Drug Delivery

About a week after I'd sent off my prescription to Healthcare at Home (HaH) I got a call to arrange payment and delivery.  They were really helpful and friendly on the phone.  There was a bit of a mess because it was going on my mom's credit card and she's in the States and they needed her to verify the payment but actually in the end it was all rather simple and easy and so the drugs were paid for at the price I was quoted (still can't believe it) and delivery was arranged for today.

They made a point of telling me that some of the drugs require chilling and so would need to be put in the fridge straight away and instructions would be provided.  This proved to be true.  It was marked on the box...

...as well as on the inventory.

So all of that has gone straight into the fridge, super easy.  The rest is all the Cetrotide which apparently does not need to be refrigerated.  That's a lot of Cetrotide!

The only disappointing thing about this was that the drugs and the inventory were all that was in the box.  I had asked if the sharps bin came with the drugs and I was told in my original contact by email as well as over the phone that everything I needed would be included, but I'm sad to report it was not.  On the other hand, I don't think it's that complicated to get a sharps bin (I'm fairly certain I can pick one up from a pharmacy or from my GP).  It's just a small hassle that I wasn't expecting.  In the grand scheme of things, it's fine.  And I think it's probably an oversight or error since multiple people told me that it would be there.

I'm really not complaining all things considered.

So it's weird to have all the drugs again.  It's still a month away and I've got a three week trip to the States that's going to happen in between now and then.  Part of me is sort of looking forward to getting it started though, and part of me is looking forward to just getting it done.

Reducing Drug Costs

I could have also called this post, "I won't do that again!" or "I wish I knew then what I know now!"

I have just received an estimate for drugs from Healthcare at Home for the drugs and I am blown away by the price difference.  Now, just to be clear, my prescription is not quite for enough drugs so I don't 'over order' but let's compare.  This was the previous drug breakdown from my first egg collection cycle:

Drug	Cost
Gonal F 900 pen x3 (£360 each)	£1080
Gonal F 450 pen	£180
Cetrotide x12 (£32 each)	£384
Ovitrelle single dose	£16
Total Cost	£1660

This is what I was just (April 2013) quoted from Healthcare at Home:

Drug	Cost
Gonal F 900 pen x3 (£142.56 each)	£427.68
Cetrotide x10 (£10.80 each)	£108
Ovitrelle single dose	£6.48
Delivery Fee	£30
Credit Card Fee	£11.44
Total Cost	£583.60

Based on my previous cycle, this is two doses short of Gonal F and two doses short of Cetrotide- if my protocol lasts as long as my first.  But lets be clear.  This means my drugs would be almost 1/3 the cost of the drugs from the clinic!!  That is a HUGE difference.  Even if I have to order a couple extra doses, it will still be significantly cheaper, even with the delivery fee and credit card fee.  I mean, I will be getting a Gonal F 900 pen for LESS than the cost of the clinic 450 pen!!

So this means if my previous projected cost for cycle 2 with no changes was £4471, my current projected cost for cycle 2 with the drugs listed above is £3384.  Even if I have to purchase a Gonal F 450 pen and two more Cetrotide from my clinic (although why would I?) the projected cost will be £3628 for a total projected savings of £843.  And if I do need extra drugs and buy them from Healthcare at Home then I will save a bit more (around £40 more based on the above costs) even with delivery and credit card fees, so still worth it!

Part of me is annoyed I didn't know to check this out for my first cycle.  I'm also a tiny bit annoyed that my clinic never mentioned it, although obviously they make profit on selling the drugs, so I don't entirely fault them.  To be honest although I think it would be a nice thing to do, it's really not their job to mention it- I didn't specifically ask if there was any way to reduce my costs either.  However, I definitely know where I'll be getting my drugs from for cycle two.  I need to get on with ordering them now as I'm out of the country for most of May and when I get back for the start of June it will be time for round two.  But I'll keep updated here with my drug purchasing experience.  So far Healthcare at Home has a huge endorsement from me (if you can't tell by my repeating their name and posting the link :) )

Follow-Up Consultation

Today I had my fist meeting with the doctor since my collection.  I am sad to report that I was charged for this visit.  I feel that this is not ideal and that a single follow-up consultation should be standard with an egg collection procedure.  But, you can't be pleased with everything.  So the new update on costs is:

Previous total cost	£6876
Follow-up consultation	£120
Total cost to date	£6996

But it is what it is.  Either I choose a different clinic, or I accept that this is how it is.  Can't be pleased with everything.  And overall I am really generally pleased.  So I am going to stick with them.

So I saw my doctor today and we discussed how everything went and he did a scan to check on my ovary since I said that I could still feel it and I knew it had not gone back to normal size.  I was of course concerned it was the cyst but I am happy to report that my cyst is still the same size as it was before and has not grown at all.  On the other hand, my ovary is currently about twice it's normal size.  The doctor said this was 'normal' and that it can take up to two period cycles for it to return to normal size.  When stimulated it can be 7 or 8 times normal size.  So my ovary has definitely 'gone down' but it's not all the way down yet.  In keeping with this he suggested I stay away from impact exercise and twisting until I don't feel it anymore.  I'm glad that I wasn't making it up that I still 'felt' the ovary and also glad I was taking it easy and not rushing back to the gym.

We discussed how the retrieval went.  In the end there were 10 follicles and 6 had eggs and all 6 were mature.  They can't tell you anything about the quality of those eggs.  I asked if there was anything I could be doing now to help improve number or quality as there are many things talked about online.  He said the only thing he suggested was that I consider some slow weight loss between now and my next procedure.  That's fair.  But he cautioned me it needs to be slow and steady, not a crash diet as that can negatively impact egg production or quality.  So I need to be a bit more serious about seeing if I can lose 10-15 pounds in the next two months.

He said he felt the protocol was good and he didn't particularly want to change it.  He said that as I only have the one ovary he didn't want to be too aggressive or risky because we want to protect the ovary as well.  That seemed reasonable to me.

He gave me a prescription for my drugs and said they are happy for me to source them elsewhere if I can get them for cheaper, so that was good and I need to follow up with that over the next couple of weeks.  He also said that my retrieval procedure was a bit tricky.  That surprised me. I asked why and he said that my ovary moved around a lot during the retrieval.  Apparently the dermoid cyst can make it wobbly or a bit less stable, or even float inside the gut, so apparently it wasn't exactly straightforward to retrieve my eggs.

So there you have it.  I'll post more about drug pricing as I look into that.  In the meantime I have 2 months to see if I can drop some weight.  That's not going to be easy though if you consider I'm back in the States for 3 weeks in May.  But I'll do the best I can.