare Protocol)

• When my cycle starts this week, I'll call to report in
• I'll use OPK to test for ovulation at home
• 7 days after surge I'll go in to verify ovulation 
• Upon verified ovulation, start Estrace, in pill form 2x/day (to synch ovaries)
• On my next CD1 come in for bloodwork/ultrasound
• Start Stims (Gonal-F 400IU)
• Somewhere in here I also take a microdose Lupron (prevent premature ovulation)
• Dr. T recommends adding Saizen, a human growth hormone; this will not be covered by insurance (approx $600) but goes along with the more aggressive approach I requested
• She wants to do a Day 3 rather than Day 5 transfer this time, citing that my uterus would be the best environment to give the embies a chance
• She see's no problem with A, my acupuncturist, coming with me to Transfer to do treatment immediately following transfer
• Retrieval/Transfer will be sometime around late February/early March

I'm looking forward to getting started again!  

WTF Appointment Prep

I know, I know, I've been MIA.  It's the middle of January and I've not posted YET this year.  Well, here I go...

First, thank you for all of your encouragement and support from my dark day.  All of your comments were wonderful and well received; some of you were very perceptive as well.  I've been wanting to post since then to let everyone know that I've been better (it was a bad day) but I have not had the words after exposing myself so fully... and then my laptop crashed (fixed today).  Those who follow me on Twitter have the privy of knowing things are improving and that day was just my "crash" after my failed IVF on top of 6 failed IUI's, coming off of 8 months of hormones, the holidays and going into the new year where I will turn 40!

I did start seeing the IF shrink again and have started taking Xanax 3x's a day... WOW... it takes the edge off the terrible anxiety I was feeling AND I sleep well at night without any other drugs!

My WTF appointment with my RE is on Monday (yes my fertile friends who follow my blog, WTF means what you think it means).  I've not spent too much time prepping for it.  What do I ask?

• What have you learned about my ability to conceive after 6 IUI's and 1 IVF?

• What are the leading causes of my inability to conceive?  How do we address this?

• What could have been done to improve the number/quality of eggs/embryos from my IVF?  

• Will I be able to have a child with my own eggs?

• When can I do another IVF?  What will we do differently?  What are my chances for success?

What should I add to the list?  Will Dr. T have the answers?

It's not been a full month since my IVF BFN but this break has seemed to last an eternity.  I've actually enjoyed not counting my cycle days, no injections or suppositories (no alarm going off multiple times daily to remind me to medicate).  But I don't enjoy knowing it's a month where I've "wasted" an egg and I have no chance at pregnancy.

Sorry friends, for being a bad blogger.  I think the lack of blogging goes along with the TTC break.  I'm hoping my break will end next week (AF is due a few days after the WTF appointment).