January 2016 - IVF #1, So Many Shots

Sunday, January 10, 2016, was the official kick-off of our first round of IVF.  After much discussion, Michael gave me the first shot.  Having received some good advice from a colleague, I tucked a snack-sized zip bag of ice in my waistband while I mixed up the medicines in the syringe.  It was definitely more complicated that I had envisioned, and I laid all the notes and instructions from the nurse on the counter top to follow along and be sure I was doing it correctly.  Some of the medicines (the Gonal-F, Cetrotide, and ultimately the Ovidrel) must be kept in the refrigerator.  With a little back and forth to the fridge and all the bits and pieces, it took me about 20 mins until I had the syringe loaded and ready.

Instructions on left, supplies on the right.

All the supplies for the very first shot!

300 units of Menopur, which consists of 5 vials (1x saline, 4x of a powder pill that would melt / dissolve into the saline upon combination)
300 units of Gonal-F (dosed from a "pen" that you dial in the correct dosage, then push the plunger to dispense that exact amount)

In short, I would put the 300ml of Gonal-F in with the last vial of Menopur, then use the saline to dissolve and combine the other 3 Menopur tablets, finally mixing that 3x Menopur mixture with the last vial of Gonal-F/Menopur combo.  Getting everything mixed and extracting as much of the liquid from the little vials at each step was a bit finicky.  Sometimes bubbles would form and they would cling to the walls of the vial and thwart my efforts to get as much of the (very expensive) medicine back into the syringe.  I would get much better at this as time went on, but the first few tries were a little frustrating.  Thankfully, it wasn't supposed to go on for too long, and we had been told the average person goes through 9-12 days of "stims" before retrieval.

Once extracted into the syringe, the cocktail was ready, the injection needle is twisted on, and it was ready.  Michael would then take it, tap the air bubbles to the top and squeeze the medicine to the tip of the needle...you know, like addicts do in the movies!  I tried to ignore that part while I removed my ice baggie and wiped the spot with an alcohol pad.

No denying it, I was nervous.  I kept telling myself that many, many people do this all the time.  I felt like I was being a wuss.  I have several diabetic friends who would probably laugh a little at the butterflies I was having in that moment.  I pinched the skin on my stomach a couple inches below and to the right of my navel, and closed my eyes.  Michael did it!  I felt nothing.  Suddenly, I felt a bit silly...but I was very glad for it to be so painless.  The injection site bled a little, which led to subsequent shots concluding with a tiny spot bandaid...which also helped us keep track of which side was up next.

Starting that Wednesday, I would go in to the RE's office for an ultrasound and blood test every other business day.  They would check my ovaries, uterine lining, and blood hormone levels then reconfirm the injection dosages going forward.

Ironically the other kind often leads to pregnancy...if I had the option, I would definitely choose tequila. 

We proceeded with this injection routine between 9:30-10:30pm every night for 9 days before they told me my hormone levels were high enough to add in the Cetrotide (which as an ovulation "antagonist" keeps my ovaries from releasing the eggs to early).  By this time, adding a second shot to the process was easy.  The Cetrotide has to be mixed like the Menopur, but it's just 1 tablet vial and 1 saline vial, which now that we were pros at this, was a cinch.  It was also around this point that the RE called a halt to any exercise, strenuous activity, or lifting of any sort.  He explained ovaries undergoing stimulation will grow quite large with all the follicles, and are a bit like "bobble heads"...if they were to twist, say if I were lifting something heavy, it would be extremely painful and also likely cut off circulation to the ovary, which might then die.  Scary, right?  Best excuse I've ever heard to avoid exercise at all costs...

On January 18, the ultrasound was still not showing very much, just a few smallish follicles (mostly on the right ovary), which wasn't very encouraging...it was becoming apparent that my schedule would be longer than "average".  Concern crept over me that this cycle could get "cancelled" for lack of response (meaning that there aren't enough follicles to warrant going through with the retrieval), I asked if there was anything else I could do.  My nurse recommended looking into acupuncture.  She explained that it has been proven to help, and that there's a clinic they highly recommend.  I got an appointment for the next day.  I had never done acupuncture before, but what's a few more needles at this point, right?  I will go into the adventures in acupuncture at another time.  It is worth noting, however, that the acupuncturist recommended I immediately start a few key supplements as well as a gluten-free, dairy-free, caffeine-free, low fat, low sugar diet.  The diet part was almost as hard as the shots at first, but again, more on this later...

On January 20, I had to take a business trip with all my injection paraphernalia.  It was only for 24 hours, and it would require taking all of it through airport security.  Important things to consider (from TSA instructions I read):

• Pack everything together
• Bring documentation of prescriptions
• Ensure medicines are labeled and in original packaging
• If they must be kept cold, ice packs are ok, so long as they are frozen solid as you pass through security; liquidy ones will be taken away

I jumped through all the hoops, prepping for everything, including a backup ziplock I could fill with ice if they took away my ice pack that was keeping my medicine cold.  Packing it all into a neoprene lunch bag, I wedged down into my laptop bag and headed to the airport.  I was so ready...and security didn't even bat an eye when I put it through the scanner.  Could not care less. Sigh...

The main thing about this trip was that I would have to give myself the shots for the first time.  This was intimidating, but I knew I could do it.  In the hotel room, the adrenaline started pumping as soon as I started mixing them up.  What if I didn't stab myself firmly enough?  What if I stab my finger instead?  I held my breath and did it (in the stomach, not the finger)...and the second one, too!  Suddenly I was dizzy (likely from holding my breath for so long), so I left the clean up for later and laid down on the bed.  Here I was in a hotel, two empty syringes on the side table, and I'm sprawled out on the bed gasping for air.  Might have been an misleading scene for someone to walk in on in that moment...but at least I had all my documentation...thank you TSA!

Interestingly and something I had rarely noticed before, most airports and many other public places will have sharps disposal units in their restrooms.  The next day, I was able to dispose of my used items at the airport ladies' room before going back through security.  I had one more day's worth of medicine with me, just in case there were major delays, but in the end, I made it back to Houston and home just in time for Michael to give me the next set of shots. 

In the end, we would go through 15 days of shots starting January 10, ending with trigger shot on January 24 and retrieval on January 26.  They might have kept me on them longer, except that my estrogen level started to plateau, meaning it was time for extraction, whether the follicles were all ready or not.

All of the medicines taken during IVF round #1.  Each Gonal-F pen contains 3 doses.

Overall, the cycle wasn't miserable, not like the horror hormone reaction stories I had heard from some, but it wasn't easy.  My stomach was sore from the shots, and as the follicles grew, I was feeling bloated and uncomfortably pinchy on the inside.  I had a confetti of little bruised spots about the size of dimes at the injection sites, at various stages of fading.  It was around this time that I was getting pretty regular headaches and felt generally exhausted.  There were a few mornings when I just couldn't get going on time...sleep just felt far more important and getting up was far, far too hard.  I was very fortunate that I could work from home when I wasn't feeling great.  For the days I went into the office, I bought stretchy work pants made of yoga pant material (which were clutch), which I wore religiously as I started to feel more and more uncomfortable.

The most publicly visible symptom of the "stims" was behavioral. I got very absentminded and flaky.  It was reminiscent of when I was pregnant...total "baby brain".  The more self-conscious I would feel about it, the worse it would get.  Anything important had to be written down, and even then, it was a gamble if I would remember.  I put the majority of my efforts into remembering things for work, and let the rest of the chips fall as they may.  The stress of the shots, the constant numbers game of the follicles and their sizes, and the extra stress of forgetting things left and right led to some emotional breakdowns.  Maybe the hormones made me more susceptible, but thinking back, there were tears on a pretty regular basis throughout the process.  Usually just short bouts of emotion, but sometimes longer...and Michael was always there.  The whole cycle took a lot of teamwork, and not simply with Michael giving me the shots.  He was so understanding and patient with my forgetful and emotional self, gently saying, "You just told me that a minute ago," or the many times he said, "Don't forget..." to help keep me on track.  I'm certain it was testing his patience on several occasions, but he rarely let it show.  And for the last week of shots he was extra-protective of my "bobble heads"...he did all the lifting (physical and emotional), even including my purse when we would go places.  He was completely there for me and helped prop me up every day, which I know was exhausting, especially with several other stressful events at work and with family playing out at the same time.  he was (and is) my hero, and despite being in a fragile emotional and physical state, I felt so protected and loved.