Medications for FET

Medications are arriving. Have last of them coming tomorrow in the mail and 1 to pick up at the pharmacy yet. Seems so surreal that everything is arriving and getting ready to go. I'll have to do a picture of them all when I get the last box. It's a lot. Less than IVF but more cause of the extra things from Dr. K. Now all there is to do is wait for my period to show up. Praying this time around we get our take home baby.

FET Meds - lots of shots this time around

FET starting in JUNE :)

Was all set to start my FET plan today I'm on CD4 BUT my RE is not doing any IVF transfer the last two week of June and so that makes this cycle out as transfer would of fallen in those weeks.

FET will have to start with my June period which won't come around again till the week of June 10th and then a 21 day wait to start in on Lupron end of June. He is going to call in Intraplids for me to Coram Specialty Infusion place I found in WI (he is talking to Dr. Sher on the dosage and order info) and get all my other meds on order so they will be here in plenty of time.

He is a little skeptical of any of the additions by Dr. K of Intraplids, Predisone, Lovenox, Metanx will make a difference as he feels there is not enough studies to show it does. He's not against me doing it and is willing to go along with it but just said he felt he doesn't know if it will help. I'll be his first patient doing Intraplids. Also going to do PIO and oral Progesterone instead of Crinone this time around.

I know there is no guarantee's but I feel I got a good plan going cause of the testing I went through and even though immune protocol is not proven by papers published I know it works through testimonies in the immune group I am in.

So June is the month - I think I may go crazy waiting though!! I was so ready to get it going now.

Around 51 days to continue to work on my exercise, weight loss, chiropractor care etc. We have a yard sale too we are working on for end of May and also give us time to save more for travel expenses and the intraplids that insurance won't cover. 

Somehow time will go by and June will get here and prayerfully by end of July transfer and a BFP :)

 

 

IVIg and/or Intraplids

One of the challenges of needing a Immunological protocol for my FET cycle is trying to get my insurance to agree to the medications and cover them. Even though the field of reproductive immunology has been around for a long time it's not widely recognized as anything other then experimental, even though thousands of woman have been helped by this protocol to go on to have healthy pregnancies.

Right now my stress level has been going through the roof trying to get my insurance to say yes to covering IVIg IV infusions. I have a feeling they will not and I will have to go to plan b Intraplids. Dr. K feels Intraplids are not as effective as they are synthetic and not a blood product so in order to do them instead I have to get my RE to prescribe them.

Why do I need this treatment? During my immunology treatments I was found to have elevated levels of the below. It's a good possibility because of this and the blood clotting issue that this is the reason for my infertility and repeated mc. Correcting it should allow me to go on to have a normal pregnancy.

NK assay:
50:1 32.1 should be 15 or less
cd56 9.9 should be 12 or less

Th1/Th2 cytokines:
TNF 44.5 should be 30.6 or less 
IFN 18.9 should be 20.5 or less

In order to lower these levels to prevent them from attacking the embryo they do a IV infusion of a blood product (made from antibodies extracted from the blood plasma) called IVIg (but it's very expensive and not always covered by insurance) or the alternative (but Dr. K won't do it as she feels it's not as effective) is something called Intralipid another IV but it is a synthetic product composed of 10% soybean oil, 1,2% egg yolk phospholipids, 2.25% glycerin and water.

With plan A not looking so promising I hope my RE on Monday's visit will be able to help with setting up Intraplids instead and pray they will be just as effective. I'll probably still have to pay out of pocket for Intraplids but from my research the cost of the medication is significantly lower, hopefully my insurance will at least cover the infusion of it with a nurse.

Would appreciate your prayers that one of these options works out for us soon as well as the rest of the medications so we can start our FET cycle soon. 

UPDATE: Insurance DENIED IVIg so it's on to plan B Intraplids for us - makes me really upset but nothing I can do. We could appeal but that could take forever and still be a no so hopefully Intraplids will work out instead. Will have to trust God to do the rest. 

RE Consult

Monday the 13th at 2pm is my consult with my RE Dr. Olive. Go over the FET plan, items Dr, K added and make sure both Dr. are on the same page. There is some meds I need from him yet to get called in and I am sure will need to sign a financial thing too for the FET. Hopefully Scott will be done with work in time to come with.

Still working on getting the medications approved and praying that will go through without any troubles. 

 All of this is just one step at a time. Please continue to keep us in prayer.

With Mother's Day approaching on Sunday this is a good read. I know many don't understand how those of us struggling with infertility feel especially at church when mother's are praised and made to feel they are of great value. It leaves a empty hole in one's heart, it's a day I made sure I did not attend church for fear of being in tears and no one understanding. I am a mother to angels and our godkids but that is not recognized. More Pastors need to be sensitive to ALL woman on this day!

Article

  

FET Plan - 2 (addition of Dr. K's recommendations)

So I am home - one long day!!! My apt down in IL was at 1pm I had to wait 20min cause the nurse was still at lunch. Ummmm can you say REALLY!!! Did blood work first, went over lovenox shots gave me a kit on them. Lovenox is the medication for my blood clotting issues.

Then I talked with Dr. Kwak-Kim (she is such a fascinating Dr. so much knowledge). Went over her plan etc. She had me do a vag u/s to see if I ovulated this month as today was cd 25 and I DID a good size one on the left side, (take that RE) but my lining was thin. Overall what I thought was going to be a hr 1/2 max apt. took 2 1/2 hrs.

Oh the best part of today was I got to educate the Dr. about Infertility lol - I gave her a gift of a pair of my IF awareness ribbon earrings and she didn't know that blue/pink was the awareness colors and she had no idea what "baby dust" was as I gave her a HBW wristband and a small bottle of "baby dust". She thought it was all so cool and said she's been in this field for over 25years and this is the first she heard of the term "baby dust".

My dh napped in the car this time and I dealt with it all myself since he needed to rest to drive home again. We did find a little shorter route and cut out about 20-30min so that helped think we made it in 2hrs 30min. down there. Actually got there way early compared to last time leaving at same time too. Still a long trip when you do it all at once but we saved on not getting a hotel room this time.

Got blood lab orders, got prescriptions called in and a collection kit to send Dr.Kwak-Kim some blood so I can skip one trip there, maybe, depends if my RE will do it for me. Otherwise we got at least 3 more trips down there during the FET cycle if he won't, if he will then 1 before transfer and 1 after a pos preg test and maybe a few during the preg also.

I typed up all her scribbles and combined it with Dr. Olive sheet and e-mailed it to her nurse to go over just to make sure I understood it all before I go see my RE.

This morning before we left I had called my insurance to see about the status of authorization on IVIg, talked to 3 people and they first said yes it's authorized and copay is $65 then last one said not sure yet we need Dr. notes. Told the nurse this and she was like I sent them ALL then notes on the 25th so she re-faxed it all again today too then told me to not get my hopes up that what they told me this morning was going to happen as far as them authorizing it as a lot of times they see Dr. K and RI and go nope not for fertility reasons. Also she said some have issues with getting the Lovenox too. *SO PLEASE PRAY this does not happen to me and they DO authorized this medication. I need to also explore the option of Intraplids with Dr. Olive in WI just as a back - up plan as there is not way I can do 3-4k for ea. IVIg infusion if insurance won't cover it.

I am unsure if I can start this cycle as I am due for AF any day now and still have some loose ends to put together yet. Below is my new FET plan so far from the notes I put together and typed up tonight when I got home. Hoping the nurse will get back to me Monday or Tues as I asked her to go over my notes and make sure I got everything right, after that I can then make the apt to see Dr. Olive and get the medications I need from him called in. Seems like so much work, a go between two Dr. Long tiring day but one step closer.

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FET PLAN - 2 (combined with Dr. Kwak-Kim and Dr. Olive)

1.   Call Day 1 of menstrual cycle (call both Dr.’s)

2.   Per Dr. K - Highly suggested on cycle day 20 request a u/s to confirm ovulation with Dr. Olive before Lupron shots are started on day 21.  (reason; her cycles are longer (32-35ish days past few months) and it’s best to confirm follicle is released to cut down on starting Lupron too soon and causing the unreleased follicle to turn cystic.)

a.   *Vag u/s was done with Dr. K on 4/3 cd 25 and it was noted patient ovulated from left side, ovulation est on day 21, cycle maybe becoming more regular with thyroid function and homocysteine levels returned to normal along with weight loss of patient, lining though was on the thin side, blood flow issues to uterus – bf need to be min of 2 with 5 best and patient at 0, likely cause is clotting issue and Lovenox should help improve this.  

b.   Per Dr. K when Lupron is started also start Predisone 10mg 1x day 

3.   Dr. O - After aprox 10 days of lupron go to Dr. O for Baseline Visit/trial transfer, blood testing estradiol level.  Continue on Lupron if all is ok no cysts and low estradiol. Begin Estrace 2mg 3 times a day (already on baby aspirin 81mg per Dr. K)

a.   Per Dr. K - begin weekly TSH level blood testing for next 12 wks when estrace is begun as estrogen can lead to a raised TSH and must be monitored to keep under 2.0.

b.   Per Dr. K - when menstrual cycle begins blood testing needs to be done on cd1 or before cd3 at latest. (options are to return to ILL for blood draw, or ask if RE Dr. Olive can draw blood and that blood can be FedEx overnight to her lab for testing for ANA, NK assay F/U, and TH1/TH2 Cytokine Ratio) Rest of blood work (Plasminogen Activator Inhibitor – 1, CBC, TSH, FT3, FT4, and Comphrehensive Metabolic Chemistry) can be done locally and faxed to Dr. K.

c.   Per Dr. K - Cd6 begin Lovenex 40mg injections daily

4.   Per Dr. K - return to IL between CD 14-15 (after all bleeding has stopped). Do first IVIg infusion (still working to find out if insurance will authorize this, will need a back up plan so do need to know from Dr. Olive who can do Intraplids in WI and see if I can also get that authorized with insurance and set up in case IVIg is not a affordable option). Blood flow u/s will be done to check on effects of Lovenox and any adjustment in dosage as needed that day.

5.   Dr. O after 7-14 days of Estrace administration, go in and have u/s done to insure no follicles have grown and to determine the thickness and pattern of the endometrial lining. If the lining is less than 7mm or not multilayered the dose of Estrace will be increased and the u/s repeated in one week.

6.   Dr. O – When lining is appropriate discontinue Lupron and begin progesterone

a.   Dr. K would like me to take Progesterone Injections 2cc 100mg 1 xday in the morning and at night she wants me to do Prometriam oral pills 1x day to start then maybe up to 2. She feels crinone is not as effective but can use the stash of it I have on hand later in pregnancy so not to go to waste.

7.   Dr. O - day 5 or day 6 embryo (which all mine are this) is to be thawed and transferred you will undergo the transfer on the 6^th day of progesterone admin.

8.       Dr. O – day of embryo transfer schedule preg test

a.   Dr. K would like not only Quantitative BHCG, but Progesterone levels and Estradial levels done and faxed to her

b.   Dr. K if positive preg test return to IL and do second IVIg infusion (or second Intraplids in WI) She would like another u/s for blood flow with her to determine any adj to meds. Continued monitoring of NK cells etc. Will give me more instructions when time comes.

9.  Dr. O - estrace, progesterone and baby aspirin continue to week 11. Early preg u/s d 2-3wks after pos preg test.

a.  Dr. K with positive pregnancy test you will continue the prednisone increasing to 10 mg twice daily. If pregnancy is negative you will stop the prednisone if positive you will continue until instructed to stop. You will increase the Lovenox to twice daily with a positive pregnancy test and continue throughout the pregnancy, if negative you will stop the Lovenox.