CD Whatever

So, here's the thing. Wednesday could easily have been described as "full flow" making it CD 1. And then most of yesteday? Almost nothing. Today? Full flow is definitely a good description.

So is this CD1 or 3 or whatever?

Well, whatever it is, I went in for CD3 monitoring this morning. They managed to draw my blood in just one try today, which is nothing short of miraculous since Dracula had the day off. And I got to see my beloved Margaret, the super sonographer. My one bright spot in this whole ridiculous ordeal of having to do this all over again is that I get to see Margaret again. M is responsible for my blog name, you know. She always refers to my ovaries as "perky" because they're always full of antral follicles, which, yes, I get is a good thing, but it was, for a time, disconcerting to hear my ovaries referred to as perky. They felt slightly mocked at first, you see, which is (I'm certain) why the first IUI didn't work (though it doesn't explain why the 2nd and 3rd didn't work... surely by then they were used to the good-natured ribbing?).

MY POINT... if I ever had one in the first place, is that I adore Margaret. So while I wasn't entirely PLANNING to see her again until April or so of 2008, I'm happy to see her now, even if it's because my body sucks.

Anyway, today was no terrible shock. My ovaries, true to form, are definitely perky. I couldn't count the number of antral follicles even in one single view, let alone by seeing it all the way through. So I think it's safe to say that I've got good ovarian reserve. Shocker. Also that if I were to do IVF I'd be a super responder. Another shocker. But it does rather accentuate why it is that IUI is such a dragged on process for me. With that many eager follicles, they've got to be careful to bring just one or two to the front and ditch the rest. So teeney, teeeney, teeeeney doses of follistim for me. (More than last time, though, 66IUs) Assuming, of course, that my E2, P4, and Beta all come out indicating that it's appropriate to start stims. And they had BETTER come out saying so, because I just spent scads of money on Follistim. Which brings me to the one surprise of the morning:

I stopped at the pharmacy on my way out to pick up my Follistim. I'm fairly certain that I have a vial at home, but I'd hate to get home and find out it was no good or had been misplaced, or had expired, or whatever after I got home. Shabbos comes in at 4:30 today, so there wouldn't have been time to find a more local pharmacy to take care of it. So I stopped to pick up a vial just in case. Anyway, my insurance had rejected the Follistim because it didn't "match the existing authorization." My insurance has paid for probably 30 vials of Follistim in the last year, but I think the problem is that there was an intervening order for Gonal-F back in November, which I decided against using, because it's such a pain in the neck for non-standard dosing.

I'm certain the insurance will pay for it once it's resubmitted, but in the meantime I had to pay out of pocket for it. Not the end of the world, fortunately, but not inexpensive. Since I'm taking such a tiny dose, one vial should get me through about 5 days, possibly 6. And that one vial cost me $300. I know people who take 5 vials PER DAY for IVF cycles (I'd never be allowed to take that much for fear of OHSS). That's $1500 PER DAY. If they take stims for the standard 12 days, that $18,000 in drug costs alone for an IVF cycle. Actually, that's $18K for JUST ONE of the many necessary medications. Holy Schmoly! Suffice it to say, I'm thrilled that I have generally good health insurance and that it covers the medications as well, despite this temporary hiccup.

(I do know that the pharmacy I use heavily discounts their Follistim for out-of-pocket IVF patients. They didn't discount it for me, because they know that the insurance WILL cover it in the long run and because it was "only" one $300 vial. So at least I know they give a lot of folks a bit of a break, but even so, I can't imagine how devastating the costs must be for someone with no insurance coverage in need of that high a dose of stims! Ugh!)

So, um, let the fun begin!