Trigger + Follicle Questions

teresaide · January 2014

Hi ladies. I'm on my first round with Femara (5mg CD 3-7), and had my CD 13 ultrasound yesterday at noon, which revealed one 11mm follicle (and lots of tiny insignificant follicles on my right ovary). Before my ultrasound, my doctor suggested that if my follicles were mature enough, he'd trigger. Needless to say, I walked away from the ultrasound without one.

So then I got a call last night from my doctors assistant who instructed me to pick up Novarel (the trigger shot) at a specialty pharmacy in town, then go in on Wednesday to have it injected. This made me totally side-eye her because even if my follicle grows 2mm per day, it can only be at most a 15mm or 16mm by Wednesday, when he had told me previously that he wouldn't trigger until I was at least at an 18. I explained this to her and she had nothing really to say about it, so I asked her to have the doctor call me. He hasn't called yet (though he usually calls in the afternoon hours and it's only 1pm here), but I priced out Novarel and it's going to cost me $280 because my insurance doesn't cover anything fertility related.

So, if I absolutely need the Novarel, I want to be 110% sure that my follicle is mature enough to trigger so I don't go and waste $280. In fact, I'd much rather pay the $170 for another ultrasound later this week to confirm my follicle is growing and is at the right size AND pay $280 for the Novarel, instead of just guessing/hoping my follicle is mature enough.

Or, am I misunderstanding what a trigger shot does? My thought was that it helped your follicle mature and then be released (made you ovulate). But, the follicle does need to be at a certain size before the trigger will work, correct? Am I being paranoid, or what do you all think?

Milagros315 · January 2014

I'm sorry that you're feeling anxious about this. It's tough because you want to trust that your doctor knows what they're doing, but you also want to understand as much as possible so you're not just blindly following instructions.

I don't have any experience with IUIs or triggers yet. I do know that for an IVF cycle, my doctor is looking for at least four follicles to be between 18 - 20 mm or so. I have seen other clinic's say that they're looking for follicles to be over 16 mm before trigger though. It's not just the follicle size that matters. Did they check your E2 levels? Maybe their reasoning for triggering at this point has something to do with your blood work as well.

It's really important that you feel comfortable with what's happening, so if I was in your position I would try to call and speak with a nurse so that you know why they're making this decision.

sunlavender · January 2014

I agree with getting another u/s to check the size of your follie (and any that have grown in the days since). A lot can change in a couple days. I personally wouldn't feel comfortable assuming that one follicle had kept growing and reached a mature size.

I can only speak to my experience, but at my recent monitoring appointment, I had a 15 and 18mm follie and my RE had me trigger two days later. From the stories I've heard from other ladies going through treatments, most of their doctors wouldn't consider triggering until follies had reached the 16-18mm range.

A trigger does allow your body to release mature follicles. If done too soon, it can have no effect.

Could you ask your doctor for a different trigger? I know every insurance/pharmacy has different prices, but my Orvidrel trigger was about $100 (and we're OOP). Your doctor may have a reason for that specific medication, but it's worth asking, in my opinion.

I hope talking to your doctor brings some answers. Good luck.

Twinkie0612 · January 2014

I used pregnyl for my IUIs and it was only $66 OOP, $280 is insane. If they charge you $280 for your trigger, I would look into using another pharmacy for any future cycles. Even if it is not local most offer overnight shipping, many for free.

Also since your follicles were so small, I would want another u/s to check size before triggering.

Milagros315 · January 2014

Twinkie0612 said:

I used pregnyl for my IUIs and it was only $66 OOP, $280 is insane. If they charge you $280 for your trigger, I would look into using another pharmacy for any future cycles. Even if it is not local most offer overnight shipping, many for free.

Also since your follicles were so small, I would want another u/s to check size before triggering.

I agree with this. I am 100% OOP too, but I only paid ~$90 for the Novarel trigger. I got it from Walgreen's and they use the same pricing as Freedom Fertility which is a widely used mail-order pharmacy. I would definitely see if you could get it from one of those places.

Pintobean39 · January 2014

I use freedom pharmacy for my meds and my novarel was only 99.50 and they overnight all my meds to me. $280 is ridiculous. I'm OOP too.

Also my RE wants my follicles at least 18 before I triggered. I triggered this morning and yesterday morning at my us my biggest was 18. I'm not doing an IUI, just TI. I'm so proud of myself learning these terms.

Twinkie0612 · January 2014

Milagros315 said:

Twinkie0612 said:

I used pregnyl for my IUIs and it was only $66 OOP, $280 is insane. If they charge you $280 for your trigger, I would look into using another pharmacy for any future cycles. Even if it is not local most offer overnight shipping, many for free.

Also since your follicles were so small, I would want another u/s to check size before triggering.

I agree with this. I am 100% OOP too, but I only paid ~$90 for the Novarel trigger. I got it from Walgreen's and they use the same pricing as Freedom Fertility which is a widely used mail-order pharmacy. I would definitely see if you could get it from one of those places.

Yeah I got mine from Avella, which happens to have a local pharmacy down the road from my RE's office. For IVF I ordered my meds from Alexander's twin out of NJ, because they were the cheapest on follistim. Mi think my trigger was only around $75 from them.

teresaide · January 2014

So @Milagros315, @sunlavender, @Twinkie0612, @Pintobean39, @WhoCanItBeNow, and @MeatandBandP, GREAT NEWS!!!!! I went in this morning for an ultrasound and had a different tech who was SO amazing and compassionate. My lining was at a 7 which was an improvement over what it was on Monday (I think it was a 3 before), and I have a NEW follicle on my right side! It was only at 12mm, but she thought that was very encouraging. Then she moved over to my left side and was like 'Wow, look at this one!' with a smile on her face, and she swiveled the screen around and I saw a HUGE follicle. My 11mm follicle from Monday had grown to 22mm!! Immediately tears started streaming down my face and I was so overcome with joy! Then she said 'Looks like someone is getting a trigger shot today!' I was SO excited. Then I saw my doc, he said that we're good to go, and they injected me with the (PAINFUL) trigger shot in my butt and I left. I am seriously in the best mood today. My heart is so full!! Now hopefully it works

Thanks for all your support, ladies. You guys like so totally rock.

>-

Twinkie0612 · January 2014

GL, I'm glad you had a nice big mature follie!

I do recommend calling around for prices on trigger shots if this cycle doesn't work out. I hate to think of you continuing to get screwed over paying $280 for a trigger.

Milagros315 · January 2014

That's great! I'm so glad that they were able to see you again and that everything looked good for triggering. FX for you!

teresaide · January 2014

@Twinkie0612 - Yes, I actually called A TON of pharmacies the last two days and can get Pregnyl for around $85 which is SO much more do-able. The only problem was that it was backordered so couldn't make it here in time. Luckily, the pharmacy that wanted to charge me $280 for Novarel was willing to price-match to Walgreens which charges $219 for it, so I at least saved about $60. Next time though, I'll definitely be using Pregnyl instead.

ETA - though I'm praying and hoping and crossing everything that this will be the first and LAST trigger shot I'll ever need. [-O<

Twinkie0612 · January 2014

You might want to try Alexanders Twin Pharmacy in NJ. I used them for IVF and I paid $75 for Pregnyl and they are supposed to have free overnight shipping regardless of order size (I would verify this though, since I have always ordered a $1,000-$3,500 worth of meds from them). I've never had an issue with meds being on back order. You might be able to save another $10 and not have to worry about back order.

Being OOP I am always trying to find the best deal!

teresaide · January 2014

@Twinkie0612 I too love a good deal! The crappy thing is that I live in Washington State and our regulations make it difficult for pharmacies to get licensed here, so none of the awesome online providers can sell to me. It's a HUGE bummer.

Twinkie0612 · January 2014

teresaide said:

@Twinkie0612 I too love a good deal! The crappy thing is that I live in Washington State and our regulations make it difficult for pharmacies to get licensed here, so none of the awesome online providers can sell to me. It's a HUGE bummer.

Huh, well that's a real PITA. They technically aren't an "online" pharmacy, but a brick and morter pharmacy, that then ships your meds to you. I don't know how that applies to Washington State law.

teresaide · January 2014

@Twinkie0612 - Either way, I'll definitely be calling to see. Fingers crossed that they can get me the goods!

sunlavender · January 2014

So glad everything worked out. Good luck!

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