So Letrozzzzzzzzzzzzzzzzzole sleepy…

March 6, 2015March 6, 2015Leave a comment

Wow, these drugs make me sleepy! Letrozole (AKA Femara) comes with a warning on the bottle ‘Do not drive or operate machinery until you know how these drugs affect you’. Well I never saw that on the bottle first time around!

Pharmacy Fun Time
Yesterday, I got my ‘refill’ of 10 tablets of Letrozole (2.5mg) from my local pharmacy just in the nick of time. I am supposed to take x2 Letrozole tablets for five days, starting from CD3. Yesterday was CD3, so I when I received an email from my local pharmacy saying I could pick them after 5pm I was relieved. However, there was a note in the email saying that I would have to pay full price because it was so close from ordering to pick up, the insurance had not been calculated yet. That would be $103 full price v $0.26 copay due. Fortunately, when I got to the pharmacy, the insurance had done its thing and I only owed $0.30. An increase from last cycle of $0.04 – weird (My progesterone has gone up by $2.00 as well – has there been a nationwide increase in drug prices? Do drugs fluctuate like oil prices??)

Rahhhhh – Dodgeball is a great place to let off some steam

What time of day do you take your Letrozole?
I have decided to take the Letrozole in the early evening because last time when I took them in the morning, the drugs were affecting me on my drive home from work, dangerously so. They do make me extra sleepy – I guess from using all that energy up to grow those extra follicles. Let’s see how this works out. Last night I slept pretty well for the first time in a while, maybe it was the drugs or maybe its about time I had a good nights sleep after two weeks on the progesterone.

Dodge, Duck, Dip, Dive and Dodge
Right – off to dodge some balls at our social club and let of some steam!! More on dodgeball next week when I will be facing the dilemma of whether to play in the play offs or sit on the side lines…. :-S

A new day, a new cycle and new worries!

March 4, 2015March 4, 20153 Comments

Yesterday sucked. Today sucks still, but not quite as much as yesterday. Cycle Day (CD) 2 and tomorrow is start of Letrozole! Wait – tomorrow??!?! Wow, where is the time to breathe? I don’t even have a prescription yet. The nurse didn’t mention anything about my medication for a new cycle. She just told me that if I was pregnant I was to call in and arrange a blood test and keep taking the progesterone, but if I was not pregnant, to stop the progesterone and my period would come (late, not to worry, that’s normal because of the progesterone) and then we would follow my doctor’s plan. At the time, this all made sense. But my period came full flow three hours after I took my pregnancy test (seriously, what a waste of a test!!!). My period wasn’t late, and suddenly I realised I don’t have my prescription ready for CD 3. In addition I realised that CD11 for my first ultrasound was due the day I was planning on returning from Paris for a work trip. Uhoh. And if all went to plan as the last round of IUI, we would be doing the IUI either the Saturday that my brother is visiting from the UK (sorry bro, you’ve come all this way and we just got to pop to the doctors for half a day) or potentially the day I will be travelling to DC for work (sorry bro, was supposed to be taking you to DC with me for some site seeing). Aghhhhhhh! Too much to think about. How much of my best laid plans could I reschedule?

All of this came quickly. I thought about it yesterday, but was in no state of mind to deal with it. So I dealt with it all today…I decided to still go to Paris, just come back one day early (fingers crossed my flight isn’t delayed by more than 24hrs), we have a plan for when my brother is visiting, and I can delay my DC work trip (My boss has been helpful in this respect).

Today I called the clinic to schedule my CD11 ultrasound, check about medication, how I go about refills and to check the status of them passing on our medical records to our insurance company. It turns out some of my prescriptions were on refill, but not the Letrozole (the nurse asked me if I still wanted to carry on with it – I guess so??). The nurse said she would arrange it immediately. However, when it came to my medical records, there was no note to say that my medical records had in fact been sent to my insurance company. However, there was a note to say that they needed to do it… But not to worry, because I can always check again when I come in for my CD11 ultrasound. Well I do worry because I still do not have approval from my insurance company to have IUI treatment – and there is nothing I can do but let them figure it out together. We can afford the IUI, we have the savings for it, but we would rather know now than later down the road what we do and don’t have to pay for.

On a more positive note, today is our 3 year wedding Anniversary. We celebrated this evening and I enjoyed a lovely big glass of Merlot. Good timing 🙂

Happy Anniversary Mr F!

I need my safe place today

March 2, 20158 Comments

14 days past IUI round 1 and I have one negative pregnancy test in front of me….we were good and didn’t test until day 14. But I’ve known since Saturday it would be negative because I have been having those well known period pains. But maybe, just maybe I was confusing them. But no. I was not.

As it is my first time on all these hormones it has been a very confusing month. My right breast grew significantly larger after I took the Letrozole (and it’s stayed like that); I’ve had horrible ovary pain around ovulation and a swollen abdomen; then after the IUI, sharp pelvic pains that stop me in my tracks, aching lower back, swollen breasts and nausea. Damn you drugs.

But now I’ve figured all that out this time, surely, the second time round will be easier and less confusing?

Chris was dying as much as I was to take the test, but I knew already and woke up crying this morning because I just knew. So Chris made me take the test to resolve it once and for all. I’m not going to put all my thoughts down about how I feel right now, it would not make for good reading. Maybe later this week when I’m a little more composed.

My safe place is my ‘anchor point’ I developed on a ‘Presentation Skills’ course. We were taught to have an anchor point that reminds us of our safe place. Some people on my course thought it was odd and just didn’t get it. We were made to sit down on the floor and meditate, thinking of a place that makes us feel warm, safe and happy. Whilst thinking of this happy place we were asked to hold our thumbs to our middle fingers. We were guided through this meditation to visualise this happy place, smell it, listen to it and feel the warmth of it. By associating this happy place with this action of holding our thumbs to our middle fingers, we can easily calm ourselves before giving a presentation. I learnt this ‘skill’ almost 9 years ago and still use it today when I feel anxious. Today I’m walking around with my thumbs to my fingers, a lot.

IUI round 1: My Big Fat Negative

What is the probability of IUI success?

March 1, 20153 Comments

Our Doctor told us that we have a 20% chance of success with our IUI treatment (Letrozole Day 3-7, Ovidrel trigger 36 hours before IUI procedure and progesterone suppositories (50mg) for two weeks after IUI). After three rounds, that would be a cumulative chance of success of 60%. But this probability is a calculated estimate based on many factors that our doctor knows about us. For example, if you were diagnosed with unexplained infertility the probabilities of success are lower than if you have been diagnosed with an ovulation related dysfunction. Age, number of years trying to conceive and sperm quality are all examples of other factors that will influence your probability of success.

Success rates for IUI?

There are many predictive models out there to determine likelihood of success of IUI. Each model seems to be slightly different, but in general they tend to range between 9-23% success for unexplained infertility, and the important factors that determine this success also seem to vary from model to model. This is probably the real reason why that if you were to google ‘the probability of IUI success’, you won’t find much of a straight or clear answer.

Why do I care? The difference between 10% (a one in ten chance) compared to 20% (a one in five chance), is psychologically different and I’d like to prepare myself for these seemingly different odds! I trust my doctor, but I want to know more about why it’s 20%.

I spent several hours trying to find something useful that explained the most recent stats. But the website with the most useful statistics explaining the different probabilities is www.advancedfertility.com. However, the website is confusing, statistics are hidden away in text paragraphs that require reading several times, multiple hyperlinks to different pages that break up ease of understanding, how recent is this information and it is not always clear where their statistics have come from.

If you google ‘the probability of IVF success’ there is a plethora of useful information and supporting data (because the govt mandates the data is collected by clinics), also there is a really good resource, Society for Assisted Reproductive Technologies (http://www.sart.org/) who summaries the most recent data at the clinic level and the national level. They even have a patient level ‘Predict my success’ interactive tool.

So, I herby call for greater transparency and clarity on IUI success rates, similar to what can be found online for IVF success rates. I’m not looking for exactness, just more openness.

If you know of good resources to help understand success rates of IUI, please comment below and share!

On occasions I forget that there are two of us on this journey

February 26, 20151 Comment

I was really mean to Chris the other night. I mean really mean and I feel bad about it. We were in bed together and just about to switch out the lights when Chris asked

“Can I touch your tummy?”.

Now, I hate, hate hate my tummy being touched after eating dinner, I just hate the feeling, something probably related to my Irritable Bowel Syndrome (IBS). But even so, Chris wasn’t just being polite….so with a slight quizzical look said

“No!! Why???”

Chris rather coyly replied

“Because…..well….there might be a baby in there!”.

Oh. I can’t remember exactly what I said next because I had mixed thoughts at the time. But I know whatever it was, it wasn’t very thoughtful. I argued that that he shouldn’t get his hopes up because the chances of our success were low. Then we argued about the statistics of IUI vs natural conception. And so we rolled away from each other after our mini dispute agreeing to disagree and the lights went out. After about 30 seconds in the dark, I felt guilty, terribly guilty. I have been trying to not get my hopes high with this IUI because I’m afraid of them just being put back down, again… so there I was, trying to put Chris’s hopes down too. In the darkness, I quickly apologized for being mean. He said it was OK. I couldn’t get to sleep for an hour or so after this brief incident because I was lamenting on why I felt so guilty. Really it’s because I realised I had not considered him and his feelings, I was selfish and temporarily forgot that actually there are two of us on this journey together and I am not alone.

This is our journey together

Oh no applicator? Nice one freedom fertility pharmacy…

February 20, 20151 Comment

At my last visit to the fertility clinic I asked the nurse if she had any tips or hints on the progesterone suppositories. She looked at me funny and said slowly,

‘Well, they are trans-vaginal’.

OK so I got that part, but they look a little awkward to insert?

‘Ohhhh, well it’s easy with the applicator’.

Ahhh, well I don’t seem to have been given an applicator.

‘Oh I am sorry, that’s not really helpful’ the nurse sympathized.

No, not much. I’ll figure it out.

Last night was the first evening I had to ‘insert’ the progesterone suppository.

Progesterone Suppositories: Greasy little things

I have to take these for at least 14 days just before I go to bed. These suppositories help to thicken the uterine lining, increasing the chances of a successful implantation. The suppositories are quite small, certainly no bigger than a small tampon. They are oily and greasy, feel like a cross between warm candle wax and hair wax. I think they would melt very quickly if held in your hand longer than a minute.

I forgot to cut my nails. Mistake #1.

When I started walking it began to fall out, I had not ‘deposited’ it in a suitable place. Mistake #2.

I am very much aware of the sticky and greasy residue and so have worn a panty liner for most of the day. When I got home I thought I was done with the leaking. Mistake #3.

I haven’t had any side effects from the progesterone noticeable as of yet. I’ve had a sore lower back, but that could be from trying out a standing desk for the last couple of days. Fingers crossed I won’t get any. Ha…famous last words!

Purple sperm and a painless IUI#1

February 17, 2015February 17, 20154 Comments

Today Chris and I tried to make a baby without touching each other (well later on we will try the normal way too!!). Totally weird.

Last night I had killer ovulation pain. Both my ovaries were painful when I went to bed – the timing seemed to be just right, 12 hours before the scheduled artificial insemination procedure. Thankfully, I woke up this morning with just a dull ache in my ovaries rather than a sharper pain.

Chris worked from home today and I had a day of leave planned. We headed out to the clinic for our 10AM appointment and we were out of there by 12PM (with a short interlude to Starbucks). First of all Chris gave his sperm specimen for washing. He didn’t take long at all! Then we headed to Starbucks for a quick coffee and catch up on a bit of work. Chris collected his washed sperm sample and we waited in the waiting room with his purple sperm for about 20 minutes. Yup it was purple!

Chris’s purple sperm

The specimen that Chris gave was excellent according to the doctor:

semen volume: 1.7mL

Sperm Concentration: 12.45 million per mL

Percent motile: 64.3%

Number of motile sperm: 13.6 million

After washing (centrifugation)

Number of motile sperm in vial: 6.6 million

Motility: 95.7%

volume of vial: 5mL

recovery rate for processes sample: 49%

It seemed a bit weird sitting in the waiting room whilst Chris held his sperm…but then again I am currently blogging about his sperm, so we are not prudish about it. It was just weird and I can’t put my finger on why. We did get a good giggle though from the diagram on the results form. It was more of a cartoon than a diagram because I don’t think it accurately represents a medical procedure of washing sperm. But perhaps it is, and this is how they wash the sperm, in a nice warm bubble bath.

A highly technical diagram on how sperm are washed

I wasn’t nervous about today, just more excited to get it over with. I was called into the examination room with Chris and the nurse briefed us on the procedure. Very simple. A speculum is inserted, without any lubrication (because that kills sperm), then a catheter is inserted through the cervix to the womb. The sperm are then slowly injected into the womb. Actually it wasn’t very slow and was over within seconds. Apparently the doctor pulled a funny face after she removed the catheter. I didn’t notice as I was concentrating on the picture taped to the ceiling of a happy place – a tropical island beach. The face was one of puzzlement. Chris wondered if she was going to say that something didn’t work. But no, that was it, over and done with in less than 2 minutes. It was painless and hurt less than a pap smear test. I was asked to lay down for 15 minutes, and the nurse left a timer. We laughed about bun making, ovens and timers. All in all, the process was very easy. I’ve had cramping for most of the day, but I’d rather that than the sharp ovulation pain I was having any day of the week.

We are now into the two week wait and I have told Chris if he asks me one more time ‘Do you feel pregnant yet?’ I’ll punch him in the face. Luckily he doesn’t really mean it and we can have a bit of a giggle about it. No point in stressing, my glass is back to being half full again 🙂

My first ‘self’ injection and my true valentine hero

February 15, 2015February 15, 20154 Comments

I wish wish wish I had video recorded my experience with my first ‘self’ injection with Ovidrel. It would have been pure comedy and had you all rolling around in stitches. But I didn’t video it because I had no space left on my iPhone and at 1130pm I was too tired to be bothered with all that.

I worked my self up into a bit of a nervous panic knowing I had to do this self injection. Fortunately, the evening was spent mostly distracted with a romantic dinner at a lovely local restaurant. There were 6 courses and I was stuffed silly by the end. The last thing I felt like doing after all that food was grab the fat of my tummy and stick a needle in it.

I watched several you tube videos with other people doing the injection. The instructions given to me were pretty clear to follow, but I wanted to see other people’s experience with it.

Here is one adorable couple trying the injection for the first time: http://youtu.be/Yv_KvnNfCOg

And another lovely couple: http://youtu.be/Gm7AkZgVHkA

I wanted to be able to do the injection myself, and I tried, I really did. But every time I came to put the needle on my skin I freaked and stopped myself. So I asked Chris to do it. But then he was nervous and didn’t look comfortable doing it. So that made me more freaked out more. So I closed the bathroom door and tried to do it again on my own. But I just could not bring myself to do it. So I called Chris back in. We agreed I would hold my tummy skin, and I would look away. He was just as nervous as me, and is not particularly good with seeing needles either. So he counted. On two he stabbed me gently, then counted to three til it was all the way in, then counted one – two whilst he injected the drugs in and was out on three. So six seconds in total and it was all over with.

It didn’t hurt, but I felt really queasy afterwards, it’s just the thought of the needle that always gets me. We had a good giggle about it afterwards. Afterwards I felt overwhelming love for my husband; he overcame his own fear because I was too chicken to do it myself. This was his greatest valentines gift to me ever.

My what big follicles you have – all the better for inseminating with!

February 14, 20153 Comments

Today is Cycle Day 11 and I attended the first ultrasound for my first ever Intrauterine Insemination (IUI). The clinic were very efficient today, I was in and out within 15 minutes. I sat waiting in the examination room for the doctor to arrive, and there on the wall was a poster explaining the differences between fraternal twins and identical twins – A handy guide or perhaps more of a handy reminder of the increased risk for multiples with IUI. Today, the doctor had a student shadowing her, I had no problem with this, but I think he looked a bit awkward throughout – bless his cotton socks.

The doctor showed the student my good uterine lining – apparently three lines is good. This is all new to me, so I appreciated her explaining everything. I had two follicles in the right ovary (as I had predicted) one 20mm and the other 28mm. I also had a teeny tiny one in the left ovary, only 6mm, but she said it might be nothing. So I am ready to go. They don’t open on a Sunday, so my appointment is on Monday 16th Feb. As a romantic Valentines day gift, I get an injection of Ovidrel at 1130pm. Not looking forward to this given my phobia of needles. I am undecided yet whether I will do it myself or get Chris to poke me in the abdomen.

This is all assuming my medication arrives tomorrow as freedom fertility pharmacy have promised me. Today I called them to check the status of my order with regard to my insurance approval. They had the approval for the Ovidrel, but not yet negotiated the progesterone. I don’t understand how this system works in the background, but from what I understand, it is crazy. So I said I would go ahead and pay full price for them rather than wait for the insurance company to do its thing. If it is covered, then I can just try to claim it back later….but I needed my meds ASAP!

The progesterone was $49 and the Ovidrel was $123 full price, with the insurance agreeing to pay up, my 10% copay made it only $12.30. Not too bad.

Cost of this IUI cycle, full price:

Meds inc. letrozole, ovidrel & progesterone: $311
Ultrasound: $225
Sperm Wash:$140
Insemination:$225

Total: $901

Expensive stuff!! Chances of success? Our doctor told us our chances were about 20%. Advanced Fertility.com breaks down the success rates even further depending on age, sperm mobility and treatment options. Apparently there is a 7.6% chance of success with one follicle, and an increase chance to 26% with two follicles. Wooohooo! But those numbers are still pretty small. there is almost a 4 in 5 chance that we won’t conceive. Putting it like brings you back down to earth.

Fingers crossed for a Valentines baby (Just like Chris is!). Happy Valentine’s day everyone!

Freedom Fertility Pharmacy Fail

February 12, 2015February 12, 2015Leave a comment

My nurse recommended freedom fertility pharmacy rather than my usual pharmacist, Walgreens, because the ovidrel trigger shots and progesterone suppositories are much cheaper if my insurance does not cover it. Sounds great, I said, let’s do it!

So once my prescription was ready freedom fertility pharmacy dutifully called me via a robot, who then proceeded to tell me there were no free reps available at that time, please call back later. Unfortunately, every time I tried to call them back their lines were busy and I was put on hold for aaaaaages. Usually I don’t mind waiting if I can leave my phone on speaker and wait for a representative to pick up. Unfortunately freedom fertility put in ads and notices over the music. Something I don’t really want my colleagues around me listening to. So I gave up. Then there was the snow storm and they were closed. Eventually when I did get through to them several days after they called me, I arranged delivery of my meds for 11th Feb (Cycle Day 9).

Later that day I had a missed call from freedom fertility. I thought it was probably the robot that kept calling me to say I had to call them, so I ignored this. If it wasn’t the robot I’d get another call. And I did not get another call, so I wrongly assumed all was well. This was until yesterday when I came home expecting my meds to have been delivered. Nothing, nudda had been delivered. I had no missed calls asking me where my house was (a frequent occurrence from delivery people) and no email saying delivery had failed. So first thing this morning I called them up.

‘Oh’, the representative said, ‘your order was cancelled because your insurance card expired.’

My insurance card doesn’t expire! And no one bothered to check with me????!??!?!?!?!?! BAHHHHHHHH!!!!!!

So I re-confirmed the insurance details, which went through correctly this time (why couldn’t the other lady have done that when I was on the phone last time??). I said I needed the delivery ASAP because I will probably need to do the trigger shot this weekend. ‘No problem’, the lady said ‘we will get it to you tomorrow, stay with your phone today in case we need anything else from you’.

As I am driving home this evening I had another missed call from freedom fertility. So I call them back as soon as I could….

‘we are sorry, we are currently experiencing a high caller volume, please hold’ DOUBLE BAHHHHHHHHHHHH!!! Luckily for them someone answered within three rings.

The representative said ‘we have to have authorisation first’….Okaaaaaay….I said ‘sure you have my authorisation!’ I thought this was for payment as I had previously set a limit on my card. Then there was this awkward silence.

‘So we can put the meds on hold then?’ the lady on the phone said. ‘Ummmmmm, wait, what? No? I don’t understand, we may have our wires crossed’ I asked thoroughly confused.

The lady realised she was talking to a bit of an insurance process idiot and explained that the Ovidrel shot required prior authorisation from my insurance company first. I thought to myself, isn’t that what I checked with my insurance company the other day? No – apparently the insurance company have to check with the doctors about something, they will do that within 24 hours. So you are telling me that even though a doctor has prescribed me some medication, they still have to check with them? I am sooooo confused.

So let’s hope that my follicles aren’t quite big enough at tomorrow’s ultrasound and I can wait another day. I am sure the clinic will help me figure it out tomorrow if I do need the shot sooner.

Eeeeeeeeeeek! Why is it all so confusing???!?!