Show Me the Money!: Part Deux - IVF Meds Cost

Hello Again!

The below information shows pricing for IVF medications from 4 different pharmacies. If you would like to know the names of them, please message me and I would be happy to go over them with you.

No one will use all of the medicine below.  For the antagonist IVF protocol it will break down like this:

Bravelle OR Gonal-F  OR Follistim
Menopur
Ganerelix OR Cetrotide
HCG Trigger Shot

Will also need to be on Birth Control Pills (BCP) for about 14 days, an antibiotic, and a few other oral medications that will be taken at various times during the cycle. In addition to that, will be taking progesterone.  I’m hoping the oral medication prescriptions are covered. I know the BCP’s will be covered at 100% thanks to Health Care Reform.

 This post will mainly focus on the injectables since I’m out of pocket for all of the those costs.

Drug Name	Pharmacy A	Pharmacy B	Pharmacy C	Pharmacy D
Bravelle (40 vials)	$2,272.02	$2,156.00	price not provided	$2,249.99
Gonal-F (3) 900 IU pen	$4,860.00	$2,664.00	$2,664.00	$4,815.57
Follistim (3) 900 IU pen	price not provided	price not provided	price not provided	$2,343.00
Menopur (10 vials)	$758.00	$739.00	$759.00	$739.50
Cetrotide (5 vials)	$472.50	$472.50	$472.50	$559.65
Ganirelix (5 vials)	price not provided	$724.50	price not provided	$580.50
Trigger Shot (name varies)	$84.75	109.90	$89.90	$91.95
Needles  (30)	$11.39	included	$15.00	included
Syringes (30)	$15.33	included	$15.00	included
Shipping	free	free	free	free

 

After price shopping and applying discounts (captured below) I will take the follow medications:

Gonal-F redi-ject pen 3 pens each containing 900 IU’s (international units)
Menopur- 10 vials each containing 75 IU’s
Cetrotide- .25mg (5 of these)
HCG Trigger shot – 1 shot (10,000U)

Discounts:

Heart+ card: Can be obtained from your physician’s office. There is a $10 enrollment charge which is handled at the pharmacy level. Discounts apply to Bravelle, Menopur, Endometrin, and Novarel.

Go-Direct Savings: Mail-In Rebate for $10 off every 75 IU’s of Gonal-F and $10 off every .25 mg of Cetrotide. Obtainable if you go to HERE.

Will also have to take progesterone.  It can be administered via injection or vaginally. Both methods have their drawbacks and advantages. My clinic recommends the latter.

I also asked my RE about any sample medications they have available that patients have returned to the clinic. They are going to give me about $200 worth of Crinone 8%.  Should get me through until I find out I’m pregnant (fingers crossed!). Then my insurance may cover it after that.

So here is my cost break-down:

Drug Name	Pharmacy B	Pharmacy B with Discounts Applied)
Gonal-F (3) 900 IU pen	$2,664.00	$2,304.00
Menopur (10 vials)	$739.00	$739.00
Cetrotide (5 vials)	$472.50	$422.50
Trigger Shot (name varies)	$109.90	$88.90
Needles  (30)	included	included
Syringes (30)	included	included
Shipping	free	free
Additional Savings		($100) on orders over $2,000
Total before Savings	$3,985.40
Total with Savings		$3454.40

 

 Here is the final cost between all 4 pharmacies:

Pharmacy A	Pharmacy B	Pharmacy C	Pharmacy D
$3,613.99	$3454.40	$3,605.40	$3,434.10

 

Pharmacy D was less expensive by about $20.00 and I would have to use Follistim, and spend $25 on a savings card that would be in the form of a gift certificate.  I liked the responsiveness of Pharmacy B over Pharmacy D too. Also, the amount cost is for 10 days’ worth of medications.  I only got a 10 day supply of medicine so if I need to add 2 more days worth, I want to work with a company that has great customer service.

So that’s it! Please let me know if you have any questions, and good luck! J

Testing, Testing, 1, 2, 3!

Hello Again!
Wanted to wait to post again until I had more information, and I have loads!
I had my 'Polypectomy, Hysterosalpingogram (HSG), Hysteroscopy, and Possible D&C' on Wednesday June 18th. I can recall what was done because I had to tell everyone who touched my chart what was happening. I know it's for liability reasons, but part of me thinks hospital staff are dumb because I have to tell them what's going on.


If you're in my boat, there is nothing to worry about because you will be knocked out.


The night before, no food or drink after midnight. Had to report at 9am. No make-up and no contacts. To heck with that! A little powder never hurt anyone!
The admitting nurse for same day surgery takes my weight, blood pressure and pulse. All 3 are a little elevated and two of them are because I'm just a wee bit nervous.


My doctor visits with me and tells me that there is another case ahead of me but wouldn't be more than an hour. My husband sits and waits with me, but does more pacing than waiting. He was a little nervous too, I just didn't call him out on it.


I get wheeled into the surgical area, and it's freezing! They should really give people something before they roll them in that area because without my glasses I see blobs of people and objects and it's a little unnerving.


One of the guys that's fiddling with my IV is chewing spearmint gum, trying to make jokes with me. I have a perma-grin because that's what I do when I'm nervous.


He said, "You should feel more relaxed now." I said, "I don't think my IV is hooked up right because I'm still just as nervous."  About 10 seconds later, the room gets even more fuzzy and I'm out.


I wake up in recovery and a very pleasant nurse is trying to get me to stay awake. I just want to sleep. I was up most of the night before and so this is the perfect time for a nap.


Doctor comes in short time later. "You did great. Got the polyp, sending for biopsy, everything else looked great, however your tubes seized when the die was injected."


OOH! Left out something major. Before the day of surgery, you will have to insert a pill up yonder to help soften your cervix, makes the process for doctor and you much easier. I can see how this would definitely matter if you weren't under general anesthesia. And stock up on some pads because you will bleed.
Back to recovery...


What happened to me was called bilateral spasms of my fallopian tubes which can happen. It's not necessary, but if the doctor were to repeat this test, my results would come back normal. He said that when the testing is done again on other patients, normally tubes would be open about 80% of the time. I'm ok with that.


I got the results back yesterday that my polyp was benign, which is what he thought it was. So I'm all set! All my tests are done, I'm in great shape.
We also got the news that my husbands most recent sample was 300,000 little guys. We were ecstatic! He will have to produce another sample when we do the egg retrieval, but just for good measure.


I'm expecting my cycle to start in the very beginning of July. I have my surgical follow-up with the doctor Tuesday July 1st. Will also have to go back to the doctors office on the 3rd day of my next cycle.
And the appointment I'm most looking forward to: My IVF nurse consult.
I've already got a list of meds I'll need to take, and I priced them from four different pharmacies. I will create a post just about IVF meds.
During my IVF nurse consult, she will go over my medications list and my own personal IVF calendar. She will also go over how to self-administer the medications, or Husband-assist the medications.


So many appointments! Before all the craziness starts my hubby and I are taking a little mini-vaca. Well he's working at a convention, I'm going to take advantage of the pool and channel my relaxed self because I haven't seen her in a while.


Hope you are all well. Check back in a few days for my medication pricing post.
Have a great rest of your week! :)

My Stats - FSH, AMH and other tests

Hello and Happy Monday!


AF finally reared her ugly head but this time I was excited to see her. This cycle was long for me (38 days), so it made things hard, just waiting for her to arrive. However, since she was late, I was able to schedule my hysteroscopy, polypectomy, and Hysterosalpingogram (HSG) for Wednesday, June 18th. You cannot be ovulating for these tests.


My AMH test was just a blood test and that was done on my first visit. I didn't get the results until recently because I wanted to call the RE and say my period arrived, let's schedule things, and by the way, what's my AMH. Maybe it's my way of being less neurotic.


Anywho, my AMH is 3.6 ng/ml. What is AMH you ask? I've been spending a lot of time on this site ( Click Here ) but I've pasted some of that information below for your convenience.
 
"The table below has AMH interpretation guidelines from the fertility literature and from our experience. Do not get carried away with the cutoff values shown here. For example, the difference between a 0.9 and a 1.1 ng/ml test result puts a woman in a "different box" in this table - but there is very little real difference in fertility potential. In reality, it is a continuum - and not something that categorizes well.

Interpretation (women under age 35)	AMH Blood Level
High (often PCOS)	Over 4.0 ng/ml
Normal	1.5 - 4.0 ng/ml
Low Normal Range	1.0 - 1.5 ng/ml
Low	0.5 - 1.0 ng/ml
Very Low	Less than 0.5 ng/ml

Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. In general, having more eggs with IVF gives a higher success rate."




However, checking your AMH is just one part to finding out how well you will respond to an IVF cycle. The other test is the FSH 3 day test. Again, please Click Here for more information on the FSH levels.

"Why does your RE measure the FSH level on day 3?

By measuring a woman's baseline FSH on day 3 of the cycle (we do it on day 2, 3, or 4), we get an indication as to whether she has normal "ovarian reserve". We are looking at how hard her body needs to "step on the gas" early in the menstrual cycle to get a follicle growing. Therefore, if the baseline FSH is elevated the ovarian reserve (how many eggs are left) is reduced (sometimes the egg quality is also reduced)."

Day 3 FSH level	FSH interpretation for DPC Immulite assay
Less than 9	Normal FSH level. Expect a good response to ovarian stimulation.
9 - 11	Fair.  Response is between normal and somewhat reduced (response varies widely). Overall, a slightly reduced live birth rate.
11- 15	Reduced ovarian reserve. Expect a reduced response to stimulation and some reduction in embryo quality with IVF. Reduced live birth rates on the average.
15 - 20	Expect a more marked reduction in response to stimulation and usually a further reduction in embryo quality. Low live birth rates. Antral follicle count is an important variable.
Over 20	This is pretty much a "no go" level in our center. Very poor (or no) response to stimulation. "No go" levels should be individualized for the particular lab assay and IVF center.

My FSH level came in at 4.9. I felt like a scored an A+ on a test!


The doctor also performed an ultrasound to see how many follicles I had in each ovary. My right side is not that great of a performer, coming in at 6 follicles. The left side fared much better with 12 follicles. The doctor didn't make any comments about the follicle amounts. She wasn't my normal doctor and I was going to get the complete results from my visit in a few hours so I didn't ask her.


It's kind of awkward having the ultrasound done on Day 3 of your cycle, but the doctor was a complete professional and the nurse was great too. My husband was in the room with us and he was quite the gentleman.


They only took one vial of blood this time. I've captured the rest of my results below. Not sure why they run a beta test (for pregnancy?) but they did.


Estrogen: 43.1
Progesterone: 0.4
Beta: Negative (duh!)
FSH: 4.9
LH 2.49
AMH: 3.6
Right Ovary: 6 Follicles
Left Ovary: 12 follicles


These results will tell my doctor what kinds of medications I will need and the amounts or if you prefer fancy words, my IVF medication protocol.


I go back to the RE on Thursday June 12th for my pre-operative blood work. Then, I'll have my surgery the following Wednesday, June 18th.


I've heard stories from women who have said that the HSG or the Hysteroscopy is uncomfortable. Because I'm having a uterine polyp removed, I'll be under general anesthesia so all of those other tests will be performed while I'm under, which is fine by me! The Doctor will also perform the mock transfer at that time as well. It's going to be a big day for me (well reproductively) on June 18th.


One big question is looming in my brain right now...will the RE want to start my IVF cycle at my next cycle start or wait a cycle?
I wonder if I need that extra time to heal. He's not doing a D&C to remove the polyp, so my lining should be unaffected but I just don't know.
I'm going to ask him on the 12th when I have my pre-op blood work done. I'll keep you posted and let you know.


Please message me if you have any questions or leave me a comment. Have a great week everyone! :)