17p Shots Are too expensive - is there an alternative?

This piece is in reference to the recent news of progesterone shots becoming insanely expensive : http://blogs.wsj.com/health/2011/03/10/price-of-drug-to-prevent-preterm-labor-skyrockets/ I have a bit of a love hate relationship with progesterone - but that's partly because of my IVF experience with progesterone-in-oil shots, the fact that I'm on 17p shots, and the fact that with my PCOS my progesterone levels are always too low! I won't go into all of that, but in light of the price of 17p shots skyrocketing from 10-20 bucks to 1500 bucks a shot - I thought I'd share an alternative perspective on this dilemma.

Now we know that women at risk for pre-term labor need their 17p shots. Well... perhaps I should say they need progesterone supplements to prevent uterine contractions and reduce their risk of pre-term labor. The question is - although the 17p shot is the most common form of this - is it our only option. And if the 17p shot is suddenly above and beyond all of our means , what's the next best option.

I'm only aware of this because my perinatologist told me that I could have a second option if I was unable to tolerate the injections. I did Progesterone-in-oil shots during my IVF cycle and they literally crippled me. I couldn't lie down, sit, lay on one side, or walk without excruciating pain! After 3 weeks of being in unbearable pain, using heating pads for hours on end, and being miserable, I was switched to vaginal suppositories - endometrium. I told my perinatologist about this - and he mentioned that I could do vaginal suppositories instead of the 17p shots if I couldn't tolerate the shots. I decided to do some digging online to see what I could find on those suppositories.

From March of Dimes :  http://www.marchofdimes.com/baby/premature_indepth.html

Treatment with the hormone progesterone may help prevent another premature birth in women who have already had a premature baby. The American College of Obstetricians and Gynecologists (ACOG) recommends that this treatment be offered only to women with a previous spontaneous (not induced) premature birth who are currently pregnant with one fetus (21). Studies show that weekly injections of a form of progesterone (called 17P) reduces the risk for preterm birth by about one-third in these women (22).

Another study found that treatment with vaginal progesterone suppositories greatly reduces the rate of premature birth in women with a short cervix (most of whom had no history of premature birth) (23). A vaginal ultrasound can determine whether a woman has a short cervix. ACOG recommends that providers consider progesterone treatment for these women, but does not recommend screening all women for a short cervix (21).

Studies have not found progesterone treatment helpful in preventing premature birth in twin pregnancies (21). More studies are needed to clarify which high-risk women may benefit from progesterone treatment and which form of progesterone is most effective.


Research Findings From some online journal: http://www.jfponline.org/Pages.asp?AID=1888&issue=March_2005&UID=

.... large double-blind, placebo-controlled, randomized study established the effectiveness of 17 α-hydroxyprogesterone caproate in preventing preterm delivery.....Vaginal progesterone suppositories have also been shown to decrease the rate of preterm birth in patients at increased risk.


I guess my point is that we may have other options. If the FDA and Makena are going to screw us so badly that our pregnancies may cost as much as $30 000 out of pocket to save..... we may have to look to alternative forms of progesterone to keep our babies cooking.

Embracing my first IVF BFN

Well I might as well just say it – I got my first BFN after my first IVF. I feel kind of weird about it. I mean I have been level headed through this entire IVF. I understood all of the risks. In fact, I haven’t shed a single tear through all of this (don't think that's normal). Every step of IVF is a huge question mark. You don’t know if you will get follicles, you don’t know if they will grow to full size, you don’t know if they will contain eggs, you don’t know if the eggs will fertilize, you don’t know if the fertilized eggs will develop, and then you don’t know if the embryo will stick. So you know better than to get your hopes up. But if all of that wasn’t enough – they give you progesterone which actually makes you feel pregnant. How much of a mind F&*K is that? Now you spend 2 weeks feeling pregnant while you wait to see if you really are. Through all of this you have to keep a level head and realize that nothing is guaranteed. I know that if you do IVF enough times – you’ll get preggers, but it just hurts when it doesn’t happen. SO I get my BFN and my mind sort of goes into a haze as the doctor babbles on about potential clotting factors and possible family background for heart attacks. Ugh… all I know is that we’ll be having a consult to discuss what went wrong and what could be done differently.

I don’t blame myself yet I feel like a failure. I feel like there’s something wrong with me. I feel like there’s something I didn’t do. I feel like if I had spent one more day resting, or perhaps not switched from PIO shots to suppositories or perhaps if I just wanted this baby a little more – I’d have gotten my BFP. I've been pregnant before so I know my uterus works - so why did it fail me now? I know none of these thoughts are rational – yet my mind keeps moving in that direction.

Now I have the pleasure of waiting for AF to come. Not only will this confirm just how NOT PREGNANT I am, but I have the pleasure of enduring another period with nothing to show for it. I then get to begin counting down to my next cycle. I’m already hell bent on doing as many cycles as I have eggs or at least until I get preggers. I guess I just have to channel my frustration into positive energy for the next cycle. It’s just hard right now.

So… IVF Score 2 – FlowerChica Score 0!

20 things I wish someone had told me about IVF

1. There’s no way to prepare for the ways the hormones will make you feel. You might feel nothing, you might feel completely off.

2. Every step of the IVF process is a question mark : Will your eggs mature, will you be able to extract enough follicles, will there be eggs in the extracted follicles, will the extracted eggs fertilize, will the fertilized eggs mature, will the mature fertilized eggs stick? Etc.

3. Vaginal ultrasounds are actually pretty invasive and can be painful. Not only that – but you may very well have to do them daily.
4. Subcutaneous injections are nothing to be afraid of. Scarier things will come after.

5. The doctors cannot predict how much ovarian stimulation medication you will need – so this is a big cost question mark! Assume the worst.

6. Intramuscular shots don’t hurt when you get them. Don’t be afraid of the needle! Be afraid of the pain that follows the morning afterwards

7. Do NOT inject an intramuscular shot anywhere near the middle of your butt cheeks – you will not be able to walk the next day. In some cases, for the next few days.

8. Progesterone makes you feel really pregnant. So after your egg transfer, you really feel pregnant – how’s that for screwing with your mind?

9. Having to hold your pee while you do the egg transfer sucks!

10. Egg transfers are not painless procedures. It might feel very uncomfortable and you’ll be tempted to piss all over the doctor trying to get that egg in.

11. A test run for an egg transfer is a very good thing!

12. Ovarian Hyper Stimulation is no joke – and it’s directly tied to the number of follicles you produce. Although rare, if you’re PCOS you’re really at risk. Drink water like you’re about to cross a desert with no supplies. Drink electrolytes like crazy and go on a super high protein diet.

13. Swollen ovaries hurt like all hell – and you can’t cough, have a full bladder, or laugh without discomfort. You also can’t walk right and have trouble sleeping on your stomach.

14. You probably need to take time off of work during your IVF process

15. Progesterone in oil shots can actually leave your butt cheeks misshapen, sore and lumpy for days, weeks, or longer

16. If you get pregnant – you may have 12 weeks of progesterone in oil shots

17. Even if you get a BFP after your IVF, it can still degrade into a BFN

18. Progesterone can give you horrible dizzy spells

19. You may find yourself quite immobile during your cycle – it’s not a bad thing to lose some weight before you start to offset any immobility related weight gain

20. Get a heating pad! It will help you in so many ways.

Goodbye PIO Shots!!!

So my doctor let me switch to suppositories. I'm so happy. They finally conceded - I simply don't have enough booty to tolerate these shots. I'm so happy - I'll be able to walk in a few days

Next step in the battle with Progesterone in Oil shots

So I'm still struggling with these shots. Dh and I keep working on different techniques to alleviate the symptoms. Last night we did this :

1. Heating pad for 15 minutes
2. injecting higher ( near the very top of my butt )
3. 10 minutes deep strong massage in my cheeks
4. Heating pad for 20 minutes
5. Stretching exercises raising my legs to 90 degrees ( PAINFUL)
6. Heating pad for another 20 minutes
7. One more 30 minute massage
8. In the morning - gave myself another massage
9. 10 minutes on a treadmill - 1.0 on the speed, level 8 on the incline to stretch the butt

That's brought my pain from a level 9 to maybe a level 8 - 7.5 . I don't hurt as much when I walk but sitting is still painful. Also - sitting for any period of time creates pain when standing up and walking. Sigh*

Today I go and beg the nurse for a better regiment. I'm also getting my progesterone levels measured. I can't go back to work until I can tolerate sitting in a chair

Day 4 of the 10 day 2WW wait after my first IVF and ET

Ok - so this totally sucks. I've never been one to be obsessive about every possible symptom - but it's hard for your mind not to wander. I keep telling myself - even if I see something promising, I can't take it as definitive - so there's no reason to pay attention. So far I've had a bad dizzy spell 1 day after my transfer. I've also had some fluttering down there that has gone on for about a full day. I'd sort of call it really mild cramps!

I'm freaked out about sleeping on my stomach, but my bum is still sore from the PIO shots. Shamefully I've started taking my temperature, but this is useless since I didn't track my temperature through the full cycle.

7 more days until I test - I'm not going to do a self test. I don't want any of the agony associated with falsely positive or falsely negative tests.

Ugh!