07/05/2016
Shout out to all fertility doctors out there.
So, for starters, I’m in a better place than I was last week. Partially due to the cider I had Sunday afternoon (Angry Orchard Summer Honey = AMAZING). Mostly, though, due to the doctor visit I had yesterday. Yes, yesterday. On the 4th of July. They really don’t take days off in fertility clinics.
Okay, so last we spoke (typed) I had just received news that my 4th IUI was another fail. Technically, it was only the second cycle attempting artificial insemination, but I’ve been inseminated 4 times. They do it the day you ovulate and the day after, just to make sure sperm is in place to meet the egg. So yeah. 4 times. 4 fails.
Anyway, Dr Landay asked me what I wanted to do, because the IUIs aren’t working. She mentioned IVF, which is a HUGE DOLLAR SIGN to me – $13-15,000. She did say that a large part of that was the medicine, and I could apply for a discount on the drugs, but it would still be pricey. Insert panic attack here.
So, I got my period Saturday. Even though we’d done the HCG blood test, it still sucked when I started. I was still holding out that it could be wrong. Anyway. Called my doctor, u/s scheduled for Monday (yesterday), Day 3 baseline ultrasound.
I have 6 follicles. Three on either side.
Dr Koopersmith (Landay was out of town, they switch off weekends and holidays) said three were a decent size, but three were really small. Like, they would probably never mature.
So, really only about 3. I’m supposed to have more than 10 good sized follicles on each ovary. I’m used to this bad news, it was just a little worse than before.
So, we talked injectables, because the Clomid isn’t working. I’m on the highest dose they prescribe and I’m only getting 1-2 mature follicles. Most women on Clomid, taking half my dose, get 3-5 each cycle. Friday and Saturday I was panicking because when I went to pick up my DHEA at the pharmacy, there was a woman there picking up her meds to prep for IVF and we spoke. She also doesn’t have infertility coverage on her insurance. Her bill? $4300. On just the medication (if anyone follows my facebook, this was the woman with the absolutely incredible albeit man-made chest. I’m STILL jealous!!).
Anyway, I was also panicking because Dr Landay mentioned injectables when she gave me the not pregnant news, and again when we scheduled the u/s, and she said they’re a little more effective, but a lot more expensive than the Clomid. Like, one month of injectables is $1000. My Clomid is $35. So, yeah. More pricey. Also, there’s a “significantly higher risk” of multiples on injectables. I really, really don’t want multiples.
So, I went to my u/s yesterday with all this bouncing around in my head. Dr Koopersmith asked how many IUIs we’d done, and what my AMH level was. AMH is the hormone that tells you how many quality eggs you have left. My AMH is 2.25, which is really, really good. So even though I’m not producing follicles, I have a really good quantity of eggs left, so I’m a good candidate for injectables/IVF (you burn through a LOT of eggs on hormone medication, like dozens and dozens and dozens each cycle).
She suggested a combination of pills AND injectables. She switched me from Clomid to Femara, which is actually a breast cancer drug. It treats breast cancer because it’s an estrogen inhibitor; apparently estrogen fuels breast cancer. Didn’t know that. Anyway, she warned me that if I read up on Femara, it’d talk about nothing but treating breast cancer, but to ignore it. She suggested 5 days of Femara, followed by only 4 days of injectable hormones.
This is good for a variety of reasons. First, there’s a higher rate of success using BOTH oral and injectable hormones. So, that’s one. Also, even though the Femara was 3x more expensive than the Clomid, ($100 for 10 pills!!!), she said some people respond better to it than with Clomid. Next, the $1000 that Dr Landay quoted me for the hormone injections was based on ONLY injectables. Using a combo of oral/injectables, I’d only need 4 days of injectables, not 12. So, the price tag dropped to around $300. Still waiting on a call back from the office for an exact price, but she quoted me $100 on Femara, and it was literally $94.99, so I’m not too concerned it’ll be any higher than $300. WAAY better than a thousand dollars.
ALSO, using injectable hormones, they do an ultrasound the day you complete the shots (next Wednesday for me), and depending on the number and size of your follicles, they actually trigger your ovulation with another shot of hormones, and can time the IUI precisely. They inseminate 36 hours after the trigger shot.
This is good for a couple reasons – but the main one is IUIs are $600 each. We’ve been doing 2 each cycle…or $1200/month on JUST the IUI. So by only doing 1, I’m already saving $600 right off the bat.
Now, there is a small chance that on the Femara and FSH shots, I’ll produce a ton of maturing follicles. They don’t inseminate with more than 6, it’s too risky and they don’t want people to get pregnant with litters of kids (insert how badly I DON’T WANT MULTIPLES here). However, the chance of me – with only three decent follicles right now – making more than 6 mature eggs is really, really slim. She says with women with fewer than 10 follicles, she expects 2-4 mature ones. BUT – if by some small chance I make 6-10 follicles, she says we then have the option of moving directly to IVF. The eggs are already there for retrieval.
And it’ll mean that I would have only spent $300 on the drugs, as opposed to $4300. So, IF I create too many follicles, there’s a pretty good chance we’ll go ahead with IVF this cycle. Which has a 43% success rate.
So that’s where we stand. Please continue to pray for me and Quincy. As much as I don’t want triplets, twins would be….okay. But please pray that we get pregnant this cycle, and with only a singleton.
Also, on a happier note, I have realized that on all these hormones, I’m sporting a pretty amazing rack myself right now. Silver linings!!
My Stork Got Lost 