One-woman pharmacy, Redux

Now that we have the green light for IVF, I finally trekked over to the pharmacy and picked up the rest of the drugs for my protocol. Here’s the loot this time:

Image

Between Dr. Y’s sketchy (in my favor) billing and two hefty manufacturer coupons, I got quite a discount. Even with the discount, though, the grand total was quite a bit more than for my IUI drugs:

 

List price

Covered by Kaiser?

Coupon?

My cost

Androgel ~$380

Yes

$20

Androderm ~$390

Yes

$20

Estrace ~$100

Yes

$10

Aspirin ~$5

No

$5

Menopur $750 for 10 vials

Yes

$20

Clomid ~$50

Yes

$20

Decadron ~$7

Yes

$10

Prednisone ~$5

Yes

$10

Vibra-Tabs ~$120

Yes

$10

Pregnyl $89

No

$89

Follistim $299

No

$300

$0

Antagon $354 for 3 syringes

No

$100

$254

Omnitrope $867

No

$867

Total $3416

I actually paid:

$1335

From a chemical standpoint, this list includes 8 small molecule drugs, 4 protein drugs, and one peptide (ganirelix) that is pushing the upper limit of what I’d usually call a small molecule. (I usually give 1000 atomic mass units as the cutoff; ganirelix has a molecular weight of 1570 amu…)

Here are the structures and modes of administration for my drugs:

Image

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Notice anything?

The small molecules tend to have more appealing modes of entry (often pills). Protein and peptide drugs tend to involve needles, for reasons I explained in a previous post.

*****

I also found the biological source of many of these drugs interesting. (Note: If you’re using any of these drugs and are easily grossed out, or are philosophically opposed to Genetically Modified Organisms, you may not want to keep reading!)

Testosterone was originally discovered by painstaking isolation from bull testicles. The yield was paltry, though – just 20 milligrams from 40 pounds of testicles. (I’m trying not to think about how many bulls had to be emasculated to get 40 pounds of testicles…) Thankfully, nowadays testosterone – along with most other steroid drugs – is made semisynthetically from steroids isolated from plants (often soybeans or Mexican yams). In other words, chemists isolate a similar plant steroid and perform chemical reactions in a laboratory to convert it to the desired human hormone. Drug companies sometimes use the term ‘bioidentical’ to emphasize to non-chemists that hormones that are made semisynthetically are exactly the same – chemically and biologically – as the ones produced in your ovaries (or testicles…)

Menopur is a mixture of FSH and LH purified from the urine of postmenopausal women (hence its name; think Menopausal urine…) Historically this urine came from nuns living in convents in Italy, though I’m not sure if that’s still the case.

Pregnyl is also urine-derived, but presumably not from nuns… Pregnyl is purified hCG from the urine of pregnant women.

Follistim, on the other hand, is made from recombinant FSH (Follicle stimulating hormone) produced in Chinese hamster ovary (CHO) cells. This means that scientists copied a piece of human DNA – the blueprint that tells our cells how to make the FSH protein – and put it into the hamster cells. In effect, they hijacked the hamster cell’s protein factory and programmed it to produce large amounts of human FSH protein. (Don’t worry, the hamster cells now grow in Petri dishes; nobody is manufacturing protein in live hamsters…)

Omnitrope is also made from recombinant DNA technology, but in E. coli bacterial cells instead of hamster ovary cells. Unlike FSH (which is a challenging-to-make glycoprotein requiring sophisticated mammalian cell machinery), growth hormone is relatively easy to make. The human DNA ‘blueprint’ for growth hormone can be put into Escherichia coli cells and the bacteria cells produce the hormone for us.

*****

I think I’ll stop there. If you want to know more about the chemistry of these drugs, you might check out my previous posts about the structures of FSH, LH, hCG and Clomid; doxycycline; aspirin; testosterone and estradiol (in the context of my current IVF cycle, or of what makes them steroids); the role of estradiol in predicting ovulation with the Clearblue fertility monitor; how hCG is detected in home pregnancy tests; or the significance of FSH and estradiol for diagnosing infertility.

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18 Comments

  1. I love these posts! I knew of the origins, but never stopped to think about the names. Very clever!

    Reply
  2. This is fascinating. I knew people mentioned nun urine, but somehow didn’t think that’s what it actually was. I feel like you should be in charge of some kind of fertility drug Q & A forum. All of these drugs were initially a mystery to me, and there’s only so much truth you can find through Googling!

    Reply
  3. Your posts are always so fascinating! I love it! Thanks for sharing your knowledge dear!

    Reply
  4. Hurray for your discount! Those fertility meds are expensive! I am excited for your IVF!! I hope all these meds result in your baby. so nice to see your informative posts.

    Reply
    • Thanks. Yes, I’m so grateful that Dr. Y has figured out some way to charge Kaiser for many of my IVF meds (even though they don’t cover IVF…)

      Reply
  5. Lovely.. so if I ever get to the stage of having these meds, I’ll be thinking ‘Nuns urine???’ Hell.. if it’s gonna make me pregnant, I’ll take it.

    Reply
  6. Wow! You have an awful lot of meds. It makes my cycle look really easy. Good luck. I hope they all work for you.

    Reply
    • Yeah, it is a lot! I’m still trying to make sense of what they’re all for…I’ll post once I think I’ve got a handle on it. 😉

      Reply
  7. Man, that’s a lotta drugs. The origins of Menopur still freak me out a little. But when I go menopausal (sooner rather than later, methinks) I’m still looking at selling my pee as an option to bring in extra cash. 😉

    Reply
  8. God, I miss chemistry!!!

    I wonder where one goes to look into donating pee for the production of menopur… could be a source of retirement income. Maybe I could take early retirement after all…

    Reply
  9. Uhm…I love you.
    Wow! This post is so fascinating. I won’t lie. The Nun pee freaked me out a bit, but I figure it must be blessed:-)

    Reply
  10. Woow. it’ll take me a while to fully understand this. But I love this! Best of luck!!

    Reply
  11. It’s awesome that you got your meds on such a discount! I love that you break everything down, I’ve learned so much from you.

    I also nominated you for an award on my blog.

    Reply
  12. 1) I cringe every time I hear ‘bioidentical’ because 95% of the time it is followed by quackery.

    2) I don’t know about testosterone specifically (and of course bulls do get castrated) but a lot of stuff was discovered using leftovers from the Chicago slaughterhouses, my hand to God.

    3) Good luck!

    Reply
    • I think you’re totally right about the slaughterhouses. I think that’s a better image than chopping them off of live cows…maybe.

      Reply

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