Fertility Medication

All of my medication

Okay so in this blog post, I am going to be telling you all about fertility medication. I will tell you what they do, their costs, and the side effects. This picture above is all the medication I will be taking over the next two weeks. There are a lot of needles, wipes, and 3 different kinds of medication!

Treatment

First things first: your treatment plan. Before you leave the hospital, you and your nurse will discuss the medicine you'll be using, the dosage, and when to take it. There are many different kinds of medicine. The ones I am taking are microdose lupron, follistim, and pregnyl (hcg). I am on the highest dosage of all of them, but that is because of how low my AMH and FSH levels are. Depending on your levels, will depend on your dosage levels. Dosage means how much of each medicine you inject inside of you.

Next, you will lay out a calendar of when you will take each medication. You don't start taking them all at once. I will go over my treatment plan, just know that this is something that will vary:

Day 1- I take 20 units (dosage amount) of microdose lupron at night

Day 2- I take 20 units of microdose lupron in the morning and at night

Day 3- I take 20 units of microdose lupron/225 units of follistim in the morning and 20 units of microdose lupron/225 units of follistim/10 units of pregnyl at night

And I continue Day 3 until my "trigger" day. I will explain more on this tomorrow. On your trigger day, you take a different kind of medication. And then 3ish days later, you have your egg retrieval. This typically happens after 2 weeks.

Costs

The costs of the all of the medication is insanely crazy. I only had to pay for one and my pockets started hurting. The one I had to pay for was microdose lupron. It cost about $600. The follistem comes in different units. I got 900 units of follistem. It all costs about $1,000. I got this medication for free. Pregnyl costs about $300. I had to get two tubes of that so really $600. That's about $2,200 just on medication alone. The only reason why I got the majority of this paid for was because of my past history of having cancer. The financial burden fertility preservation puts on families is so incredibly sad. I really do hope one day as a country we can reevaluate our healthcare system. 

What Does the Medication Do?

Each of these medications serve a purpose in helping stimulate the follicles in your ovaries. 

Microdose Lupron

Lupron is the medication that stops your body from ovulating. It stops the bodies process of hormone and egg development. When you first get the medication, You will have to mix it together. Your nurse will tell you exactly how to mix it and the dosage amount to use. It sounds a lot more complicated than it really is. You will have a very long needle that is only used for mixing. This medication needs to be immediately refrigerated after you mix it.

Follistim

Follistim is in a little tube and you use the blue and yellow pen. Follistim is a man-made form of a hormone that occurs naturally in the body. This hormone regulates ovulation, the growth and development of eggs in a woman's ovaries. This is also another medication that has to be refrigerated as well.

Pregnyl (low dose)

This is another medication that you will have to mix. The pregnyl is a powder that you turn into a liquid. This is a hormone used to cause ovulation. It also needs to be refrigerated after use

Usage

So the usage of each medication is a little different. The follistim is my least favorite. There is a special pen you use just for this medication. How it works is you put one of the tubes inside the pen

You then put the yellow part down and twist it onto the blue. The tube has a specific amount of medication in the tube.

 Mine all of 900 units. Your nurse will tell you what your dosage is for each injection. You will then turn the knob to that dosage amount

The needle goes on the top yellow part

You have to screw the needle on yourself. The needle isn't too big

The reason why I don't like this needle is because sometimes the medicine runs out before you have the right dosage.

This probably about 100 units of medicine. So I will have to inject the rest of this. Then take the empty tube out. And then put another one in. And then inject the rest. AKA getting poked TWICE. I hate needles so I don't like this. The pen will remember how much more of the medication you need, so you don't have to remember that.

Lupron and pregnyl are both a little easier to inject

Both of the needles look like this. You stick the needle into the vials. Turn them upside down and then take out the correct dosage amount.

I always ice 30 minutes before I get my injections. But to be honest, after awhile, the ice doesn't work. I am on day 5 of injections and they've ALL started hurting like yesterday. You have to give yourself the injections in your stomach. Your stomach starts hurting and it is so sore. It always hurts

:( you get 5-6 injections a day. It all depends on the follistim. It is horrible. I will not sugar coat it haha. 

Side Effects

The side effects are the worst and almost mimic pregnancy symptoms. I feel like my side effects have been 10x worse than the last two times I've done this. I feel nauseous every single day. And if I don't lay down for 30 minutes after taking the medication, I will have a headache all day. You get hot flashes and are so exhausted. You are very moody and hormonal. I am so irritable all the time and I randomly feel like crying. You also get bloated. These are the ones that I notice the most that effect my day. It is a challenge sometimes with working but I definitely make it work. 

I hope you enjoyed this blog and learned a little bit more on this process and all about medication. My next blog will focus on your second doctors appointment and what all the entails.  

First Doctors Appointment

My doctors appointment today was kind of frustrating. I was angry and upset all because of the cost. I went back to the "why me" mindset. Why did I need to get cancer? Why did I have to get cancer that would really mess up my chances to have kids? Why did I have to go through the pain and frustration of fertility preservation 5 years ago, just for a hospital to LOSE ALL MY EGGS?? Now fast forward five years, I am going on round 3 of fertility preservation and I might not even get any eggs this time...this is the sad reality for many women. It's a hard concept to grasp at the young age of 24...I will get more to this later. First, I am going to talk about what happens at your first visit!

First Visit

So you are at your first doctors appointment after you made the decision to go through fertility preservation...now what?? Well I will tell you, that first appointment is long and very informative. In the past, my mom was able to always go with me. However, because of Covid, hospitals are a lot more strict. When we walked in, we were greeted by two people at a table. We kind of had to check in and state why we were there. They almost didn't let my mom up because she didn't have an appointment. After explaining how she needed to be there to learn how to give me the injections and stuff they let her go up. This was the only appointment she was going to come with me to. The first appointment is always information overload, so it's nice to have someone who will have a clear head space go with you! You will probably be overwhelmed and emotional, so you might not focus the whole time.

After you check-in, you will go back to get a baseline ultrasound. All the ultrasounds you get are TV ultrasounds. I hate these. The baseline ultrasound is just so your medical team knows exactly what your ovaries are supposed to look like. They also let them know if they think there might be any complications. You will also get blood work. The first time you go, they take like 8 tubes of blood. They test your blood count, STDs, your fsh level, and your amh level, and if you're pregnant. Your fsh and amh levels are very important. Make sure you pay attention to what they say about these. Your amh levels lets you know how many follicles you have inside of your ovaries. Or essentially, your egg count. FSH levels allows you to know how close you are to menopause. The higher your amh and fsh levels are the better. That means you'll be able to get more eggs. The lower the levels, the less likely you are to retrieve many, if any eggs. 

After that, you will consult with your nurse practitioner. There she will go over your treatment plan, show you how to take your medication, and you can ask questions! Make sure you ask as many questions as you need to put your mind. If your test results are ready, you can also ask questions about your amh and fsh levels. They also talk to you about financials and how you want to pay. Make sure you get paperwork on how to administer the medicine. My next post, I'll go more in depth about medication and administering it and everything. 

The nurse will also go over your medication schedule with you as well. You have to start your medication on a certain day. You need to be on birth control before you start to help regulate your levels. You need to stop your birth control two days before you start your injections. You have a staggered start with taking the medication. The first day, you take one of the medications in the afternoon. The second day you take one in the am and on in the pm. The third day you add another medication, the fourth day you add another one as well. On your 6th day, you go back to the hospital to get another ultrasound and blood work. I will go more in depth on this process on my next blog when I talk about medications.

Cost

This is the part that truly angered me. How expensive it is to go through this. Insurance companies won't pay for fertility preservation or IVF because they are considered "elective procedures". These aren't things you need done. It's very frustrating. The surgery alone, costs a little over $3500. The blood work I got done today, cost $1500. And that's just for the first day of blood work. I haven't had to pay for all of my medications before, so I don't know how much that total cost is. I do have to pay for one of them and it's $500 dollars. It's a lot. It all adds up. Like I said in my last post, you will pay about $5,000-$12,000 just to do fertility preservation. That's not including IVF. It's insane. And the hospital I am going to has no payment plan. So you have to have the money up front. It's a big financial commitment on families. That is what frustrates me a little bit about the american healthcare systems. People who have to go through this shouldn't have to worry about the cost. There are ways to get discounts on things. I was able to get my blood work discounted. I am also in the process of getting majority of my medication paid for.

Livestrong: If you had cancer this organization will pay for part of your medication and egg retrieval surgery. Hospitals have to have a partnership with them though. 

Walgreens: If you had cancer this organization will pay for part of your medication and egg retrieval surgery. Hospitals have to have a partnership with them though.

My Experience

Today was a lot for me. I had to really come to the realization that my chances of having kids naturally are very slim. After I got my ultrasound and blood work, I went to talk to my nurse practitioner. It's nice because I am at the same hospital I was at before and so I have a lot of the same nurses! My nurse went over my amh and fsh levels with me. 

When I had ovarian cancer, I had to have one of my ovaries removed. Chemo damaged a lot of my eggs in my first ovary. When I was 18, my amh and fsh levels were the levels someone in the their mid 30's. Fast forward to today, and my levels are a lot worse. I do not have a lot of eggs left and my fsh levels indicate that I am actually in pre-menopause. This means that I may or may not get any eggs while going through this process. 

It is a really scary thought. I will know in about a week whether or not the medication is working. If it's not, I will stop this process. I only have 5 eggs frozen from the last time that I did this. If I am able to get qt least 5 eggs this time, it will be amazing! I am hoping for the best at this point. It is crazy to me to think at this young age, I may not be able to have my own kids. It is concept that is really hard to grasp. Working with kids all day, I do not know how I would feel if one day I wasn't able to have some of my own. 

I am trusting this process and hoping that This will go well and they I will be able to have good and viable eggs to use for the future!

Thank you for reading my blog :) my next one will be about medication and the treatment plan. I will also be talking about all of the wonderful shots you have to get!! 

Fertility Treatments

So last Thursday I went a fertility doctor to figure out my options for the future. I needed to see a fertility specialist because I have a tumor on my last ovary. This tumor is not supposed to be cancerous and I am going to get a surgery to get the tumor removed. My doctor told me he wanted me to see a specialist before he did the surgery in case he had to take out my ovary. I had my left ovary removed when I had my first surgery back in October. If I lose my last ovary I will go into “forced menopause”, I think it’s called that, and I won’t be able to have kids.

The appointment was just supposed to be a consultation and my mom and I were going to get information on my options. I wasn’t sure if I wanted to go through with the treatments. I was nervous and scared and I didn’t mind the idea of adopting my kids.

However, when I got there my fertility specialist just started talking to me like I was going through with the procedure. My mom really wanted me to do it and they both made a really good point. I can always just go through it so I have that option later down the road. I started preparing myself for everything I would need to do and I became more comfortable with the idea.

My doctor went over the basics of what the procedure would be like and everything I will need to do. The whole process is 2 weeks and I will need to take medicine during those weeks that will increase my hormone and estrogen level. On the 36^th hour of the last day, I will go into the hospital and prepare for surgery. The surgery will be very minor and my anesthesia will be light. It will feel like I am in a twilight. I have never had any teeth pulled, but I think it is the same feeling when they put you to sleep. While I’m asleep, they will go and get as many eggs as they can and then freeze them. The whole process takes up to 45mins. So it will be a very quick, easy procedure.

After I talked with the doctor, I spoke with two nurses that will be helping me with the medicine and surgery for the whole two weeks. First they explained to me how to use my medicine. I have two shots I have to do BY MYSELF and one pill I have to take orally. The shots have to be given at night in the belly and I can take the pill anytime that I want. I have to also come into the doctor’s office three days a week early in the morning to get an ultrasound and blood work done.

I had to get a lot of blood work done at my appointment when I went as well. They had to check to make sure I didn’t have a lot of diseases and wasn’t pregnant and things like that. I always warn nurses before they poke me that I am a hard stick. They normally need to get a specialist to put an IV in or get blood. The nurses never listen, and I don’t if it’s a pride reason or what but they always think they can do it. They tell me how they have been doing this for a while and they should be able to handle it. Well five pokes later they finally listen to me and get someone who specializes in this area. The same thing happened that day and I had to get poked 5 times before they found a good veinL.

This day was so stressful because my doctor wanted me to start this procedure the very next day. When he did an exam on me he looked to see how many eggs my ovary had released and there were 16. You need 8 eggs for one baby. Each month your ovaries release a certain amount of eggs. 16 was very low, but I only had one ovary and my doctor thinks chemo messed up some of my eggs. He was very happy with this number because he was expecting it to be much lower.

I was way too nervous and felt like I was being pressured into starting the next day and I did not like it all. I wasn’t even sure if I wanted to freeze my eggs yet. The appointment had gone from a consultation to you are freezing your eggs to you are starting tomorrow all in the matter of seconds and I was beyond scared. After much talking, I was able to get everyone on the page of me starting next week! I am not sure how many eggs I will have but I need at least 8.

I am very fortunate because most of this stuff is being paid for by two different companies. Both Livestrong and Walmart have programs where they donate the medicine that is needed to people who have been effected by cancer. These companies will also pay for my surgery and when I am ready to have kids, there is a good chance they will pay for the surgery to put the fertilized eggs back inside of me. My family is very lucky because this process is very expensive. I am not sure how much my medicines or the initial surgeries cost, but to keep your eggs frozen it is $570 every year. I will have to start paying for this in 2018 until I am finished with them. The surgery to put your eggs back in is around 15k. So it is a lot and very stressful.

I will post more when I start my treatments and keep everyone updated on my experience!