Regarding Infertility Testing and Treatments
In general, most testing and/or treatments must be timed to the menstrual cycle, or they may not be helpful. You are usually asked to call me at a certain time in your cycle for scheduling purposes. It is important to do this on time, otherwise things may be delayed a whole cycle. Call the main number at (231) 487-0970 Ext.4 (the infertility line) and either speak with the nurse directly, or if she doesn’t answer, leave a message with your name, phone number where you can be reached, and the important information (i.e. menses started on what day, you had a positive OPK test and when,etc)
OPK kits (tests for LH surge and predicts ovulation). I don’t know of a specific brand that always works better, but I have found any of the inexpensive brands such as Wondfo, ordered on Amazon, are quite good and significantly less expensive, compared to the brands offered at the local pharmacies. I recommend testing 2x/day, 1st AM and mid afternoon, if you don’t want to miss it, and especially if we need to time another test or treatment mid-cycle.
POST-COITAL TEST – Have intercourse that AM of the test, or if not convenient, the night before.
WASHED INTRAUTERINE INSEMINATION (semen collected at home if you live < 1 hr. away, otherwise can be collected in a private area in the office. Specimen then prepared to be safely injected up into the uterus, through the cervix. It takes about an hour at the office.)
Diagnosis code – 606.1 Procedure Codes – IUI – 58322-$200.00
Sperm Washing- 58323-$50.00 (payment due at time of service if not previously confirmed to be covered by insurance)
HYSTEROSALPINGOGRAM (HSG): Xray done at Radiology facility to check potency of Fallopian tubes. You will be given specific instructions about where to go and when. You will instructed to take some medications beforehand. Diagnosis Code – 628.9 Procedure codes – 58340 (Dr. Heidtke), 74740 ,(Hospital), $225.00, $625.00
FERTILITY MEDS TO IMPROVE OVULATION
ORAL – Clomiphene, Femara (letrazole)~$10 – $50/cycle
INJECTABLE – Gonadotroping (purified FSH or FSH/LH)
The overall process involves daily subcu injections for 7-10 days, followed by a one-time trigger shot, then timed intercourse or IUI 30-40 hrs. after the last injection. Dosing of the medication is very individualized and therefore the ovaries need close monitoring to properly adjust it. This requires an ultrasound on Day 2 or 3 of the cycle, followed by 2 or 3 more ultrasounds during the 1st 2 weeks of the cycle. You may also need blood work on some of those days to help with the monitoring.
Progesterone supplementation (pills or vaginal inserts) are then taken after ovulation, and through the 1st 10 weeks of pregnancy.
There are a number of brands of gonadotropins. The names are listed below with their CPT codes. They are interchangeable, and can be decided on based on cost to you. To find out your best option on cost, check on your pharmacy benefits coverage. Without insurance, cost runs $700-$1,000.
Gonal F (S 0126), Follistim (S 0126), Bravelle (J 3355)
To determine approximate cost, assume you will need 1200-1500 units of medication per cycle. If you have insurance coverage, find out if the med needs to be ordered from a specialty pharmacy of their choosing and/ or if you need prior authorization (PA) to get coverage. If a PA is needed, this can take weeks.
Trigger shot, is HCG 10,000 units, one dose needed. This can be in subcu or IM form.
Ovidrel 250 mg. (J 3490). Subcu and easy to administer but may be more costly than IM. Runs about $100 without insurance
HCG 10,000 (J 0725) for IM injection. Brand names include Pregnyl or Novarel
They will overnight the meds to you (no added shipping costs), and are more reliable than trying to get them through your local pharmacy. Some have special discount pricing if you are paying cash and meet income requirements. Several reliable pharmacies I have used are listed below. Check out each one for price comparisons.
If you decide to see Dr. Heidtke to discuss infertility, please print out and complete the Infertility-Questionnaire
Click here for a list of Sperm Banks
If you are a cancer patient interested in preserving your fertility prior to chemotherapy you can visit the Livestrong website to apply for financial assistance at Livestrong Fertility.