I found the whole thing very, very overwhelming.
We ordered the drugs from Walgreens, which was really easy. The drugs are really, really expensive. (We were told they could easily run more than $6,000, but lucky for us insurance covered a large part of our cost.) We shopped around to try to find the best deals (crazy enough, pharmacies charge different amounts for drugs and they do not make it easy to price comparison shop), so if you don't have insurance or if insurance won't cover much (or even if it will, just out of principal) I suggest you do the same.
Here's a summary of the drugs and procedures I faced:
Lab work (March-April)
Blood tests for me (follicle stimulating hormone and estradiol blood tests on day three of cycle)
Hysterosalpingogram test (the one with dye that hurt like a bitch) - it showed I had major scarring in my right fallopian tube--much worse than the result two years earlier--and my doc thought I had a 50% chance of having an ectopic if I conceived naturally; looks like at least one of my miscarriages might've done further damage
Blood tests for hubby (STD, other?)
Semen analysis
Birth control (March - April 20, only active pills)
After my period, I started on birth control. Funny, right? I can't get pregnant--what's the point of birth control? Well, it suppresses your ovaries (no early ovulation). Also, they run some nasty tests and you wouldn't want a little guy trying to party in there. More importantly, they can control the start date of your cycle.
The birth control was easy. I'd been on it for over a decade before.
Antibiotics (early April)
Not sure why I was on these. I guess they really don’t want you to be sick. They made me a little sick (nauseated).
Lupron (AM med, 20 units April 17 - April 26, 5 units April 27-May 8)
On April 17, four days before I went off of birth control, I started the lupron injections. (Lupron is used to suppress your ovaries and prevent untimely ovulation.) Lupron was my first shot. It was relatively easy. Not as easy as my pre-filled ovidrel syringes, but still pretty easy. There was nothing to mix--just pull some liquid out of a vial and inject it into your abdomen with a tiny (insulin) needle.
I only made one mistake with the lupron. Even though I was warned, I did not put air back into the vial before I pulled the liquid out (due to a misunderstanding in what my husband told me), so after a few days I started pulling against a pretty strong vacuum, making exact measurements really hard. I just put some more air in and fixed the problem.
Lupron did give me some monster headaches though. When I went from 20 units to 5 units, they went away. Also, early on in the lupron (after my period) I had some spotting, which made me nervous but is apparently normal.
There's no set date to stop lupron, the doctors monitor you and then have you stop before the HCG trigger shot.
Dr. Appt (April 26)
Checking things out. Ovaries quiet. Lining thin. Let's get this party started.
Menopur (AM med, April 30 - May 8)
On April 30 I started my stimulation meds. (These are the meds that make you ovulate like crazy.) The first one I had to take was menopur, and that one was a little tricky. (Menopure stimulates follicle production and helps your lining grow.) It involved mixing a vial of powder with a vial of distilled water. The mixing process was a little complicated (q-caps, taking the needle off and on, etc.) but I got the hang of it. (I did accidentally fling one vial of distilled water across the bathroom. Good thing I had extras!)
The needle on this one was bigger than the lupron shot (or at least it seemed bigger--maybe I was just sick of giving myself shots) and I did get a few bruises. One time I had a needle with a small curve at the tip (I realized after I gave myself the shot) and that hurt like crazy. It took a lot of force to push into my stomach and pull out. If you notice you have a dull or otherwise messed up needle tip and it's easy to switch out, get a new one!
Follistim (PM med, April 30 - May 8)
The second stim med I took was follistim. (Stimulates follicle production.) That was also kinda tricky. It was easy because I didn't have to do any mixing or measuring. Instead, you pop a pre-mixed cartridge into the "pen" and then dial your dose. Literally. It was tricky because dialing the dose was scary--what if I go too far!? (I never did)--and you have to keep track of how much is left in the vial inside the pen from day to day so you don't accidentally give yourself a shot only to find out the cartridge is empty.
The mistake I made with follistim was when I pushed the top down to give the shot, I let my thumb fall over the side. So when I pushed, it seemed like I also had to twist to dial it down. I'm not talented enough to push and twist. And it caused me to move around when I was giving myself the shot, increasing the pain. Once I realized what I was doing, I was more careful with my finger placement and it was easier to push the plunger.
I was on a 225 dose. The medicine comes in a 600 unit cartridge, so you have to change it out after every three shots. In theory, you can save the remainder (approximately 75) and give yourself one of your 225 dose shots by spreading it out over several cartridges, but I said nuts to that. I'm not giving myself any more shots than I absolutely have to. (This medicine is really expensive. I still have several mostly empty cartridges, maybe I'll use them next time around.)
Husband -- Doxycycline (April 30 - May 6)
On day 1 of my stim cycle, husband started taking antibiotics. Why? I have no idea. I guess nobody’s allowed to be sick.
Dr. Appt (May 2)
Checking things out. Follicles are growing.
Dr. Appt (May 4)
Follicles are growing. Seven are between 10-15, so getting close.
Dr. Appt (May 6)
Follicles still growing. Nurse thought I’d get six mature follicles—that’s about ½ the normal amount. Commence freaking out.
Dr. Appt (May 7)
Three mature follicles and three close behind. Still only six. Still freaking out. Estrogen 2200. Lining 9b. (Good.)
Dr. Appt (May 8 – happy mom’s day!)
12+ follicles today! More likely to mature. Yay! Estrogen over 4000. Lining 8b. (Good.)
HCG (May 8)
After monitoring, my HCG shot was scheduled to take place on May 8. HGC is the shot that finally causes your eggs to mature and release (ovulate). This was the first scary shot because it's intramuscular (into a muscle). This is opposed to all of the other shots I'd been doing, which are subcutaneous (under the skin). Basically, I have to use a needle the size of a toothpick.
You have to be really careful about where you have an intramuscular shot. You can do some serious damage if you hit a nerve, and after you insert the shot you have to pull the plunger out a bit to make sure you're not in a vein or anything before you inject.
It also had to be given at a very specific time—exactly 36 hours before egg retrieval. For me, 10:30PM.
So around 10:15, husband and I prepared the shot. I iced the hell out of my butt, and then laid on the bed. He bravely stuck it in. Honestly, I barely felt it at all. (Icing was a GOOD idea.) [The last few sentences of this paragraph are very awkward. I think you get the gist.]
The next morning it felt like I'd bumped my butt on something and had a bruise, but there was no visible injury other than a little red needle mark. So it was sore, but not too bad.
I was really, really glad I iced before the shot.
Egg Retrieval Day (May 10)
This was the easiest day of the entire cycle:
Eat nothing after midnight. (So you don't throw up during surgery while you're unconscious and get anything in your lungs. Bad news.)
No perfume, scented lotion, make-up, fingernail polish, etc. (Everyone knows eggs hate smells!)
Talk to doctor about the procedure. In my case, the doctor said because of my large number of follicles (more than 16--that's actually not too many) and high estrogen number (I was over 4000 on the day I took the trigger shot) I was at risk for developing ovarian hyperstimulation syndrome. (Less than 1% of women have this, but it can be bad news.) More on that later.
Get totally knocked out through an IV. While unconscious, doctor uses a needle to suck every last egg out of all of your mature follicles.
Husband gives "the sample." Because husband's sperm is sublime, we did not use ICSI (intracytoplacmic sperm injection)--injecting a single sperm directly into the egg.
Wake up to be told how many eggs they retrieved. They got 16 for me. Apparently anything from around 10-20 is normal. I was totally stoked.
Veg out all day.
Tetracycline (May 10 - May 13)
Antibiotics for me. Four times a day. Oral. Easy.
Progesterone (May 12 - ???)
The shots that were REALLY stressing me out were the intramuscular progesterone shots. Huge needle. Every night. The shot is suspended in oil and the oil beads sit under your skin causing great discomfort. You have to try to rub them in and walk around, possibly while using a heating pad. No ice because it makes the oil beads even more viscous and harder to rub in.
I have a friend who did one failed round of IVF and chose not to do it again because of the agony of progesterone shots.
And my husband travels for his job, so most of the time I'd be giving them to myself. In my ass. Not sure how I was going to manage that feat of flexibility.
The stress was literally keeping me awake at night.
Fortunately, I mentioned the stress to my acupuncturist (yes, my acupuncturist) and she said, tell your doctor you want to use a suppository instead. Mayo doesn't even use progesterone shots anymore.
If it's good enough for Mayo, it's good enough for me!
I have no idea if Mayo uses progesterone shots anymore, but when I called my doctor's office and asked to be allowed to use a suppository instead, they said okay right away.
My husband was livid that I wasn't given that as an option originally.
I was just deliriously excited that I wasn't going to have to go through with those awful, terrible, downright nasty shots.
Who knew I could get excited over suppositories? Give me an S! Give me a U! Give me a P!... You get the gist.
Embryo Report -- First Call (May 12)
Two days after the egg retrieval, the doctor's office called to tell me how the eggs and sperm were getting along. (Swimmingly. Ha!) Of our 16 eggs, 14 were mature and 10 were fertilized. So that wasn't too bad. (Good job sperm!) Because we had enough embryos, we decided to go for a day five transfer instead of a day three transfer.
If you don't have a lot of embryos, better to put them in mom right away to give them the best chance of making it. But if you've got enough for them to fight it out a little longer, better to see who's strong enough to survive to day 5.
Embryo Report -- Second Call (May 14)
All I got was the transfer time -- 10:00 AM tomorrow. Everything was "looking good."
Valium (May 15 - one hour before transfer)
I'd never taken a Valium before. I took it at home and then we drove to the doctor's office. Husband asked how I was feeling. I said I didn't think it had kicked in. Then we parked and when I went to get out of the car I felt a little woozy--like tipsy, but with none of the nauseated side effects. So I guess it was working.
Day 5 Transfer (May 15)
This was a very stressful day (as I discussed in my second post). When we got to the doctor's office, only two of our ten embryos had made it to the blastocyst stage. The doctor said he would have expected a couple more. And of the ones we had, one was a B2 and one was a B3. So we had no B1 superstars. But we got to see a picture of our little B2 and we picked that one to go in. (Apparently B3 was the better looking embryo early on, but B2 bypassed him at the last minute. Everyone loves a comeback story.)
Husband and I decided to do a single egg selective transfer. Using two eggs significantly increases the chance of getting pregnant (in our case, we had a 50% chance with B2, so that might raise as much as 65% if we added B3), but it DRAMATICALLY increases chance of twins (from less than 1% to over 30%). Yes, twins are twice as nice, but husband and I agree that we want to give mom and baby best chance at health and that means single birth. And we’re good candidates for single egg selection—this is our first IVF attempt, we’re both under 35, we had at least a B2, and we had one to freeze for later.
On transfer day, drink so much water that you think you might explode. Okay, not really, but they want a full bladder to make it easier to place the embryo. If you forget, they’ll make you use a catheter.
Procedure was quick and easy. I actually got to see B2 getting put in. As did husband and half a dozen other people. IVF is not for the meek.
Froze B3 for later.
Rest for next two days. No exercise or sex until pregnancy result. (Boo!)
Embryo Report -- Last Call (May 16)
One more guy made it to a B3, so we froze him too.
Vivelle Estrogen Patches (May 19 [transfer + 4 days] - ???)
The patches are also really easy. Basically two clear stickers you have to wear on your abdomen. The only bad thing is if you wear anything dark / fuzzy, it's going to get stuck to the edges of the patches. Then they become very conspicuous very fast. They are switched out every three days.
And that’s it. Simple, right??
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