Endometriosis

endometriosis

According to the Mayo Clinic, Endometriosis “is an often painful disorder in which tissue that normally lines the insides of your uterus—the endometrium—grows outside your uterus.” In a 2009 in-depth report on infertility in women, the New York Times reports that “endometriosis may account for as many as 30 percent of infertility cases.” Infertility, as a result of endometriosis, can be caused by endometrial lining growth in the fallopian tubes, blocking an egg’s path; growth in the ovaries, which can cause complications in the release of an egg.

Columbia University’s Medical Center in New York City works closely with Cornell University in Ithaca, New York, as the NewYork-Presbyterian University Hospital, where they have found that there are “several theories as to the cause of endometriosis, but none has been established with certainty.” New York University Langone’s Medical Center has an Endometriosis Center, where they specialize in the research and treatment of endometriosis. NYU Langone estimates that “six percent to 10 percent of women of childbearing age have endometriosis.” The endometrium in a woman’s uterus swells and thickens during a menstrual cycle in preparation for the possibility of pregnancy. However, if no pregnancy occurs, the endometrium exits the body during menstruation. Due to endometriosis, endometrial cells coagulate outside of the uterus and “attach to other organs in the body, where they grow into nodules called ‘implants,’” according to NYU Langone’s diagnosis information on endometriosis. Most often, endometriosis implants take form on the ovaries, fallopian tubes, cul-de-sac, and outer lining of the uterus. Less commonly, implants can form on the lower regions of the large intestine, bladder, and rectum. NYU Langone identifies possible, though still uncertain risk factors as: first menstruation at age 11 or younger and hereditary factors. They also mention that “not having been pregnant is also linked with a higher risk.” However, once a woman reaches menopause, ending menstruation, endometriosis will improve.

Endometriosis can be diagnosed in a variety of ways. Ultrasounds are the easiest and most comprehensive way for a medical professional to detect any structural abnormalities in a woman’s pelvic region, using a series of high-frequency sound waves that ricochet off of surfaces within the body, creating live images. More likely, however, a doctor will first perform a pelvic exam, where a doctor palpates “areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus,” according to the Mayo Clinic. Pelvic exams are not as reliable in the detection of endometriosis, unless the disease has advanced and formed cysts within the pelvis region. Another method is laparoscopy, which is similar to the laparoscopic surgeries that are used to treat endometriosis. Laparoscopy involves a small incision, usually at the navel, and the insertion of a long, thin tube with a telescopic lens that allows a doctor to visualize the interior of a woman’s pelvis.

Symptoms of endometriosis are expressed primarily during menstruation, or leading up to menstruation. They are shown as pelvic pain “before or during menstruation, with urination or bowel movements” and during sexual intercourse, according to NYU Langone. The severity of endometriosis will not impact the severity of the symptoms. Treatments for endometriosis, as recommended by Langone, begin with birth control pills. A Langone doctor may recommend either oral contraceptives or an injection, such as the synthetic progesterone medication, Depo-Provera®. The synthetic hormone is medroxyprogesterone, meant to treat the pain associated with endometriosis by thinning the uterine lining and shrinking implants. Another medication at Langone is Lupron Depot®, which must be prescribed by and administered at a medical facility every six months. This medication “suppresses hormonal signals from the pituitary gland in the brain to the ovaries, thereby curbing estrogen production and putting the body into temporary menopause,” according to the NYC based medical facility. Lupron Depot® treatments may put endometriosis symptoms in remission for an elongated period of time.
The New York Endometriosis Center (NY EC), based out of New York City and Greenwich, Connecticut, is a leader in the surgical treatments of endometriosis. Among their staff is Dr. Kanayama, a highly awarded specialist in endometriosis treatment and surgery, having been awarded placement on America’s Top Obstetricians and Gynecologists list in 2004, 2005, and 2007 after training and residency at the Mayo Clinic. Another acclaimed NY endometriosis specialist is Dr. Tamer Seckin, who specializes in gynecology and laparoscopic surgery. Dr. Seckin focuses his work on minimally invasive advance laparoscopy. He was granted the Ellis Island Medal of Honor in 2012, having founded the Endometriosis Foundation of America in 2009.

While laparoscopic surgery is a highly advanced method of endometriosis treatment, another avenue of surgical treatment is endometriosis excision surgery. This surgery aims to remove endometriosis implants with the goal of alleviating pain, increasing fertility, and removing the physical cause of inflammation and endometriosis, the implants. Rather than burning the accessible portions of an implant, as with laser surgery, excision surgery digs into the roots of the inflammatory tissue and allowing the surgeon to see the mass in order to effectively remove it and alleviate pressure on organs that the implants have attached themselves to. This also increases the functionality of those organs. Excision surgery has also been used in cancerous cases. However, if endometriosis is advanced enough, “where pelvic architecture is deformed, and organs are fused with various degrees of adhesions, the difficult of the excision surgery can be more complicated than most cancer surgeries,” according to Dr. Seckin’s explanation of excision surgery. In cases such as these, a surgeon must suture any injured organs and reconstruct them where necessary, after removing the lesions.

Laparoscopy is different from excision in that the pelvic cavity is seen through a telescopic lens (the laparoscope), a 5 mm long tube that is inserted after carbon dioxide is “injected into the abdomen. This colorless, odorless gas swells the cavity, lifting and separating the organs to allow the laparoscope to be safely inserted,” according to Seckel’s explanation of laparoscopy. This direct line of sight to the state of the pelvic region allows a surgeon to understand the extent of an endometriosis case, while remaining minimally invasive.

Here are some helpful links on endometriosis:

http://nyulangone.org/conditions/endometriosis/treatments/surgical-treatment-for-endometriosis

http://nyulangone.org/conditions/endometriosis

http://www.drseckin.com/

http://www.drseckin.com/laparoscopic-surgery

http://www.drseckin.com/endometriosis-surgery

http://www.gynecosurgery.com/endometriosis.htm

http://www.mayoclinic.org/symptoms-causes/dxc-20236425

http://www.gynecosurgery.com/dr_kanayama.htm

Infertility and Leading Infertility Medication

infertility-and-leading-infertility-medication

 

The World Health Organization defines infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse,” in their glossary on Assisted Reproductive Terminology. Infertility is not solely a female issue, and the Center for Disease Control reported in 2002 that “7.5 percent of all sexually experienced men younger than 45 reported seeing a fertility doctor during their lifetime—this equals 3.3-4.7 million men. Of men who sought help, 18 percent were diagnosed with a male-related infertility problem.” In women, the Center for Disease Control reported that infertility affects “about 12 percent of women 15-44 years of age in the United States.”

However, there are a number of leading medications that can help couples suffering from infertility raise a family of their own. For example, there are several fertility clinics with a variety of specialties, be they medication or other advanced treatments, based out of just New York City. In the Health Grove directory for successful fertility clinics, over 100 clinics are located in the greater NYC area. These specific clinics help couples in New York, or those from anywhere in the country seeking the expertise found in these clinics, begin their own families with medications that will treat their specific vein of infertility. This is a growing field of study, as scientists are learning more and more about the female body and reproductive system.

The following are some of the medications referenced by the American Pregnancy Association (APA), as well as what they are prescribed for, what they do, and explained potential side effects. Most commonly, leading medications are used to treat and enhance ovarian stimulation and the prevention of premature ovulation.

These pertain specifically to ovarian stimulation, where women suffer from long, missed, or irregular period cycles.

Clomiphene Citrates

The APA notes that there are two medicinal options, by way of Clomiphene Citrates (CC): Clomid ® and Serophene ®. These medications elevate Follicle-Stimulating Hormone secretion in the pituitary glands. These Follicle-Stimulating Hormones (FSH) controls a woman’s menstrual cycle, as well as ovarian egg production. FSH levels are highest in women just before she ovulates. In men, FSH controls sperm production. Contrary to the fluctuations of FSH in women throughout their menstrual cycle, FSH levels in men are generally constant. The APA emphasizes that regulated FSH counts are integral to fertility. It is recommended by the APA and the American Society for Reproductive Medicine that “clomiphene be prescribed for only three to six cycles” because the “chances of side effects increases as the dosage increases.” Possible side effects of Clomid ®, Serophene ® and other clomiphene citrates include increased chances of: multiple birth, where a mother has more than one baby, which has increased by 74% from 1980 to 2000, in a study by the National Center for Health Statistics on twin births; miscarriage, defined by the APA as a “pregnancy ends on its own, within the first 20 weeks of gestation.” Other side effects of clomiphene citrates include headaches, mood swings, depression, nausea, hot flashes, breast tenderness, ovarian cysts and over stimulation of the ovaries, resulting in pelvic pain or discomfort.

Follicle Stimulating Hormones

Due to the importance of FSH in fertility, Follicle Stimulating Hormones have been developed as medication via injection, where it “bypasses the hypothalamus and pituitary glands to directly simulate follicle growth in the ovaries.” The most common FSH medications are Bravelle®, Follistim® and Gonal-F®. Bravelle® is a urofollitropin, “derived from the urine of postmenopausal women” and purified into the injection format, according to the New York Times’ health guide on infertility. Follistim® and Gonal-F® are both synthetic injections of FSH. The New York times also stated that these three common treatments are sometimes combined with a Human Chorionic Gonadotropin medication, which also triggers ovulation. Possible side effects of these treatments are: increased incidence of multiple birth and miscarriage, just as clomiphene citrates. These natural and synthetic urofollitropins also increase a chance of premature delivery, defined as a “birth that takes place more than three weeks before the baby is due,” according to the Mayo Clinic, a nonprofit practice based out of Rochester, Minnesota. Other side effects include swelling or rashes at the injections site, mood swings, depression, breast tenderness, abdominal pain, bloating and Hyper Stimulation Syndrome, which may be caused by enlarged ovaries.

Human Menopausal Gonadotropins

Another leading treatment is Human Menopausal Gonadotropins, which contain an equal balance of FSH and luteinizing hormones (LH), “given to stimulate the ovaries to produce multiple eggs during one cycle,” according to the APA. Luteinizing hormones, produced in tandem with FSH in the pituitary gland, triggers ovulation when there is a significant rise in production of the hormone. Three leading hMGs are Menopur®, Humegon® and Repronex®. Their side effects are in line with those of FSH medications, due to how similarly they function. hMG is derived similarly to FSH, from the urine of menopausal women. It is also delivered similarly, through a series of injections. They are “usually given for 7-12 days,” according to the New York Times.

Human Chorionic Gonadotropin

hCG, as mentioned previously, is closely tied to FSH and LH. hCG triggers the release of an egg in women. Natural drugs are “derived from the urine of pregnant women,” according to the New York Times. Leading, natural hCG medications are Pregnyl®, Novarel ®, Ovidrel® and Profasi®. The APA emphasizes that if taken independently, rather than in tandem with another medication as is recommended for other treatments, there are “no known side effects.”

In order to prevent premature ovulation, there is one medication vein recommended by the APA:

Gonadotropin-Releasing Hormone Analogs and Antagonists

Gonadotropin-Releasing Hormones (GnRH) are produced in the hypothalamus. They stimulate the production of FSH and LH by stimulating the pituitary gland. GnRH medications are synthetic. Analogs are used to “enable the body to produce a higher number of quality eggs, and preventing “the mid-cycle hormonal surge which can result in a cancelled cycle,” according to the APA. Lupron®, Zoladex® and Synarel® are the three leading analogs, the first two being injections and the latter a nasal spray, respectively. Potential side effects include: mood swings, vaginal dryness, pain during sexual intercourse, hot flashes, headache, insomnia, bone density loss, and decreased breast size. Antagonists such as Ganirelix Acetate® and Cetrotide® cause GnRH “to be released to help prevent premature ovulation,” according to the APA. Like analogs, antagonists are injections and have similar side effects.

Here are some helpful links and sources:

http://www.nytimes.com/health/guides/disease/infertility-in-women/medications.html

http://americanpregnancy.org/infertility/infertility-medications/

http://www.who.int/reproductivehealth/publications/infertility/art_terminology2/en/

http://www.cdc.gov/reproductivehealth/infertility/

http://www.cdc.gov/nchs/nsfg/key_statistics/i.htm#infertility

How To Battle The Rising Cost Of Infertility Treatments in NYC

battle-the-rising-cost-of-infertility-treatments-in-nyc

 

If you’re dealing with infertility in NYC, you know that the common question patients have is: “what will my insurance plan cover and how much will my out-of-pocket expense be?”

There are two sides of the coin to consider:

  • the clinical costs
  • and the medication costs

Patients are often surprised at the cost of the injectable medications used for fertility treatments such as in vitro fertilization (IVF). For many, insurance will help to significantly reduce the out-of-pocket costs. But when insurance isn’t an option, pharmaceutical companies offer their own financial programs to help patients. Understanding your options and working with your dedicated medical team can help you save.

TIP 1: UNDERSTAND HOW THE PROCESS WORKS

Informed patients can achieve the greatest cost savings when it comes to medications. Understanding the medications and the discounts and programs offered by their manufacturers can help make navigating the financial options easier.

Commonly-prescribed stimulation medications: Frequently, physicians prescribe follicle-stimulating hormone (FSH) medications to intrauterine insemination (IUI) patients (who are using injectable medications) or IVF patients during the follicular development phase of the cycle. These medications work to recruit, develop, and grow multiple follicles which contain an egg. For most patients, the stimulation medication makes up the bulk of their medication cost.

TIP 2: BE YOUR OWN ADVOCATE

Use your resources: When preparing to start a cycle, find out who will handle your prescriptions on your medical team—it will likely be either the clinical assistant or nurse. This member of your team will order your prescriptions and help you when it comes to making sure you are prescribed the most cost-efficient medications.

Call your insurance company: When planning to use insurance benefits to cover the cost of treatment, proactively speaking with your insurance provider to determine their preferred brands can help ensure your physician prescribes the most cost-effective medication.

Know your medical protocol: This step is especially helpful for patients planning to pay out-of-pocket for infertility treatments in NYC. Most mail-order pharmacies in NYC will contact the patient directly to provide a quote for the medication before filling the prescription. Knowing the type of medications prescribed and an idea of the cost can help address any potential issues prior to filling the medications, saving both time and money.

TIP 3: CONSIDER A PHARMACEUTICAL FINANCIAL PROGRAM FOR MEDICATION

At Kings, we offer several financial programs to help make infertility treatments in NYC more affordable.

  • Co-Pay Savings Card

Harvoni, Sovaldi, Viekira Pak, Daklinza, Endometrin & Gonal-f, Ovidrel, Cetrotide: Co-pay card available directly through Kings Pharmacy for qualifying patients with a valid prescription

    • Financial program designed for insured patients.
    • No approval process.
    • Savings card is valid for one year.
    • Save up to $250 off of Gonal-f, up to $25 off of Ovidrel, and up to $25 off of Cetrotide prescriptions.
  • Compassionate Care Program (Offered at Kings Pharmacy)

Kings Pharmacy participates in EMD Serono’s Compassionate Care Program, which is designed to provide eligible patients savings on Gonal-f, Ovidrel, or Cetrotide. Depending on certain criteria, eligible patients may save 25%, 50%, or 75% off the self-pay price of medicine or receive a $10 discount per unit, via a mail-in rebate, off their out-of-pocket costs.

    • Discounts on Cetrotide, Gonal-f, and Ovidrel.
    • Program offers a four-tier discount program (10%, 25%, 50%, or 75%) based on income and other factors.
    • 25% discount for all military active duty, veterans, and retired—no income verification required.
    • Shady Grove Fertility Shared Help Program participants are immediately eligible for a 50% discount off medications.
    • Submit registration and income verification documents or SGF Shared Help eligibility letter.
    • Upfront savings—approved participants will receive a discount card to present to the pharmacy.
    • Since January 2013, the average SGF patient in our Rockville office saved over $1,951 with the Compassionate Care Program.
  • Go Direct to Savings  (Provided by EMD Serono. Offered at Kings Pharmacy)

Kings Pharmacy has partnered with EMD Serono to offer the GO Direct To Savings Program, which can save nearly 10% on Gonal-f, Ovidrel, or Cetrotide on every cycle. The more medication needed throughout a patient’s treatment, the more he/she will save.

    • Discounts on Cetrotide, Gonal-f, and Ovidrel.
    • Gonal-f:$10.00 off per 75 IU.
    • Ovidrel: $10.00 off per 25 mg.
    • Cetrotide: $10.00 off per 0.25 mg.
    • Available for self-pay patients who are not eligible for the Compassionate Care Program.
    • No approval process.
  • HEART+ Program (Provided by Ferring Pharmaceuticals)

Kings Pharmacy participates in Ferring’s HEART+ Program, which offers eligible patients significant savings on prescriptions for Bravelle, Menopur, Endometrin, and Novarel.

  • Foundations

Patient Access Network Foundation, Patient Advocacy Foundation, HealthWell Foundation, Good Days & Financing (available for fertility medications ONLY)

Kings Pharmacy has partnered with Prosper Healthcare Lending, the premier financing company in the healthcare industry, to offer financing options for fertility patients. With over $3 Billion borrowed and over 250,000 people empowered, this is a name and a program you can trust. With a loan from Prosper Healthcare Lending, you can expect: immediate decisions for loans under $35,000, longer terms for lower monthly payments, no collateral required, no prepayment penalties, fast & easy loan inquiry process, and 100% confidentiality.

*Please note: In order to be eligible for assistance the patient must be a legal U.S. resident and meet certain financial, medical and insurance criteria as required by the respective assistance programs and/or co-pay card programs we work with to establish funding.

TIP 4: NYC FERTILITY PROGRAMS/COMMUNITIES

NYS Infertility Demonstration Program

    • A grant from New York State for in vitro fertilization (IVF) and gamete intra fallopian transfer (GIFT)
    • The NYS Infertility Demonstration Program provides financial support to privately insured individuals whose insurance coverage for IVF is exhausted or inadequate
    • Only residents of NYC between the ages of 21-44, be clinically infertile and other clinical and program criteria are granted financial support
    • Funds are allocated to select centers meeting high standards of IVF success rates and patient volume

 

  • The program also includes a subsidy for testicular sperm extraction (TESE)
  • Services will be paid by the NYS, through the providers, with the exception of any insurance reimbursement available, and a cost sharing amount that the patients will be required to pay.
  • This cost sharing amount varies by the patient’s household income and the cost of the procedures, but cannot exceed ten percent of the patient’s gross household income in any one year
  • Financial support is available on a sliding scale basis and extends to patients with household income up to $200,000.

Myths & Facts About Fertility Medications

myths-facts-about-fertility-medications

The treatment of infertility is not possible without the use of fertility medications. There are several medications used to prepare the uterus for treatment and raise the probability that the ovaries will release many healthy eggs. The type of medication will depend on your situation but in general most women are given at least 2-4 different types of medications.

The first thing to know about these medications is that you will never be told that sometimes they do not work. Doctors will make it sound like every medication works and that is far from truth. No one knows why some women do not respond to these medications and it is a complete “hit and miss” event.

The second thing which many fertility doctors never take time to explain is that every single medication used to treat infertility has side effects. These side effects vary from person to person and may be mild or severe. If the side effects are not tolerable, then the doctor usually switches the medications.

The third thing you need to know is that these medications are also prohibitively expensive. By the time you have been through several cycles, you will have spent enough money for a down payment on a car.

The one medication that all women with infertility are prescribed is clomiphene. The medication works in the brain and is used to stimulate ovulation in women who have infrequent or absent periods. It is only taken for a few days but as the dose is increased it can cause hot flashes, breast tenderness, nausea, headache, mood swings and lower abdominal discomfort.

Another very common medication used to trigger ovulation is an injection of human chorionic gonadotrophin. This drug is relatively safe and does not cause side effects as long as it is not taken with other fertility medications.

Women who do not respond to HCG or clomiphene are administered follicle stimulating hormone or human menopausal gonadotrophin as an injection just below the skin. These hormones have several unpleasant side effects like nausea, mood swings, breast tenderness, and lower abdominal pain. These are very potent medications and only administered to women who fail to respond to the above medications.

Women who have high levels of prolactin are often prescribed bromocriptine or cabergoline by mouth. These medications can cause nausea, severe vomiting, headache, fainting, and dizziness.

Some women are administered medications like Lupron and Zoladex to prevent premature ovulation. These medications prevent the mid cycle hormonal surge which can result in a cancelled cycle. They have a few side effects like hot flashes, headache, insomnia and mood swings.

There are many other medications prescribed to women with infertility and they include steroids, antibiotics like doxycycline and progesterone injections.

The type of medication you will receive will depend on how you respond and your overall condition. The one thing you can rest assured is that you cannot conceive if these medications are not used. Unfortunately there are no herbs, lotions, potions, or magical solutions that can help women with infertility.

Fertility Treatment Costs In New York

fertility-treatment-costs-in-new-york

The costs of fertility treatment vary across the country, with the cost of In Vitro Fertilization (IVF) averaging around $12,400 per cycle, and intrauterine insemination averaging around $1,000 per cycle. IVF costs range from $7,000 upwards of $13,000 in New York City. However, this cost can fluctuate based on the cost of additional procedures like intracytoplasmic sperm injection (ICSI) or preimplantation genetic diagnosis (PGD), fertility drug costs, fees associated with donor eggs or donor sperm, and any laboratory or facility fees. Fortunately for fertility patients in New York City, New York is one of 15 states with mandated infertility insurance coverage. There are also financing options to offset costs not covered by insurance.

Fertility Drug Costs

Depending on your treatment protocol, the costs of fertility drugs can range from $50 to a few thousand dollars. A cycle of Clomid usually consists of 5 pills which cost around $10 per pill. Injectible fertility drugs, called gonadotropins, and other medications can range up to $6,000 per cycle in addition to the cost of the IUI or IVF treatment.

Intrauterine Insemination (IUI) Costs

The fees associated with IUI are initially less costly than those of IVF. However, some fertility patients will find they have spent more money over the course of several failed IUI cycles compared to the cost of one IVF cycle. It is important to discuss all aspects of treatment with your fertility doctor. IUI is not covered by financial plans at a fertility clinic. Keep in mind that medication costs can also increase the total cycle cost of IUI.

IVF Refund Programs, Multi-Cycle Discounts, and IVF Financing Options

Many New York fertility clinics offer an IVF Refund or money back program that allows a fertility patient to pay in advance for a specific number of in vitro fertilization (IVF) cycles. If the patient does not achieve a pregnancy within that number of cycles, she may receive a full or partial refund. Typically, three fresh IVF cycles are included in this package. These programs are a good option for patients who expect to undergo several cycles before achieving a pregnancy. However, there are often age and diagnosis requirements for participating in the program. If a patient gets pregnant on the first attempt, the fertility clinic is entitled to the entire cost (of three cycles paid in advance), therefore the patient has paid more for the cost of a single cycle than a traditional fee-for-service cycle.

Some fertility clinics provide reduced cost subsequent cycles to their patients who have not gotten pregnant on their first IVF cycle. The discount can range from a few hundred dollars up to the cost of physician fees, depending on the clinic.

Other financing options are available in the form of loans or grants for fertility treatment. Your New York fertility clinic may have a relationship with a specific financial institution that will help you obtain a loan for fertility treatment expenses. Some organizations offer grants to patients who qualify based on health insurance and income guidelines.

Low-Cost IVF

Treatment protocols like mini-IVF or in vitro maturation (IVM) cost less than a traditional IVF cycle because lower doses of ovarian stimulation fertility drugs are prescribed. Fertility treatment costs can be reduced if a patient partakes in a group IVF cycle (all IVF patients in the clinic cycle at the same times per year).

For patients using donor eggs for their IVF cycle, they can save money by sharing a pool of donor eggs with other couples, and by using a frozen egg bank which allows the freedom to cycle on your own time as opposed to coordinating a cycle with your donor. Consult your fertility doctor to find out which treatment is best for you.

IVF Research Programs

New York City is the home to many fertility clinics on the cutting edge of reproductive medicine research. Participating in an IVF research program can reduce the costs of fertility treatment, though you must understand the risks and benefits to participating in a research study. Clinical trials are strictly monitored by the federal government to ensure protection of human subjects. You may qualify for free or reduced cost fertility treatment if you meet the age and diagnosis requirements set forth in the research study protocol. For information on fertility research studies, visit clinicaltrials.gov.

Standard Health Insurance

New York is currently one of 15 states that mandate insurance coverage for fertility treatment, however, the degree of coverage varies depending on your employer’s policy and IVF is not included in the mandate. In New York, fertility patients between the ages of 21 and 44 are covered for surgeries and tests related to infertility, fertility drug costs, ultrasound, blood work, and IUI. You should talk to an insurance company representative and financial advisor at your fertility clinic to verify coverage.

For more information on medications used to treat infertility and additional fertility resources, click here!