Posts from — March 2009

Ganirelix was not in my original protocol.  But trust my overachieving ovaries to mess up the plan…

So, I got my receipt for the 3 syringes of Ganirelix from Todd’s in the mail today.

$322+

Grrrrr….

I should have expected it to be expensive for after all, what infertility med does not cost an arm (and a leg?). I didn’t expect it to be that expensive because before I gave my credit card info I asked nurse H*l*n about how much it costs. And she said about $20… I remember thinking… hmmm, not too bad… not bad at all.

Arrrgghh!!! And to think that I actually wasted 1 syringe, too, while we were in Colorado Springs and I was in a hurry to inject myself  because I was about an hour late already. (Could have used the $ to go check out more restaurants )

Now maybe, I did not hear her right? Maybe she said $120 and I just heard it wrong??? Maybe. Maybe not.

I googled the Ganirelix price and it showed $80-$120, so Todd’s price was just about right.  I just did not get/hear the correct price from the nurse. Oh well… a couple hundred dollars more for this cycle. Sigh…

If you had Ganirelix in your protocol, how much was a syringe and from where did you get it from?

Oh, it feels good to be home!

Denver is like a bigger version of Boise (and I loved Boise!). They are both cities on a valley where you could see the mountains from afar, have dry and cold weather, but do not have a lot greens (at least during winter).

When we arrived in Austin this morning, my nose felt much better - I can breathe more comfortably and I can smell better! I didn’t know how much I missed the oak and cedar tress in the Texas hill country until today. It’s just good to be home!

IVF FOLLOW-UPS:
Anyhow, John, the embryologist, called to say that: [Read more →]

Hey, I’m back at our hotel room. The ER went smoothly and just like what the other ladies commented before me - the nurses (Liz, Lynn and Melody) and doctors were very efficient yet had excellent bedside manners!

They have 7 retrievals and 7 transfers today - now who says there is a recession? I was their first retrieval of the day. Dr xxxxmeister, the anesthesiologist, placed something on my IV. I immediately started getting sleepy and then they wheeled me in the OR. I woke up a few minutes later feeling sore in the lower abdomen. I felt warm though and I learned later that there was warm air being blown into some plastic sheath on top of my blanket. That was comfy and soothing!

Dr Gustof did the ER. [Read more →]

I learn a lot from the Internet and the women who have traveled this Infertility Path. So, when I hear about pre-implantation genetic screening (PGS), I now know that it could be the FISH (Fluorescent In-Situ Hybridization), CGH (Comparative Genome Hybridization) or Microarray (MA).

I really do not know a lot about the CGH methodology in details. I just knew …
- that a lot of women were successful in becoming pregnant when they had their embryos screened with CGH.
- that CGH tests 23 pairs of chromosomes vs the older FISH methodology of 9 pairs
- that CGH takes about the same amount of time to have the eggs/embryos tested (6 weeks)
- that CGH costs the same $$$ ($5000)

I also knew that…
- the lab the CCRM was using for the CGH (Reprogenetics, I suppose, based on the example report that was shown during the genetic counseling) recently had an issue that caused “no results”, and which they supposedly have fixed (and that CCRM has supposedly verified)
- in my conversation with ********, she relayed that a knowledgeable friend adviced her to do CGH (instead of Microarray (MA))

So I was thinking I would still go for CGH inspite and despite because … [Read more →]

I went in for the bloodwork this morning to confirm if the HCG trigger shot last night worked. Rhonda, the IVF nurse, told us to stay in the Denver metro area just in case I needed an HCG booster shot.  

(Yeah, she must have heard of our Ganirelix fiasco while out to Colorado Springs yesterday.  Well, this means that Pike’s Peak and Garden of the Gods will just have to be on the next trip! That’s probably better since it will be spring then - greener and prettier!)

I guess I don’t need an HCG booster shot since I did not get a call.

I just got a call about 30 minutes ago though from Dr xxxxmeister (or something like that) who is going to be the anesthesiologist tomorrow. He told me that the anesthesia for tomorrow’s egg retrieval is going to be “lighter” than the one I had during my laparoscopy. He also said that I will only be asleep for a little while and will not need oxygen mask. I just told him to take good care of me which of course he said he was going to.

I think that means I will truly have my eggs harvested tomorrow! Pray that it goes smoothly, that I have lots of mature eggs and that I come back whole!

Meanwhile, I have a couple of posts I’d like to write but we’ll see how motivated I am after dinner. I need to decide where we will have our dinner before I go on fasting - Dr said nothing after 12 midnight for me!

ANTAGON
Apparently, my dusty ovaries are not that dusty…. my follies were marching well into the 20mm zone despite 0 Follistim on Saturday, Day 7 of stimulation. My E2’s were rising rapidly (>3000 on Saturday, then ~5000 on Sunday) so I needed to have Antagon/Ganirelix for Sunday and Monday.

I got that message late on Sunday afternoon because my cell phone was not with me during the day - my bad! Helen, the IVF nurse, mentioned though that she would have brought the meds to my hotel if we did not connect before she went home. Wow… they do go out of their way, huh?

GENETIC COUNSELING
Monday, we met with Danielle, the genetic counselor, again - $350 ka-ching on top of what was prepaid! Before the session, I was wondering what we else we were going to talk about since we had a relatively thorough discussion during the 1 day work-up. Turned out we spent more than the 1.5 hours allotted to us.

Highlights of the genetic counseling: [Read more →]

CCRM fees are big. And non-negotiable too. (I did ask them if they had “recession pricing and payment plan”, to which the Business Office said “no” to.)

So every penny counts when planning for the multiple trips to Denver.

This is the expense breakdown of our 1 day work-up last December:

• Airplane ticket - 700 (United)
• Hotel - 100+ (Staybridge)
• Car rental/Gas/GPS - 65 (Thrifty Compact)
• Toll fees - 15
• Food - 20 (hotel had hot breakfast and we were not able to have lunch)

TOTAL ~ $900

For the Egg Retrieval, we hope we just need to stay for 10 days. Here is the breakdown of the expenses

• Airplane ticket - 550 (Southwest)
• Hotel - 560 (Hyatt Place Denver South)
• Car rental - 175 (Thrifty Full Size)
• Gas - 50
• Toll Fees - 30
• Food ~ 500 (hotel has continental breakfast)

TOTAL ~ $1900

With the 1 day trip ($900) vs the 10 day trip ($1900) difference being ~$1000, it means that on the average the latter trip is costing us ~$110 dollars for the hotel, car rental/gas/toll fees and food. Compare that with $100+/day just for the hotel on the former trip! Now that is what I call frugalicious!

How did I do this? Read on… [Read more →]

Last week, I was catching up with some of my fellow IF bloggers posts that I have missed in the last 2 months. One thing that caught my eyes was Mamasoon’s CGH results - or should that be “no results”.

So I sent an email to my IVF Nurse and asked her about a “recent botch up of CGH test” and whether microarray is applicable for my egg (not embryo) case, does CGH and microarray differ in cost, and whether microarray is “safer” than CGH. She did not send me an email response but when we talked on the phone she told me she would get me the answers to my questions.

Last Monday, I got a surprise call from Dr Sch instead He sounded a bit miffed (I think) but he does understand that we in the IF blogosphere have a unique culture such that word gets out fast here. He said that it was not a botch job (like someone dropped an embryo or someone skipped work, etc.) but was instead attributed to the variations in the enzyme/reagent used. (I used to work with chemicals too so I understand what he means. It is still is not acceptable not to have quality control on the incoming enzyme/reagents though.)

Dr Sch stated that the choice of CGH vs microarray was typically made by them based on which lab has a shorter turnaround for the load that they have at the time that the samples are available. He also stated that they do not favor one test over the other and in fact, consider them equivalent. (I wonder if they did a study on this?) I do remember him saying these on our first phone consult though so he is still consistent. He did say that if I wanted to choose one over the other that I was welcome to do so. Based on what he said though, I would like to go for whichever would have faster results when my samples are available. Any of you have an opinion?

I told him that I needed to ask those questions I asked because of the “data” I got from the web. And I backtracked, I called it “information” instead of data. And that’s when he gently laughed and said “that anything you read in the web, you should not treat it as “data”". I agree. But I still would ask. No harm in asking, right? I’m paying good money for all these!

Guess where I am right now? Yes, I am now in Denver and probably will be for the next 10 days.

I had an appointment for Ultrasound and bloodwork at 8:15 am earlier today. I thought I had plenty of time but guess what greeted me when I opened the curtains:

SNOW!!! Yaix!!!

I wasn’t prepared for it. I knew it was going to get cold that’s why I packed my thick winter jackets and turtle neck shirts.  But not snow!

That explains the brush inside the rental car! I was wondering why they left their “cleaning” stuff inside the car! Now, I’m glad they did. I further gave away my being snow-ignoramus though when I opened the driver seat door and snow went in and deposited on the seat!  (I started to get worried that when I turn on the car heater that my seat would be all wet!) Anyhow, I actually enjoyed brushing off the powdery snow off the car - it was easy-peasy!

When I was done brushing off the snow, I only had 10 minutes till my appointment. So I drove off … and when I made the left turn into the major street… I lost control of my car and made a 180 degree!!! It was a good thing that there was no car right behind me… I guess they stayed away because the rental car had an Oklahoma plate.

There I was in the middle of the road, facing the wrong direction!!! I was shaken but I couldn’t help but grin. I waved at the oncoming traffic and they let me maneuver.  Then I was on my way… I was a bit frazzled but I thought it was more funny than embarassing. I just praise God for protecting me!

I got there on time - ultrasound showed my ovaries were on track. They should call in later today what my Follistim dosages are for the next 2 days.

Here’s my schedule in the next few days:
3/12 Thu - Ultrasound/Bloodwork. IVF Physical
3/13 Fri - Genetic Counseling with Danielle
3/14 Sat - Ultrasound/Bloodwork. Back-up Freeze #1
3/15 Sun - Ultrasound/Bloodwork
3/16 Mon - Ultrasound/Bloodwork. Back-up Freeze #2

Will keep you posted, I promise!

Who says you have to be on Day 5 to go for the 1 day work-up? The center website says so… the center documents says so and then the people scheduling it say so too.

But guess what? My period did not actually come in time for the 1 day work-up. (For someone like me who has her period once every 3-6 months, I expected that my period was not going to cooperate. Indeed… the 10 days of provera (supposedly on time for the 1 day work-up) was not enough to push it.  It took about 7 days of Prometrium (after the 1 day work-up) to coax it out of me.) But I still went through the 1 day work-up.

My conclusion? You really don’t have to be on Day 5… they just need you to get there so as to establish you as a patient. (Some of the doctors are not licensed in your state and thus, they have to see you face to face first before they can claim you as a patient and start your formal medical care and prescribing meds to buy and take.)

Here goes my recollection of the 1 day work-up we had at the yearend last year:
New Patient Consult - Dr Sch was out the whole week so Dr Gus was the one who saw us. Pleasant, smiling guy. Talked about not a lot of data on frozen eggs yet.

Hysteroscopy - All clear! Dr Gus performed this.

Semen Analysis and ASAB - Count and motility were excellent. Morphology still was low. ICSI is unavoidable. $2800 ka-ching!!! BTW, although the center was beautiful, going down to the batcave….uurrmm basement … to submit the samples was a bit eerie and cold. I guess our precious eggs, sperms and embryos need a cooler, darker place to stay???

Baseline Ultrasound and Doppler - Some regrowth of my dermoid cysts on both ovaries. Good blood flow! Linda, the nice sonologist, did this.

Nurse Consultation - The big book is given. Rhonda was thorough in going through what information we could find there. I got a free 600 IU Follistim!

Genetic Counselling - DH and I were not yet on the same page on whether to do CGH on the egg or the embryo when we talked to Danielle. (We have since then resolved that we are going to go for egg CGH.) New thing I learned from Danielle is that the Day 5 embryo biopsy done by CCRM for the CGH samples are multi-cell, not just a single cell sample. I think that multi-cell decreases the error vs single cell sample. Danielle mentioned also that there is 1 lady who is opting for egg CGH (Polly, I think she must have meant you!) so we could at least have a data point before we do it.

Rhonda later called in mid-January to say that the lady who was doing the egg CGH changed her mind. And what that meant was that I would be their first patient (guinea pig) to do the egg CGH. Yay! (Polly, you better hurry up… you go first! Aww… I just checked your blog and I am indeed going to be the first guinea pig with you coming in later this month)

As for all the rest of those genetic testings? We declined them all.

FLC Consent Review - Won’t mention names but she might have just as well left us with the forms for us to read and sign. Bummer that because of my age and my “infectious” disease results (nurses say that it is not contagious) that I cannot be an embryo donor!

Not that I will have many egg/embryo to donate or that we would want to be (DH is not comfy with that… yet), but it just doesn’t seem right that if we are willing and there is a willing couple that their criteria precludes us from having that option.

Also because of the “infectious” disease, any embryo (or egg) that needs long term storage will have to be sent out to a special storage. Talk about stressing the egg/embryo further!

How many times do I need to bring out my card for payment???
This is the only thing that sort of odd in this place. You have to draw out your card a couple of times to pay for the semen analysis, the consult, the hysteroscopy  and of course the deposit.  And they do this in 3 areas of the center. Can they just please swipe the card once and in 1 place? I know that CCRM and FLC are 2 different entities but do they really have to a ping-pong on us from 1 receptionist to the other???

All in all though, it was an efficient day. We were able to go home that night. I was just glad it was over so that we could move forward in this saga of becoming fruitful.