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:

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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:

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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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Optimistic

I’ve been feeling optimistic all day that this month is our month. It’s kind of cool, because it’s the first I’ve felt optimistic in awhile. I hadn’t admitted it out loud, but ever since our diagnosis of diminished ovarian reserve, C. and I seemed to be moving toward acceptance of the fact that we would need donor eggs in order to get pregnant… Anyway, it’s probably just wishful thinking, but I’m going to enjoy this feeling, however short-lived it may be.

In that spirit, here’s my list of reasons to be optimistic that this will work:

  • I’ve been dutifully taking my baby aspirin, CoQ10 (1200 mg), fish oil (1000mg), prenatal vitamins, and calcium (presumably upping the odds of nice, healthy, energetic eggs).
  • I’m on progesterone suppositories (that should help make a cushy uterine lining for my eggs to burrow into).
  • Despite his pain meds, C. gave an awesome sperm sample for the turkey basting (78 million swimmers, concentrated down to 30 million ‘winners’ who were direct-injected into the back of my uterus).
  • My plumbing got a good flushing during the HSG last month (only supposed to make a slight difference the month it happens, but as long as I’m being optimistic, I’m going to allow the possibility of a residual effect this month.)
  • Thanks to the injections, we had two good-looking eggs that presumably dropped (doubling the odds that one might actually be good relative to any other month).
  • The turkey baster – plus a bonus low-tech deposit the day after – should guarantee that there were swimmers around to welcome the eggs when they dropped.
  • I am 34. (Doctor said better to have my crappy hormone levels and be 34, than have my crappy hormone levels and be 42…even though my crappy hormone levels at 42 would make me more normal…)
  • I’ve cut back on coffee (<= 1 caffeinated cup per day) and alcohol (only one small glass since basting).
  • I’ve been uncharacteristically relaxed for this time in the school year (since C.’s accident, I’ve been accepting help from anyone who offered, and unafraid to say ‘no’ to annoying requests!)
  • C. and I are closer than ever, and I’m more convinced than ever that we would make fantastic parents.
  • I’ve been stocking up on ‘baby karma points’ by helping out a fertile friend on days when her husband is unavailable. I watch her baby girl (born just a couple weeks after the due date for our ill-fated pregnancy) while she puts her energetic 3-year old to bed.
  • Surely there must be some people who get pregnant on their first IUI (15-20%, if Dr. Google is correct), why not us?
  • I am just getting the hang of this whole infertility blogging thing, and will lose all my ‘street cred’ as an infertile if I get pregnant on the first IUI! (Does reverse psychology work on embryos?)

So there you have it! This could be our month. Fingers crossed!

One-woman pharmacy

I went to pick up my drugs for medicated IUI yesterday. Annoyingly, the Kaiser pharmacy at the infertility clinic was out of Menopur – the clinic’s most-prescribed infertility drug – and I had to drive across town to the hospital pharmacy…only to find that they were out of needles?!

On the plus side, my insurance is evidently pretty good, and I got over $2K-worth of prescription drugs, syringes, and needles for $32! I wasn’t as lucky with the supplements Dr. L. recommended (including Coenzyme Q10, omega-3 fatty acids, and baby aspirin). Even with a buy-one-get-one-free sale at CVS, these cost me $134!

Here’s the loot:

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For the chemistry of these, I’ll start with the easy stuff (i.e. the small molecules)… Here are structures of the supplements Dr. L. recommended:

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Aspirin is the acetate of salicylic acid – a natural product from the bark of the willow tree. Coenzyme Q10 is a quinone (hence the Q), and an antioxidant. (The quinone part of CoQ10 is shown in blue above.) Omega-3 fatty acids are a class of fatty acids that contain multiple double bonds with the first double bond starting at carbon-3 (counting from the ‘omega’ end, or the left side on the structures above). Omega-3s are made by plants. People can get them by eating plants (especially the seeds), by eating fish (who in turn get them from eating algae and plankton…), or (in my case), by taking fish oil supplements.

Dr. L didn’t go into detail about the rationale, but said that she recommends these supplements to “maximize the quality” of my remaining eggs. From reading the labels, it looks like all are supposed to promote circulation, which I guess is a good thing for eggs. (Did I mention I’m not a biologist?) There’s also something psychologically satisfying about taking a bunch of pills…feels like I am doing something.

I’ll save the chemical structures of Menopur for another day, since it’s more biochemistry (yawn!); this post is already too long; and I’m hungry!

Wish me luck for my first Menopur injection tonight!