IVIg is NOT covered!!!!

This is the e-mail I received from RE's office on Monday:

You are correct, the $7355 is your remaining balance due by May 11.

For the IVIG, you will pay for the medication thru the pharmacy - $68-70 per gram, last I heard, closer to $70 – for your first dose during your stimulation portion of your cycle. The price of the actual medication fluctuates all the time. One day it can be at the lower price, the next day at the higher.

It is the supply/demand issue. The infusion portion would be paid to us the day of
your actual infusion. Upon diagnosis of pregnancy is when the second dose of
IVIG will be infused. Payment will be the same.

Outside of your medications for the cycle, you should not have any other charges. ICSI, freezing and storage are included in your Teacher’s Access Plan.

With a positive beta and appropriate rise, we will do OB ultrasound x2. If you know for sure you have maternity coverage, we will file those ultrasounds with your insurance company and it should be covered under your co-pay.

What a bummer!!!!

Is IVIg Covered?

I e-mailed RE on Friday:

Have you heard anything from the insurance company about covering IVIg? We will be getting I loan and I need to know how much to ask for.

Also, I know Dr. Saleh said to not start BCP's later than May 18th so I am a little concerned. My cycle has gone on longer than expected (now at CD29) and there is still no sign of ovulation. If I do not ovulate within the next few days, is there anything that I can take to help AF show up? I do not want to miss out on the June cycle!

Kylie answered:

You will start the Lupron injections on 5/23 and you will need to be on the
BCP by 5/16 at the latest. If you have no menses by 5/04/07 then call the
office after doing a home pregnancy test with the result. I will
discuss with Dr Saleh and we may start you on Provera to produce a
withdrawal bleed.

I had EWCM today (CD31) so we'll see if my temps stay up or not. Then I'll call and find out if I will take Provera or wait for AF to show.

week 43 of acu

Had acupuncturist appointment today. Told her IVF is scheduled for June. I will give her more info as it becomes available to me. I am to take these herbs from 4/28/07 - 4/3/07:

1. Chinese # 0611021-20061102-1-6
2. Chinese Angelica (Radix Angelicae Sinensis--Danggui)
3. Danshen Root (Radix Salviae Mil Tiorrhizae--Danshen)
4. Dodder Seed (Semen Cuscutae--Tusizi)
5. Glossy Privet Fruit (Fructus Ligustri Lucidi--Nuzhenzi)
6. Himalayan Teasel Root (Radix Dipsaci--Xuduan)
7. Prepared Rehmannia Root (Radix Rehmanniae Preparata--Shudihuang)
8. Safflower (Flos Carthami--Honghua)
9. Turmeric Root Tuber (Radix Curcumae--Yujin)
10. White Peony Root (Radix Alba--Baishao)

I asked her if I was to drink the nasty "dinosaur-named one" from the last cycle. She said she had included it. After I told her I had a really hard time drinking it, but would keep drinking it if I had to, she switched it out for number 1 above. She said it was about the same thing, but not as strong.

For the next 7 days I am to take the following:

1. Chinese # 0611021-20061102-1-6
2. Chinese Angelica (Radix Angelicae Sinensis--Danggui)
3. Danshen Root (Radix Salviae Mil Tiorrhizae--Danshen)
4. Dodder Seed (Semen Cuscutae--Tusizi)
5. Himalayan Teasel Root (Radix Dipsaci--Xuduan)
6. Prepared Rehmannia Root (Radix Rehmanniae Preparata--Shudihuang)
7. Red Peony Root (Radix Paeoniae Rubra--Chishao)
8. Safflower (Flos Carthami--Honghua)
9. Turmeric Root Tuber (Radix Curcumae--Yujin)
10. White Peony Root (Radix Paeoniae Alba--Baishao)

NKa & IVIG Appointment with RE

Today DH and I met with RE to discuss results. Let's see if I can remember it all. First of all he said it's really great that we are finding out the problems so that we can work on them. He said that I tested positive for all immune issues therefore my diagnosis is immune implantation failure. In other words, there can be one of two problems that is preventing me from becoming pregnant.

First of all, my NK seem to be hyperactive and the results were 12% when it should be 10%. Therefore, when embryo wants to implant into the uterus, the NK's attack it and prevent it from attaching. If the embryo does happen to get through, then the APA's form too much fat and eventually form a clot which prevents the embryo from breathing. So I will use IVIG to help against NK cells and then aspirin (81mg) and heparin to work on APA's. The IVIG therapy for increased NKa will be administered at least 1 week before ET (embryo/blastocyst) and will be repeated once more upon 2nd beta confirmation. I will not need any more infusions if I become pregnant. I don't know if I misunderstood him, but I recall him saying that there are not long term side effects. I forgot to ask about short term side effects. I will ask him later. He said I will not need to run tests for NKa or APA during pregnancy since 2 doses of IVIG is enough and the 2nd dose will be given @ 4 weeks so that should get me through 8 weeks and by then everything should be okay.

To fight against APA's, I will use heparin one (1) week before ET and then the entire pregnancy. There are risks of bleeding, but since it is not a high dose and just being used as a preventative, I should not worry about it. Heparin is used BID, but there is also Lovenox, which is used QD. He said they are the same thing, so I am hoping I can use Lovenox instead! He said there are not long term side effects from either of these.

Now, since the folic acid is 800mcg, I am to take 4 tablets of it to help with the +MTHFR. He does not see a need for me to continue taking my other vitamins: B Complex, Flaxseed Oil 1000mg, Calcium 1200mg + D, Omega 3 Fish Oil 1200mg, and Vitamin C 1000mg. He says I am just throwing my money away because they are all being excreted. He said the prenatal vitamin has all of the vitamins I will need. Plus, when I become pregnant and begin with the nausea, I do not want to take anything extra that I don't have to. I will have enough going on. So I will stop all other vitamins and will just take the following: Prentals, folic acid, and aspirin.

I asked RE about IVIG Study SIRM is doing, but he said that all it does is compare IVIG against intralipids. The main difference right now is that IVIG is about 2-3K and intralipids are about $300. WOW what a difference. The RE's at SIRM don't all want to use it so Dr. Sher has it going on at the Vegas Clinic. You have to be a patient at they clinic there in order to even qualify.

I also asked him about using Nuvaring instead of oral BCP's. He said that he definitely does not advise it because it is a long term (3 month) bcp. He strongly advises for a reversible, short acting BCP that is short dose.

As for my protocol, he says I will be on the L5 protocol. If for some reason my CD3 FSH and/or E2 resutls are out of range, he will adjust the dosage to L6, but does not see it happening. He said on the L5 protocol I will use the Lupron for 10 days, then have an u/s and E2. Then, I will start on 4 Follistim (300mg) and 1 Menopur/Repronex for 5-6 days. After this, he will probably reduce the Follistim to 225 mg and 1 Menopur/Repronex.

He had told us before DH did not need semen analysis, but I was concerned because when he had it done in July 2005, I remember he had to do it twice because the first time they said that they sperm were curling up at the end. RE said that taking the Proceptin should correct anything, and does not see a need for it, but if we feel it is needed, then DH can have it done. DH said will not do if RE does not recommend. I agree.

Finally, I asked again about having EMET done. He said he strongly suggestst that we do not waste our money on this. He said last month, 19 out of 20 women became pregnant and none of them had EMET done. He said hopefully I will be in this group in the June cycle. That gives me such high hopes! I am doing nothing but positive thinking from now on and I know that I will be pregnant and celebrating my pregnancy when I am in South Padres Island on Vacation. How cool will that be? In 2000 on 4th of July at South Padre, I celebrated my engagement and now in 2007 on 4th of July at South Padre, I will celebrate life!

I called my insurance company and I think that IVIG (Gammagard) is covered but RE needs to send a letter of pre-authorization. They said more than likely if he puts in the right codes and diagnosis then I shouldn't have a problem. I'm sure he knows what to do. I also asked about some preTreatment Medical Necessity with IVIg letter to insurance that I found on a website. I'll wait to see what he says about it.

NKa is Positive!

Today I received an e-mail from my RE:

I am sorry to inform you that your NK test was positive. That indicates that
your immune system is attacking the embryos and certainly explains why your IVF
cycles failed before. That will require IVIG. I suggests you make an appointment
to discuss.

Just great! Unfortunately, I've found out that insurance doesn't pay for it. I will call them tomorrow and see what they say. I will schedule an appointment with RE for Friday, if possible.

Acupunture week 41

I am on week 41 of acupuncture. That is 10 months and 1 week of acupuncture. Today we discussed RE's results. I will come back later to add info.

Beginning today (CD17-CD23), I am to drink the following herbs:

1. Chinese # 0508231-20050823-1-10
2. Chinese # 0606011-20060601-3-10
3. Chinese # 0611021-20061102-1-10
4. Danshen Root (Radix Salviae Mil Tiorrhizae--Danshen)
5. Gambir Plant (Ramulus Uncariae cum Uncis--Gouteng)
6. Glossy Privet Fruit (Fructus Ligustri Lucidi--Nuzhenzi)
7. Himalayan Teasel Root (Radix Dipsaci--Xuduan)
8. Oyster Shell (Concha Ostreae--Muli)
9. Prepared Rehmannia Root (Radix Rehmanniae Preparata--Shudihuang)
10. White Peony Root (Radix Paeoniae Alba--Baishao)

This is for my second week (CD24-CD30) I am to take the following herbs:

• Chinese # 0508231-20050823-1-10
• Chinese # 0610081-20061008-1-15
• Danshen Root (Radix Salviae Mil Tiorrhizae--Danshen)
• Dodder Seed (Semen Cuscutae--Tusizi)
• Gambir Plant (Ramulus Uncariae cum Uncis-Gouteng)
• Himalayan Teasel Root (Radix Dipsaci--Xuduan)
• Prepared Fleeceflower Root (Radix Polygoni Multiflori preparata--Zhiheshouwu)
• Safflower (Flos Carthami--Honghua)
• Szechwan Chinaberry Fruit (Fructus Toosendan--Chuanlianzi)
• Trogopterus Dung (Faeces Trogopterori--Wulingzhi)

All right, this last one tastes as bad as it sounds, it smells like "Faeces" and it is a "-terori" to drink it. I have had such a hard time; it's not pretty. I have to cover my nose as I drink it and then continue holding it for about 5 minutes and even then I still have that disgusting flavor in my mouth!~ Ugh!

SHER Institute IVF Consent Appointment

Today I had an appointment at the SHER Institute with Dr. Saleh. I got there at 1:15 for a beta (routine) so I could have my Uterine Mapping (Mock Embryo Transfer). Dr. Saleh said everything looked great and that we were on our way. Then we sat in his office with him to discuss the consent forms and questions we had. He also said he did not see a need for PGD or EMET (Embryo Marker Expression Test). This will save us a lot. He seems pretty positive about this working out.

This is a really funny, and I mean funny, hilarious and embarrasing story. The last week when I spoke to Dr. Saleh, he was telling me the things that DH should avoid in order to help his SDI results get better. To my understanding, one of the things he said was to avoid hot dogs > 100F. Well, when we were talking to him, DH asked why he had to avoid hot dogs. Dr. Saleh seemed surprised, and asked what he meant. "Well," said DH, "my wife said you had told her I should avoid hot dogs. Why?" "Yes," I said, "I have it in my notes from when we spoke last week." He started laughing so hard and said, "I said to avoid saunas and hot tubs > 100F, not hot dogs." I was so embarrased, I felt like part of the commercial, "Wanna get away?"

• DH will continue on Proceptin. Since his results were in the good to fair fertility potential, he said he does NOT need to re-do the SDI in June. Also, he said he does NOT need to have Semen Analysis. All he needs is his bloodwork. I have the requisition form, so he just needs to go to a Labcorp with it.
• I need to come back in on Monday to have the NKa bloodwork. He said since he had already run the APA (Anticardiolipin Ab, IgM, Qn) through Labcorp and it showed that I had a problem (usually their testing is a lot less sensitive but since it detected it, it means it's pretty bad!). Basically this means that when I become pregnant and the embryo attaches to my uterus, my body (blood vessel) will begin to release fat. Since it releases so much fat, it becomes a clot and this in turn prevents oxygen from reaching the baby. He said I should begin taking 81mg of aspirin STAT and for the rest of my life (especially during pregnancy)! While pregnant, he will aldo have me taking Heparin injections throughout the entire pregnancy. Also, he has decided he will up my medicine when I begin IVF (he said last IVF I was using 4 vials and so now he will up it to 5). Also, last time we had 12 out of 21 eggs that were good, so he is expecting that we get about 20 good ones this time and hopefully have enough for all the kids we plan on having. He will wait until the eggs reach 18mm and then trigger ovuation. Then, he will wait for them (after ICSI) to grow to D5 (blastocysts) and then transfer 2 to 3 embryos at this IVF. He also said that I will need to take additional folic acid, beside the amount in the prenatal vitamins, during pregnancy due to the MTHFR mutations.

My blood results showed the following:

• Anticardiolipin Ab, IgM, Qn = 13H MPL U/mL--indeterminate (normal 0-9). These are the ATA results I discussed above.
• Lupus Anticoagulant Reflex (PTT-LA) = 53.2H sec (normal 0.0-52.0). He said nothing about this.
• WBC = 3.6L x 10E3/uL (normal 4.0-10.5)--he didn't seem concerned about this when I asked him.
• CMV Ab, IgG (Cytomegalovirus) = 3.2H index--positive (normal 0.0-0.8)--he says we all have this and since it is IgG and not IgM, it means that I got it years ago, so no need to worry)
• Varicella Zoster IgG = >1.09 H index--positive (normal 0.00-0.90). This everyone who has had chicken pox will have, but nothing to worry about.
• Factor II, DNA Analysis, Single G-20210-A mutation identified (Heterozygote) resulting in inherited thrombophilia and a 3-fold increase for venous thrombosis (will take asa and heparin for this)
• MTHFR, DNA Analysis, two mutations (C677T and A1298C--homozygous mutation) identified, resulting in elevated homocysteine levels (associated with an increased risk of cerebrovascular disease, coronary artery disease, myocardial infarction, and venous thrombosis, and in women, pregnancy complications and an increased risk of fetal open nerual tube defects). For this reason I will be on dietary folic acid to lower homocysteine levels and reduce the recurrence of nerual tube defects).

Results for NK testing on Monday should be available within 10 days and he will discuss this with us then. He did say, though, that since I had the APA come out positive, there is a chance that I will also test positive for NK. He said he hopes I'm not positive for NK because it's a real hassle, but nothing that cannot be worked around if I do.

So we paid the deposit and we are set for the June 11 CD9 cycle. He said it doesn't matter that we will be traveling at the beginning of July. On the contrary, he said a vacation would be great. Plus, they have Labcorps everywhere so a blood test (beta) can be done. Tentatively, we will have ER on June 15th and then ET around June 20 or June 21. Beta will probably be on June 29th, so we will still be here in time to take beta here.

When I go on Monday, they will give me copies of all of the consent forms that we signed today, plus, they will give me the requistion form for Labcorp so that I can get the CD3 FSH and E2 drawn. After I begin BCP's (by May 1, but no later than May 18), I will schedule an appointment with the nurse for the IVF Nurse consult for a schedule of my IVF.

This is it! I must get back on my healthy eating habits strictly and exercise routine. I've lost 3 pounds this week, but I'm guessing it was all water retention. It will be really hard since sunday is Easter Sunday.