All the Medications!

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For those of you who were wondering about the picture in my last post, as far as I know, it’s the lining of the uterus.  Again, I apologize if you were offended by that.

Thank you for your patience with the timeline!  I’ve been updating it and realized that it wasn’t linked to my posts or blog.  Oops!


Ok, getting back to the topic!!  Before doing all of this, I didn’t realize that there would be so much medication.  Since I knew, from previous invoices, how much the medication costs I wondered how much it would cost for me.  We estimated, based on the invoices, that it may cost a few hundred dollars upwards of a thousand.  The invoices I’m referring to are the ones we received from Dr. Frattarelli’s office.  It showed the total cost, minus the insurance coverage, and the balance for us to pay.  So, based on the cost Dr. Fratterelli’s office was charging my insurance company, we thought…this could get expensive!  Good thing it was affordable!

But, just to give you an idea of how much it cost…here’s the break down.  Keep in mind that without insurance you would probably pay the total value of each prescription.

I added #s to the picture I used in my previous post to make it easier to follow! 🙂

1.  Needles – I believe this is self-explanatory.  If you need an explanation for this, please let me know via a comment.  24 -30G 1/2 (0.30mm x 13mm).  I can’t remember individual the cost for this.  The needles and syringes combined, cost me $4.80.

2.  Menopur – The purpose of this medication, according to the insert included in every box, is to “help your ovaries to make eggs.”  It also says that Menopur contains 2 hormones, FSH (Follicle-stimulating hormone) & LH (luteinizing hormone).  This may sound gross but here it is…”Menopur is a preparation of gonadotrophins, extracted from the urine of postmenopausal women, which has undergone additional steps for purification.”  Menopur is reconstituted in water and then injected subcutaneously.

Value: $665.05 for 12 vials or 2 boxes + 2 vials, including water solution & Q-caps.  I PAID: $15.00

3.  Ganirelix – This injection is prefilled and individually boxed.  It’s a clear concentrated injection.  All you need to do is remove the cap (on the left side of the picture), push the air out, and clean the skin with an alcohol prep before injecting it.  When you open it up it looks like this:  Sorry about the glare!

The insert for this product gives quite a complex description and explanation.  It states, “Ganirelix Acetate Injection is a synthetic decapeptide with high antagonistic activity against naturally occurring gonadotrophin-releasing hormone (GnRH).”  SERIOUSLY?  They don’t have to confuse people! Lol.  Basically, Ganirelix stops or prevents ovulation.

Value: $563.60 for 4 pre-filled 0.5mL injections.  I PAID: $15.00

4.  Crinone Gel 8% – The instructions say for vaginal use only.  Crinone is a white gel that contains individual dosages of progesterone to help sustain pregnancy.  If you’ve ever had a yeast infection and had to insert medication into the vagina, the idea is somewhat similar.

Value: $937.00 for 56 individually packaged doses.  I PAID: $30.00

5.  Bravelle – “Bravelle contains a hormone that helps stimulate eggs to grow and mature.”  The insert also states, “Bravelle is a product containing a highly purified preparation of human follicle stimulating hormone (hFSH) extracted from the urine of postmenopausal women.”  I know, it sounds just like Menopur, huh?  It’s made by the same company.  Bravelle, like Menopur comes in powder form.  It’s reconstituted in water and injected subcutaneously.  I’ve talked about Bravelle in a previous post, when addressing injections and gonadotrophins.

Value: $3,257.15 for 60 vials or 5 boxes, including water solution & Q-caps. I PAID: $15.00

6.  Syringes – The syringes are also self-explanatory.  24 – 3ml syringe with 22G x 1 1/2 (0.7mm x 40mm) needle.

7.  Novarel – I believe I’ve talked about this too.  The purpose of this injection is to make you ovulate.  It’s given at a specific time, 36 hours before an IUI or egg retrieval.  Just like Bravelle and Menopur, Novarel is a powder, which is reconstituted in water before being injected.

Value: $181.70 for 1 vial or dosage.  I PAID: $15.00

Other medicines, not pictured are:  All are pills

I think I’ve mentioned medicines previously…

  • Doxycycline – Antibiotic

Value: $9.30 for 14 pale pink pills.  I PAID: $9.30

  • Estradiol (Generic form of Estrace) –  This is a hormone, I think it’s estrogen.  It’s usually given as a supplement  to reduce symptoms of menopause.

Value: $13.50 for 60 small light blue pills.  I PAID: $13.50

  • Methylprednisolone (Generic form of Medrol) – According to handout I received with my medicine, it says, “This medication is a corticosteroid used to treat severe allergies, arthritis, asthma, and skin conditions.”  It helps to reduce pain, among other things.  I’ll ask about it, for sure.  Sometimes the handouts and insert that come with the medicines don’t adequately explain your purpose for it.

Value: $24.25 for 14 small white oval pills.  I PAID: $15.00

  • Desogen…aka Birth control pill.  So, because I took it continuously for 7 1/2 weeks, I needed 3 packs at $31.70 each.

Value: $190.20 ($63.40 each pack) I PAID: $95.10

  • Aspirin – OTC pain relief.  81mg, 120 tablets.  I PAID: $2.01

PHEW!  SO, all our IVF costs included, we’ve paid a whopping  $3,229.71!  I hope I did the math right! 🙂 So, if we didn’t have insurance, just the medications and copayment ($3,000) would cost $8,658.36!!  Although, I’m sure the copay would be more than $3,000 if we didn’t have coverage or if we did IVF a second time.  In Hawaii, insurance covers one try at IVF! (I’ve heard that there are ways to get around that.)  A huge chunk of the costs associated with IVF are for the medications!

I had everything I needed…It was time to get started!

Next post: Ready, Set, Go!

(I like white roses!!  Just thought I’d share.)


Our Decisions…

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Do you ever wonder what will become of the decisions you make?  I do, that’s why I find it necessary to contemplate, pray, and wait for an answer.  And when you get an answer, trust it!

In my last post I went over all the costs and time that would be associated with IVF.  Well, when it came to deciding whether to do ICSI or not, it was a tough one.  I understood the repercussions of choosing ICSI or not.  Of course, I wanted the best possible chances, but we needed to make the best decision for US.

We decided to do the regular IVF cycle, which did NOT include ICSI.  So, we paid the $3,000 and waited a month until our IVF cycle was scheduled to begin.  We felt confident about our decision and were determined to stick to it.  In the meantime I was still taking the birth control pills.

The other decision we needed to make was about freezing our embryos.  Although we were not sure how many eggs would be retrieved or fertilized, we decided that we would freeze whatever we had left.  This would cost $1,500 but not until embryo transfer day…we had a couple of weeks to pay for it.

It seemed like some of the hardest decisions were made and I was looking forward to the next steps.

During the month, I was reminded by my IVF coordinator that the doctor had recommended ICSI.  I was also reminded that my success rate would be low, meaning less eggs would be fertilized, because I chose not to do ICSI.  At first I felt bad, but then I thought, no, we made the right decision.  I wasn’t about to back down or change my decision, especially when I knew in my mind and in my heart we were right.  Plus, we’re the ones paying for it.  It was around that time that I realized, this is a business too.  It made me wonder whether ICSI was recommended to every couple.  I don’t know the answer to that, but I DO know that we were not going to change our decision…no matter the consequences.  We would live with it.

The month seemed to trot along slowly until about 2 weeks before my baseline ultrasound.  My IVF coordinator called and requested that my husband do a semen analysis, which would cost $95.  I think I’ve mentioned this before, but it’s still an important part in the journey.  I guess the 1 year old semen analysis was not sufficient or current enough.  Well, my husband did the semen analysis and two days later, the embryologist called me.  She reviewed the results of the semen analysis with me over the phone and I recorded as much information as I could.  Everything was good, until she mentioned “morphology,” referring to the shape of the sperm.  She said that for IVF they would like it to be 14%.  My husband’s was at 11%.  She continued to explain that it was normal and that I should not be alarmed or worried.  After our conversation ended, I quickly went into research mode.  I found that the shape of the sperm was unrelated to fertilization or that eggs were still fertilized with less than 11% morphology.  As I read more, I learned that for IVF there is a higher expectation for sperm.  That sounds funny.  Lol.  I also learned that there are a variety of semen analysis tests and different criteria for those tests.  I’m not exactly sure about what test was used for my husband’s semen analysis.  I’ll admit, I was still a little worried that I may get a call and be recommended again, to do ICSI.

Well, my IVF coordinator called giving me instructions to pick up the rest of my medications.  We briefly discussed the semen analysis and she asked if the doctor called me.  I told her he did not, so she informed me that the doctor recommended ICSI.  At this point I was quite annoyed.  I listened to what she said, but our decision was made and like I said, that decision was not going to change.  I was getting tired of hearing the same thing over and over again.  It’s almost like a guilt trip, except it wasn’t working on me…instead, it was annoying me.  The purpose of her call was about the medication, which I picked up the next day.  Here is a picture of the medications I picked up!

I know, it’s crazy!  I wasn’t expecting to take all of that out of the pharmacy…good thing I brought reusable bags!  In my next post I’ll go over all the medications, their purposes, and how much their worth…leading up to my baseline ultrasound!

Ooh, I’ve added a picture….what do you think it is? (Sorry if you think it’s disgusting.)

Next post:  ALL the medications


The Calendar, Timing, and Costs of IVF

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One of these posts, I’m going to catch up…it’s just not going to be this one!  I have SO many thoughts right now, I’m not quite sure where to begin.  I think I’ll start off with this…

I’m going to apologize beforehand, if anyone is offended by what I’m about to say.  I don’t intent to offend anyone.

One of the original purposes for starting this blog was to inform and help others.  I’m not trying, at all, to sugar coat the IVF process.  This is not something I’ve dreamed of doing, nor is it a result of something I’ve done wrong.  I get asked a lot of questions pertaining to the “hows and whys” I’m not pregnant.  People assume many things.  I’ve had some say that I’ve put my career ahead of my decision to have a baby/child/family.  I’ve had others wonder why I haven’t had a baby after being married for more than 7 years.  Yet others assume that it’s easy for everyone to conceive just by having intercourse.  If it were that simple, I wouldn’t be writing this blog.

Everyone’s experiences are very personal and individual.  I recognize that to some degree, if you haven’t experienced IVF, you will probably never fully understand what some women have to go through to become pregnant.  It’s difficult to explain how personal this is.  Even though IVF is a process, there is a tremendous amount of emotion, physical pain, and unexpected events that accompany it.  I hope that as I describe the steps and experiences I’ve had, that you will gain an understanding.  I don’t think I can really explain everything.  I’ll do my best.

The Calendar

Like I’ve mentioned before, there are a lot of dates to remember.  Since I already wrote about the birth control, I think I’ll bypass that this time.  My calendar contains at least 2 weeks of intense activity, meaning appointments, ultrasounds, blood work, and injections.  Of course, all of this activity is tentative and subject to change, depending on how the uterus and ovaries look.  So, you have to keep your schedule open during that time.  My calendar included specific dates for my egg retrieval and embryo transfer, which I will discuss in more detail in upcoming posts. Oh ya, I forgot to mention another important date.  The calendar gives an exact date for when I will be starting the shots.  One month prior to starting the shots (while I take the birth control), my IVF copayment is due.

The Timing

IVF requires frequent monitoring, which is why timing is so critical.  Although I followed my calendar, I understood that I could be asked to come in for another appointment, the next day.  I could have an appointment anywhere between 1-3 days or more, in other words, flexibility is a requirement! 🙂

Costs of In Vitro Fertilization (IVF)

Oh my, take a guess!  How much do you think IVF costs with or without insurance?  I’ve mentioned a range in previous posts.  Since this is our first time doing IVF, insurance will cover a majority of the costs.  Phew!  That’s definitely a good thing!

We had over a month to review the costs and make a decision about IVF before paying our portion.  There are a few options available to couples doing IVF.  For me, the copayment would either be $3,000 or $4,500 plus some additional fees that, if we consented, would be paid at a later time.  The options include the following:

1.  With or without ICSI.  ICSI stands for Intracytoplasmic Sperm Injection.  Choosing to do ICSI ultimately means that after the eggs are retrieved from the ovaries, each egg will be individually fertilized with a single sperm.  When I first heard of this procedure, I was amazed!  It’s very precise and pretty much guarantees that each egg retrieved will be fertilized, thus slightly increasing your success rate.

Choosing “without ICSI” means that the eggs and sperm are on their own.  They are placed together and then responsible for fertilization.  I’m not sure if you can still consider that “natural” but it kind of is.  It’s just not happening in your body.

The cost: Without ICSI = $3,000     With ICSI = $4,500

Without insurance, IVF would cost around $18,000-20,000.  That’s right!  Thinking things through is a MUST!  You want the best chances you can get with the least amount of variables or factors.

2.  Cryopreservation of the Embryos.  This is one of the additional fees to be paid at a later date.  Agreeing and paying for this means we would be freezing our embryos, which will cost $1,500.  There is also a fee for storing the embryos.  After the first year, keeping the embryos frozen will amount to $600/year, which equals $50 per month.

3.  Frozen Embryo Transfer Cycle.  If per chance we decide to freeze our embryos we have the option of doing a frozen embryo transfer cycle.  Say the IVF cycle did not result in pregnancy and we’d like another chance.  We can use the frozen embryos and have them transfered into the uterus rather than complete the entire IVF cycle again.  Or, say that the IVF cycle was successful and we wanted to increase posterity.  This same option would be available to us.  The cost of this cycle is $4,000.

These are all HARD decisions to make.  I’m grateful we had a sufficient time to review all of these options.  The first difficult decision, for me, in the IVF process, was whether to do ICSI or not.  The $1,500 additional charge was difficult.  Paying for it wasn’t the problem, not that we’re swimming in money!  I thought about this decision for a LONG time!  My husband and I had many discussions about it…still no definite answer.  We weighed the pros and cons, pondered, and prayed.  What was really going through my mind was this…is it necessary?  I didn’t feel comfortable paying for ICSI because I felt that it was for men with low sperm count.  From what I knew, there weren’t any issues with my husband’s sperm through semen analysis.  Then there were the “what ifs” that popped up in my head.  Like, what if only a few eggs are fertilized?  We were encouraged to do ICSI but in the end, it was up to us.  It took weeks for us to solidify our decision.

The second decision we contemplated was whether to freeze the remaining embryos or not.  My husband read a lot of articles that say that many couples become pregnant naturally after IVF.  We have NO idea if that would be the case for us.  How would we know?  We just speculated.  Regardless of that, we had to discuss and decide.  We didn’t need an answer yet but the time would approach quickly.

Decisions, decisions…

Next post: Our decisions


The Beginning of In Vitro Fertilization

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Well, as the time approached for my menses, I started to get excited.  Not at all for my menses, just for the IVF process in general.

On Day 1, as instructed, I called my IVF coordinator to let her know I got my menses.  No exam or anything at this point.  I carried on with the plan, which was to begin taking birth control pills on Day 4.  I was reminded to take ONLY the active pills…the first 3 rows of white pills, at night.

So, on Day 4, I started the beginning of the IVF process, the very beginning!  I was stoked that we were heading in the right direction, making progress.  Like I mentioned before, I had to take birth control for what seemed like forever!  On my calendar, I was actually scheduled to take it daily for 7 and a 1/2 weeks.  Please keep in mind that an IVF cycle is individualized.  So, 7 1/2 weeks is what was recommended for ME.  Please don’t assume that all IVF patients will be going through the same thing I did.  If you know someone who has done IVF or know of someone that will be going through IVF they will receive their own treatment plan.  I’m just sharing mine! 🙂

Since I was not familiar with oral birth control at that time, I read the enclosed paper that included the side effects, etc.  I must not have retained all the information I read because the first few nights were rough.  I experienced sharp stomach cramps and constant breast tenderness.  I often referred to it as my “grouchy pill”.  Good thing I had to take it at night.  Lol!  It was not an exciting experience for me, quite the opposite.  I wish I had a funny story but I don’t.  If you’ve ever felt stomach cramps, they’re not the greatest.  It feels like a sharp pain a little above your naval, similar to menstrual cramps, just in a different spot.  It probably depends on the severity of your cramps too.  If you’re like me, it’s not preferred, but it’s manageable.  I survived the first couple of nights and then had an idea, which stopped the cramps all together.  This might sound really obvious, but here’s what I did…I took the birth control pill a little earlier and then took it with food.  I was taking it closer to bed time and expecting to sleep well…Ya, that wasn’t working!  Taking the pill with food was great!  Once I started that, I didn’t have anymore stomach cramps..Yay!  The breast tenderness however, that didn’t go away until I completely stopped the birth control pills.  Not too fun.

Looking at the picture, you can see that I continuously took the white pills, which contained the medicine.  The 4th row of pills were the placebos, which were green.  I never took any of the placebos, of course, because the purpose is in the medicine.

When I picked up the birth control, I also picked up a few other medications specifically for IVF.  They were pills that I was holding onto until instructed to take them.

Here is a list of the medications:

1.  Doxycycline, 100mg – Antibiotic

2.  Medrol, 4mg (Methylprednisolone – generic name)

3.  Estrace, 2mg (Estradiol – generic name)

I kept these medicines together in a bag on my dresser.  I really didn’t have a need for them at that time.  It was too early to take those specific medicines, but I’m glad I picked them up prior to needing them.  I knew I would need more medications and waited for further instructions.  I wasn’t sure who I was getting the medication from.  For all the prior cycles, I got the injectable medications and supplies, from my IVF doctor.  I thought that would continue with IVF…however, I was wrong.

About 2 weeks before my baseline appointment, my IVF coordinator gave me instructions about the additional medicines I needed to pick up.  My insurance provided the medications for the cycle.  So, after picking up the remaining medications, I was all ready to go!

Around that same time, my IVF coordinator requested that my husband complete a semen analysis.  It would not be covered by insurance and cost $95.  We weren’t sure why this was necessary because my husband completed one about a year ago.  The IVF doctor requested a current semen analysis, so he did it.

Next post: The Calendar, Timing, and Costs of IVF


IVF Preparation

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There is SO much preparation for IVF…much more than I ever expected.  After my IVF Consultation appointment, I went in the following the week to begin the IVF preparation.

While sitting in the waiting area, I was asked to fill out a questionnaire.  The questionnaire was about 2-3 pages pertaining to family history.  It was a genetic testing questionnaire.  Based on our answers, yes, my husband had to contribute too, we would be recommended accordingly.  I was instructed to hold on to the questionnaire until I was called in for my appointment.

A few minutes later, I was called in for my appointment.  I knew this appointment would include a power point presentation specifically about IVF.  I was prepared for that.  We met with the PA, who asked more questions pertaining to our personal and family histories.  She reviewed the questionnaire and then informed us that it would cost $300 to have genetic testing done.  It was our choice and it was not covered by insurance, hence, the $300 price tag.  We decided not to do the testing because we did not have a history of many of the items listed.  I have a copy of the paper that was provided, which lists everything the genetic test would cover or look at.

We viewed the power point presentation slide by slide and the IVF process was explained very thoroughly.  We listened and answered questions.  I felt good and comfortable with how the In Vitro Fertilization process would go.  The hardest part to swallow, for me, was the medication.  When I saw the list of medications I would be expected to take, I thought, “Oh my goodness.  This is crazy.”  I couldn’t pronounce all of them and remember all their purposes…and it didn’t matter to me.  I knew I had time to familiarize myself with everything.  Our appointment took about half an hour to forty-five minutes.  The PA gave me an envelope from my IVF coordinator, who was unable to attend the presentation.  Following the presentation, we went to another office to chat with the billing person.  Although IVF is covered by insurance the first time, I knew it wouldn’t be entirely covered.  I knew it would cost us between $3,000 and $6,000, depending on the options we decided on.  So, the billing person gave me a paper that had a break down of all the costs and options.  She explained everything on the paper, we all signed it, and then took it with us when we left.

When I got home, I opened the envelope.  It contained more information.  Enclosed was a calendar, a consent, and a letter.  The letter was an overview of the plan reminding me of important dates.  The consent was 7 pages long, that’s right, 7 pages.  Of course, I read it in its entirety.  It was very specific and thorough.  I was actually quite surprised at the length of the consent, but as I read it, I realized it was necessary.  One of the questions included at the end asked about frozen embryos.  So in the event that a couple separates or divorces, what would be the outcome of their frozen embryos or who would be responsible for them.  There are a lot of things that need to be considered, hence the lengthy and detailed consent.  The calendar reiterated some of the things contained in the letter.  It was a visual reminder of my complete IVF process.  The calendar helps tremendously!  But, it comes with the understanding that dates can change.  I wouldn’t worry too much about it, just be aware of the dates.  You should have sufficient time to prepare for the IVF cycle, it doesn’t start immediately.

So, now it was time to wait.  Nothing was going to happen until Day 1 of my next menses.  I had a lot of time to relax and do other things because I knew IVF wasn’t going to start right away.  I knew in some ways it would be similar to the shots but also much more than that.  It was somewhat relieving, just to know what to expect in the coming months.  While I waited, I periodically thought about the IVF process and different experiences I may have.  Of course, this was all speculation because I hadn’t started that journey yet.  Waiting was the easy part! Lol!  There was much more to come!

Next post: The Beginning of IVF