This video has been developed to orient patients to the Pharmacy Services available at the Regional Fertility Program. If you have any questions, please discuss them with the pharmacists.
How much will the medications for an IVF cycle cost?
The total cost of medications is dependent upon the protocol being used, the daily dose of FSH (follicle stimulating hormone) required and the number of days of stimulation required. The physician makes an initial recommendation on the protocol and starting dose based upon your age, weight, blood tests, previous treatment and medical history. Adjustments are often required once stimulation begins and we begin monitoring your individual response with blood tests and ultrasounds. The FSH medication makes up the largest portion of the total cost. Depending on the protocol, costs for an IVF stimulation cycle can range from $3,000 – $8,000 with most averaging around $5,000. Prices of these medications can vary between pharmacies so be sure to do price comparisons in advance.
How much will the medications for a FET (frozen embryo transfer) cost?
The total cost of medications for a FET is considerably less than for IVF. A FET does not require the use of the expensive FSH medications. The total cost is between $450 – $900.
Will the medications be covered by my drug plan?
Group insurance plans available through your employer may cover the cost of the fertility medications. Please remember that it is your employer who decides which medications are covered under the plan and to what extent. The coverage options vary for each plan. There may be no restrictions on coverage and you would pay your usual co-pay. In other cases, you may have an annual dollar limit or a lifetime dollar limit or a cycle limit (which may include Clomiphene Citrate cycles). It is best to review your benefit plan brochure to determine if there are any limits/restrictions on your coverage. You can also contact your insurance company and determine coverage based upon the DIN (Drug Identification Number) list.
Unfortunately, if you are not covered by a group insurance plan, there are no individual drug plans that cover fertility medications. Fertility medications include the injectable hormones (FSH and hCG). Most other medications used, as part of the protocol should be covered under most drug plans with the usual restrictions.
Can I purchase my medications from the RFP Pharmacy if I live outside of Calgary?
The RFP Pharmacy routinely sends medication to clinic patients who do not live in Calgary. We will arrange to courier your medications to the closest Purolator depot to your home. Your complete medication package should arrive in 1-2 business days.
How do I give the medication by injection?
The hormone medications available are given by subcutaneous injection. This means they are administered into the fatty tissue under the skin for absorption into the bloodstream. The system used for injection is different depending on the medication. (e.g. needle and syringe, pen, prefilled syringe) Overall, the technique is the same and the same size needle is used. Instructional videos are available for the most commonly used fertility medications to provide information and instructions on how to inject the medications. The RFP Pharmacy will review the instructions in person or by telephone and refer you to appropriate written information and visual teaching tools.
What happens if I develop injection site irritation?
Injection site irritation can sometimes occur and may include redness, a bump or lump, bruising and itching. You may see a small drop of blood on the skin as you pull the needle out. These local reactions commonly occur and are not a cause for concern. They will most likely resolve in 1 or 2 days. For this reason, we recommend using a different site for each injection. If they are bothersome, you can use an icepack to ice the site before and after the injection.
What are the common side effects of the FSH injection?
Local irritation is the most common side effect. Other side effects that may occur include a feeling of fullness, bloating, and tenderness in the lower abdomen due to the increasing size of the ovaries. These effects are most noticeable during the second week of injections. Changes in hormone levels can contribute to mood swings and fatigue during this time.
Where should I store/dispose of used needles and syringes?
The RFP pharmacy provides a sharps container to safely store your used needles and syringes. At the end of your treatment, the container can be returned to the clinic or to your local pharmacy for safe disposal of the used needles and syringes.
When do I take the medications?
The timing of medications is important for the overall success of the treatment cycle. Please pay close attention to your timetable for suggested times. There is flexibility in these times based upon your own circumstances, but once you select your schedule, it is important to continue this schedule.
For example, the Suprefact® nasal spray is taken every 4 hours while you are awake for a total of 5 doses per day (unless instructed otherwise). Most people find that if they take the first dose when they usually wake up in the morning, they can be finished about the time they usually go to bed at night. If you work shifts or sleep more than 8 hours per night, you may have to make some special arrangements to make sure you take the Suprefact® at the required times.
The FSH injection is taken once daily every 24 hours. We recommend the afternoon since monitoring is done in the morning and we do not want you to take your injection before we have confirmed your dose. Choose the time in the afternoon that will work best for your work/home schedule that you can commit to each day.
What are the common side effects of Suprefact®?
The Suprefact® nasal spray and injection is used to shut off or turn down your own hormone production in your pituitary gland and prevent you from ovulating too early. This results in a lowered estrogen level and the common side effects of hot flashes, mood swings and headaches. You can treat the headache with acetaminophen (or Tylenol) if needed. You may notice nasal irritation or dryness from the nasal spray until you get used to the effects. Please let the clinic know if you notice any effects with your vision.
Will I have my regular period while on Suprefact®?
You will have a period while on the Suprefact® nasal spray as the endometrial lining is shed. It may be the same or different from your usual menstrual cycle. It is not unusual for the timing or amount of flow to differ from your usual cycle.
What can I take for menstrual cramps?
If you have menstrual cramps during your period while taking just the Suprefact® nasal spray, you can take prescription or over the counter anti-inflammatories (e.g. Advil, Motrin, Ibuprofen or others) to relieve symptoms. Once you have started your hormone injections, we recommend that you AVOID these medications. They may interfere with successful implantation of the embryo.
Can I continue the medications that I am currently taking?
Medications include prescription, over the counter, herbal, vitamin and homeopathic products. It is best to review each one based upon your personal situation. Generally, it is best to continue only those medications that are safe in pregnancy from the time your FSH injections begin. Some medications require a longer wash-out period. Others may require slow tapering over time. You may also need to switch completely to a different medication that is safe in pregnancy. We advise you to check with your family doctor or prescribing physician. Your pharmacist or RFP physician may also be able to provide advice.
What dose of folic acid should I take?
The current Canadian recommendation is to supplement a healthy diet with 0.4-1.0 mg of folic acid daily starting 3 months prior to conception and through the first trimester. Folic acid 1-mg tablets are available as a single entity product available over the counter. Prenatal vitamins also contain 1-mg of folic acid. Ask your pharmacist for a prenatal vitamin supplement. Regular multivitamin tablets usually contain the 0.4-mg of folic acid in each tablet. Please read the label to confirm the amount in the product you choose.
Some patients may require a higher dose of folic acid (5 mg). Examples include, but are not limited to, patients with a personal or family history of neural tube defects, co-existing medical conditions such as epilepsy and diabetes and patients on medications such as methotrexate, carbamazepine and valproic acid. Please talk to your family doctor or RFP physician if you have any concerns.
Is there anything that I can take to improve sperm quality?
There is some scientific evidence to support the use of antioxidants and certain amino acids to improve sperm quality. This is specifically intended for males known to have poor sperm quality (number, movement or shape). Most recently the RFP pharmacy in conjunction with a vitamin manufacturer has designed a product called “Nutraception”. This product combines not only the recommended daily requirements of vitamins and minerals but also offers increased amount of antioxidants from Vitamin C, Zinc, Coenzyme Q10, Selenium, Vitamin B’s and acetyl-carnitine. The recommended dose is to take one package twice daily. Approximate cost is $85 per month. The clinic recommends trying to take the antioxidants for approximately 3 months before repeating the semen analysis.
Why do both partners need to take the antibiotic?
The antibiotic is used to reduce the risk of infection from bacteria in the genital tract during egg retrieval and transfer, which could reduce the treatment success. The bacteria of concern can reside in either partner’s genital tract. There is no requirement to abstain from sexual intercourse during the treatment process. This applies to both fresh and frozen embryo transfer (FET) cycles.
What are the effects of smoking?
Smoking adversely affects egg quality, sperm quality and the success of IVF treatments. Smoking can also affect the developing fetus and the risk of complications during pregnancy and delivery. It is best to stop smoking as soon as possible. This may be difficult for many people. There are many programs, support groups and smoking cessation products available to help you through this difficult process. Make sure you discuss your concerns with your family doctor, RFP physician or local pharmacist.
Why do I take the low-dose Aspirin (ASA, Asaphen) and for how long?
“Low-dose” Aspirin is 81 mg of ASA (common brand name is Asaphen). There is some potential benefit in improving endometrial blood flow and development. Low-dose Aspirin is taken once daily starting with down-regulation depending upon the protocol. It does not matter what time of day it is taken and it can be taken with food. Low-dose Aspirin is taken until the pregnancy test and can be discontinued in most cases regardless of whether or not your pregnancy test is positive. In some situations, your physician may recommend continuing low-dose Aspirin throughout pregnancy.