Newbie-type questions about medicated cycle

catlover790 · July 2014

I have a couple (newbie) questions and I didn't want to bug you all with a new thread but they seem to have gotten lost in the 3t weekly update! So thanks in advance for reading! Also, it seems lots have had a rough week so (hugs!)

I had my CD3 monitoring appointment Monday and everything came back good. I am not sure yet about this RE's office; it doesn't seem like they are organized and I feel like they are pushing the more expensive treatments. One nurse asked me if I wanted to do IVF!? I mean I am not opposed to aggressive treatments if necessary but I feel like it's not the first thing that is usually done. I also feel like I have to re-explain things each time that I go in.

I also didn't even see the doctor, only the nurses. I was going to ask to speak to the RE but I have my HSG Monday (CD 10) so I know for sure I will see him then and figured I'd just go over my questions then. Anyway, I feel like I have to know what's going on and tell them what I want to do so that is why I have these questions for you!

1. Is a trigger always done with femara? I know it helps to see exactly when you will O but I just wondered if there was any negatives to not doing it? Will I still O without it? Do you prefer one way or the other?

2. Are progesterone/Crinone always needed also? I have only O'd 2x since stopping the pill but each time I had a 16 day LP. I was just wondering since it is very expensive, (almost 300 dollars). If it is necessary is there a less expensive alternative? I took prometrium before and it was covered with insurance and the Crinone is apparently covered after a deductible so it wouldn't really be less expensive for this cycle. I read on some old threads that prometrium can be used as a suppository?

Also, I am not sure if the RE wants me to do both of these yet but they were listed on my profile when I went to get the Femara and I was surprised because they didn't mention it when I was in the office. We are only doing TI this cycle (we wanted to start small and work our way up to doing more like IUI) so I just didn't know if this was common practice.

Thank you all for helping me with all my newbie questions! You're all so helpful!

Pintobean39 · July 2014

I have no advise about the Femara because I've only done injectables. My RE automatically puts me on a progesterone support. As he explained it to me if there is a progesterone problem it needs to be started right after ovulation for the best results. Now I am 40 and at my age low progesterone is more common. I didn't use Crinone because it's more expensive, I used endometrim because it's cheaper. I think at freedom fertility it's about 7 an insert VS the Crinone is about 17 per insert.

WishUponAChild · July 2014

I am so new to all this I don't have any answers but I am sending my love and support!

catlover790 · July 2014

@Pintobean39‌ Okay, thank you! I saw the endometrium listed but wasn't sure if it was exactly the same. That would be much cheaper! Thanks!

@WishUponAChild‌ Thank you!! You're so sweet!

lebradford · July 2014

1. No, a trigger isn't always done with Femera. Personally, I would always do one so that you have more control and can better time your TI. But, yes, you should eventually ovulate on your own. I believe it helps the egg mature the last little bit too.

2. It seems like most REs automatically start patients on progesterone support. However, not all of them do (mine doesn't). Generally if they don't automatically start progesterone, they check your levels around 7dpo. Usually they're looking for 15 or higher on a medicated cycle. My first cycle I didn't need progesterone support. My second cycle I did, so for my third cycle they automatically started me on it right after the IUI since I had needed it once in the past.

You should definitely check into different brands because the prices vary greatly. My doctor originally called in crinone, but when I asked if they had anything cheaper, they had me do endometrin, which isn't cheap (IMO), but it's much better.

Also check around to different pharmacies because their prices vary *a lot* from drug to drug. Different pharmacies have better prices on different things. I called a few for endometrin a couple of weeks ago and I found one with a $40 coupon off a box, bringing the price to $80. I think there are 21 or so in a box, but you usually need at least 2 a day. I believe the pharmacy was MDR. Alexander Twin is another place to check. I want to say they had the next lowest price, but no coupon (so $120/box).

You might already know this, but if your cycle is successful, you will continue progesterone support for several additional weeks, so you might want to order enough for at least a few days past your beta.

Also, be aware that your doctor might call in a prescription for like 10 weeks of progesterone. You don't need to fill it all at once! Tell the pharmacy how much you want to fill at first, and you can always refill later if you need to.

lebradford · July 2014

Also, I've also heard that prometrium can be used as suppositories, but I've never done it. Just ask.

Lastly, I also assumed my doctor would do my HSG and was somewhat unpleasantly surprised to find out that day that it would be a nurse practitioner and that my husband would not be allowed in the room. Just a heads up that those are possibilities.

Pintobean39 · July 2014

Oh I forgot about the coupon I found for $50 off endometrim. I think someone posted the link a week or 2 ago somewhere on the bump. You can probably do a search for it.

catlover790 · July 2014

@lebradford‌ Thank you so much! I think we will do the trigger; my husband thinks it will help time everything better and the cost is not too bad. I will start calling some pharmacies today just to get a better idea; and thanks for the heads up about the HSG. I guess I will have to double-check with the office (again!) about it.

@Pintobean39‌ Thanks! I will look for the coupon!

catlover790 · July 2014

@Pintobean39‌ I found the coupon link! Thank you so much! I will ask the RE about switching the prescription but that will help a lot!!

jennym25 · July 2014

I am seeing a new RE and this cycle was very different and less costly than two years ago. Previously I did Clomid with TI, Clomid with trigger and no progesterone either cycle. This cycle I was on Femara +Ovidrel, B2B IUI's, tested for progesterone levels on CD21/7DPO which came back at 9.9. I am taking prometrium 200mg 2x a day (vaginally). The Femara was covered by my ins, but the Ovidrel was $145 and the prometrium was $90. Insurance did not cover. Though the prometrium was through a local pharmacy that the RE is affiliated with and they can provide the Ovidrel for $110. If your insurance does not cover maybe ask you RE office if they are affiliated with any local pharmacies.

catlover790 · July 2014

@rainbowbridge14‌ Thank you for your help. I would not mind taking prometrium at all since it is covered with insurance. If it is equivalent to crinone/endometrin I would choose that.

@jennym25‌ Thank you! I know insurance won't cover crinone, endometrin, or ovidrel. I will ask if there is a pharmacy that the RE typically recommends! thanks!

Thanks everyone! I will ask about the different options for progesterone support. I think I am leaning toward a trigger shot also to help ensure ovulation and time everything. I have a lot to talk with the RE on Monday! Thank you all!!!

catlover790 · July 2014

@kkeglar13‌ Thank you for sharing! Sounds like we are very similar! I haven't been ovulating at all which is part of why we want to try TI first. We sort of feel like we haven't had the chance to try on our own since I haven't been ovulating.

Thanks for the input on prometrium used as a suppository! That is covered on our insurance so if I can do that instead of crinone that saves me 300 dollars this cycle!

My RE too wanted to do IUI from the start but I've been reading that it doesn't add much of a higher chance of conceiving when the diagnosis is anovulatory and/or no sperm issues. So, I'm hoping when I go in Monday that they will be supportive of just doing TI for a couple tries.

I want to do what will give us the best chance but for us it's going to be 600 if we can do the prometrium/ cheaper option so I hope that will work.

Thanks again!

BunnyBerry · July 2014

My RE does not have me use a trigger or progesterone. Like you pointed out, meds can help with the luteal phase. I think most women do use a trigger to make sure, so likely your RE will suggest it.

Our office is clear about what is an RE consult (we've had 3 I think) and what is just an appointment for a procedure or monitoring. However, I can call the office with any question, and the nurses consult with the RE and get back to me. Perhaps that's a good way to get your answers.

My HSG was 1 hour late - I sat in a freezing Xray room with a bare butt for that entire time - because the woman with an HSG before me decided to turn her hospital procedure into a major consult. So I would recommend saving the HSG for questions about the HSG results, and schedule a consult or call with other questions at another time.

catlover790 · July 2014

@BunnyBerry‌ Thanks! I appreciate the info and advice about the HSG timing. I'll be sure to call and tell them I have questions and if I have time during the HSG or if I should come early/wait after. I'd hate to cause someone the stress of waiting like you had! I'm sorry you went through that!

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