May 2016 - IVF #3, Day 12 of Shots

Today is officially Day 12.  Yesterday's check went well!  I think it's because I wore my egg socks...

Walking into that appointment, I was more nervous for the ultrasound than I have been so far this round.  I knew that yesterday's count was going to be fairly definitive on how this cycle would turn out.  By this point, I have learned, if you aren't seeing the follicles, they probably aren't coming.

The ultrasound showed 2 follicles growing ~7-9mm on the right ovary, and 4 follicles ~5mm each on the left side.  Estrogen levels are rising as expected, and instructions were to keep on with the same routine until Wednesday morning's check.  The key for Wednesday will be if the left side 4 can catch up a bit better with the right side 2.

As of 7:30 this morning, I'm officially 42 injections into this round 3.  Of the 42, 8 have occurred during conference calls, 2 have occurred at a restaurant, and 2 have occurred at an Astros game.  Not that we are becoming exhibitionists with our shot routine...just trying to have some semblance of normalcy whilst going through this round.

Most importantly, I feel more relaxed about this round.  Regardless of the amount of stress I inflict on myself, the round will likely produce the same result, stressing more just makes the path to the outcome more difficult to bear.  Round 3 started off with a "it will be what it will be" mentality, and while I've found myself straying from that path for a few brief tearful bouts with fear and hormones, for the most part I have stayed steady.  Going any further toward hopeful still seems foolish and emotionally risky.  However, seeing the ultrasound count from yesterday looking more promising than round 2 is definitely making it easier to stick to the low-stress path, but the hopeful high road will have to wait...maybe until we have enough eggs to move toward transfer.

Tomorrow's check will help better forecast when the retrieval might be, though probably not precisely.  Right now it could be anywhere from Friday to early next week, depending on the growth of the follicles and stability of my estrogen levels, and we could have anywhere from 2-6 follicles to retrieve.

Follicles can grow anywhere from 0.5-2mm per day on average.  Ideally, tomorrow's scan shows my little 4 on the left catching up with the bigger 2 on the right.  If the bigger 2 continue to outpace the smaller 4, we might not get all 6 to the right size for the retrieval and be forced to settle for fewer.  We want them all to be in the 15-22mm in diameter range (0.6-0.9 inch) to go to retrieval.  This size range ensures that the eggs inside of them are mature, fully nourished, and have the best chance for successful fertilization.  Before this size, they are likely premature, and beyond this size, they are likely post-mature / too old.  My RE is the Goldilocks and my follicles are the porridge...he wants as many of them as possible to be "just right".

May 2016 - IVF #3, Day 8 of Shots

Today is Friday.  I started shots last Friday, and have been hitting the 7:30am/pm mark almost exactly every day since.  We started with just the Lupron morning and night for 2 days, then last Sunday, we added in the stimulating hormones (Gonal-F in the am, and Menopur in the pm) to get the follicle party started.  As of this evening, I have taken 28 injections in IVF #3.

I've been in for two checks (blood test and ultrasound) since starting, one on Wednesday and one today.  Wednesday's scan showed 2 very tiny follicles, and today's scan showed 3 follicles each with ~5mm diameter.  This is very similar to what we had at this point in IVF #1, which feels pretty good!

For readers who are more visually inclined, here's what that looks like:

Shots so far, including instructions through Monday next week.

The next check is on Monday (Day 11 in the figure above), so my instructions are to continue as we have been until then, at which point we await further instructions.  It's kinda funny actually, if you can bring yourself to call it that, the vast majority of what's happening is simply, blandly following instructions, getting stuck with needles, then checking in, getting stuck with more needles, and waiting again for the next set of instructions as to how many more needles are coming your way.  Most likely, we will keep going with the shots through most of next week, but it will depend on the growth of the follicles and estrogen levels as we go, just as before.

28 injections and 2 blood draws down in round 3, and I feel far more comfortable with needles than I ever have in my life.  As predicted, I have had to give myself a few of my morning shots.  I tried not to overthink it, especially since I needed to take them during conference calls.  Loading up the syringes before the call and donning my headset, I was able to lift my shirt and shoot up in my stomach while continuing the conversation.  Thankfully, I took both of these calls from home, so no one else had to witness this spectacle, and I'm fairly certain no one on the line knew it was happening either...  Stealth self-injection.  Not amongst the skills I ever expected to develop in life.

On top of the soreness across my lower abdomen from the injections, the fluctuating hormones can be rough.  On IVF stims, my recurring symptoms have included:

• Nausea with cramping - usually during the early days of shots
• Severe, light-sensitive, ear-ringing headaches - usually starts around day 4, it's a constant throbbing that gets worse in the afternoons and does not respond to Tylenol (the only pain meds I'm allowed to take)
• Pinchy, bloaty ovarian pain - especially as the follicles get bigger
• Drowsiness - the kind where your whole body feels worn down and your arms and legs feel a little like Jello
• Extreme mental flakiness - we're talking walk in a room and forget why you're there, misplacing things left and right, and forgetting parts of conversations only minutes later
• Jr. High complexion - just as fun as it sounds

 Home remedy of the moment:  Dark Chocolate

These two are my favorite gluten-free and (mostly) dairy-free varieties.

Dark chocolate helps address a couple of those symptoms fairly well, and I have been self-prescribing chocolate for a good portion of this IVF journey.  I've actually had better success easing one of these hormone headaches with chocolate than with Tylenol.  The small amounts of sugar, fat, and caffeine are so valuable when coffee combined with aspirin and ibuprofen are off the table.  With "low-caffeine" being part of the NFD, I do need to keep it somewhat reasonable.  Even when the headaches are really bad, my daily dosage stays around a 1/4 to 1/2 bar.  Given the small portions, quality is key.

The Lindt sea salt dark chocolate was one of my favorites back during pregnancy #1.  I found myself buying it whenever I was out shopping.  Eating 2-3 squares, I would inevitably leave it somewhere later that day, like in my purse, desk, or refrigerator (best served cold)...in just a few weeks, I amassed quite the stash.  I have indulged in this one a little during this round, but it does contain milk fat, and while it's likely in very small amounts, it technically doesn't qualify as dairy-free.

The Endangered Species dark chocolate with cacao nibs is one I came across when I was attempting a low-glycemic diet several years back.  No, it isn't carb-free, but it is fairly low in sugar compared to many dark chocolates out there, and it's packed with all those good-for-you antioxidants.  At the time, a square or two would tide me over when I really needed something sweet.  Plus, it is GF / DF and contains actual raw cacao nibs, making it more of a vegetable than a dessert, in my humble opinion.  Not to mention it's a fair trade product that proceeds go to helping preserve wildlife.  This chocolate may be the most responsible chocolate a person can eat.  I'm sure my acupuncturist would agree...

May 2016 - IVF #3, Counting is Important

The medicines arrived in 2.5 shipments.  1 from Conception Pharmacy with the Z-packs, Gonal-F, Menopur, and Ovidrel shots during the last weekend in April.  1.5 from Freedom Pharmacy with the Lupron that arrived during the last week.  Why do I say 1.5?  Well, here's why.

One of my fears in this process is not having a good inventory of the medicines I have on-hand...and then, worst case scenario, realizing this around T minus 5 minutes to injection time.  Pause for a moment and imagine the sheer panic of potentially screwing up the whole round due to accidental miscounting.  Terrifying for me, and for anyone in the general vicinity were it to happen.

When I unpack my shipments from the pharmacies, I count everything, and compare it with the packing slip and the original prescription on my portal.  Most of the time, this is overkill...the pharmacies do a pretty good job of making sure they give you what you need.  There is enough competition that they wouldn't stay in business if they regularly messed up shipments to high-strung, fertility-challenged, hormonal women.  Still, I don't want to be that one case in 1,000 that they might accidentally screw up.  I'm already in a 1-percentile situation with my damn ovaries...I wouldn't be surprised if Murphy is out to get me.  So I always check, even though, Lord knows, I am not generally this organized...

Conception Pharmacy's shipment arrived in the big insulated box and was perfect, as it has been during the last two rounds.  I added that with what I had leftover from rounds 1 & 2, and I was in great shape with some extra days of medicine which might keep me from having to order expensive refills.  Small win!

Freedom Pharmacy's shipment arrived this past Saturday.  It was in a much smaller insulated box containing one vial with all the Lupron, orange capped mini-syringes, and paperwork.  I counted...then counted again.  I pulled out the vial and the prescription and did the math...15 days worth of medicine total, split in 2 doses / day.  I should have at least 30 syringes, yet I only have 20.  Their invoice is calling 20 syringes 20 days worth.  This is not right.

Now this isn't the worst thing I could have found.  I did get the right medicine and supplies enough to start taking it on time, but it just goes to show why counting is important.  If I had assumed they would send me the right number of syringes, I would have found out as the needles dwindled and my hormones fluctuated, and it might have become more stressful and urgent.

I called Freedom Pharmacy, a Massachusetts based company, and everyone I have spoken with so far has delightful New England accents.  This conversation took around 15 minutes, here's more or less what was said:

Lady:  "How can I help you?"

Me:  "I received my prescription, but it did not come with enough syringes for me to take all the doses.  Can you please send more?"

Lady:  "So you need a refill?"

Me:  "No.  I just need the original prescription medicine, which I have, and I need the right number of syringes in order for me to take it.."

::silence::

Me:  "I'm afraid someone mis-counted.  The invoice says 20 syringes = 20 days worth, but I'm taking 2 shots per day, so I would need at least 30."

Lady:  "Hmmm.  Well they come in a bag of 20."

Me:  "Then should my prescription should come with 2 bags?"

Lady:  "Let me connect you with the pharmacist."

::hold music::

Pharmacist:  "Hi Kelly, you need a refill on your prescription?"

Me:  "No.  No refill, just want to get the right number of syringes so I can take the medicine you sent me.  I'm taking 20 units, 2 times per day for 15 days, but I only received a pack of 20 syringes."

Pharmacist:  "These syringes only come in packs of 20.  We usually only give 1 pack."

Me:  "So I have heard.  How am I supposed to take the extra 10 doses of medicine in this vial without more syringes?  Does my prescription not cover all the syringes I need to take the medication?  I've been told never to re-use them..."

::silence::

Pharmacist:  "Hmmm.  I see.  Well, I guess we need to send you another pack?"

Me:  "That would be great."

Pharmacist:  "Now I see that it's written in your prescription from your doctor that you need 2 packs of syringes.  We usually only give 1 pack.  We'll get that right to you!  No charge!"

Me:  "Thank you!"

Geez.  If I had been in peak hormonal form, this would have been far more frustrating.  Thankfully it got sorted out, and I received the extra pack of syringes on Thursday in a pint-sized FedEx box, making my stock for round 3 complete: 

Round 3 Prescriptions Complete!

Freedom Pharmacy Package - Lupron, 2 packs of syringes, instructions

Lupron & Packaging

Lupron Vial, 15 days worth

May 2016 - IVF #3, Here we go again

Tuesday's baseline check went great.  Well, I say "great" in the sense that nothing was wrong...I guess that's the low bar we are currently calling "great'!  The ultrasound showed that everything is quiet, and the blood tests showed my hormone levels were close to where they needed to be to get started.  Since my estrogen came back around 7.5 pg/ml, my RE asked me to continue with the birth control pills for one more night (Tuesday) to hopefully lower it a little further and then start the injection protocol Friday/today!

I wasn't enthusiastic about another day of birth control.  The double dose had been giving me some serious nausea, especially the day before my Tuesday appointment.  However, it was great to hear we were close to moving forward and that there were no show-stoppers on the ultrasound.  Feels a little funny, but even though I'm a bit nervous about it (mostly the outcome), I'm actually looking forward to the shots.  The shots feel like action.  Progress!  Hopefully also success...

The Lupron started today/Friday (AM and PM shots, 20 units each), which should start my natural hormone flare to kick off follicle growth.  Then on Sunday, I will add in the Gonal-F (300 units) alongside the AM Lupron, and Menopur (300 units) alongside the PM Lupron.  2 shots every morning and 2 shots every night from Sunday until they say we are ready for retrieval.

With the twice a day situation (12 hrs apart as consistently as we can), there are some new dynamics. Previously, we timed the daily shots around 9:30pm.  We are usually always home by then, or at least it's pretty easy to pull that off for a couple of weeks.  Now in this round, if we keep the 9:30pm slot, I will most definitely have to do my morning shots solo and also at work.  I'm not too panicked about this, but I would prefer to avoid the potential of dropping the syringe down the office toilet, and also I like having Michael do it (team effort!).

We settled in on timing the evening shots reasonably for Michael to be involved (~7:30-8pm) with his increasingly busy work schedule.  For the mornings, if I'm shooting up solo, 7:30am is early enough that I might still be able to work my schedule to do it from home rather than haul all the temperature sensitive stuff into the office (and, again, avoiding the toilet dropping situation.  This does, however, mean waking up on time on the weekends for the next two weeks.

At the moment, the timing coordination is more stressful than the idea of doubling the number of daily injections to 4.  As I've said before, I really like having Michael involved in this part.  During the first round, my stress level was fairly high and my fear of stabbing my own finger was real.  I was so thankful he was willing to take control of the shots.  During round 2, I was far more relaxed, but the 600 units of Menopur burned like crazy, so it was great to have him do it...I might have wimped out part way through.

Both times, having him involved and in control of the shot-giving was great.  We felt like a team, and this was our wacky science experiment TOGETHER!  Growin' eggs!  With his active role, he was a little more involved and little less of a bystander to the process.  When it was working, we felt great together, and when it wasn't, we were sad together.  Choosing this kind of teamwork means that the importance of his role was greater than his "donation" on the day of the retrieval or being a shoulder to cry on when I was just needing to cry (several times) along the way.

I'm sure not everyone's spouse is up for it, but mine is, and I'm really thankful for that.  Since we started this way, I'm not sure how the dynamic would change for us if I gave myself all the shots.  So far, we have been able to stick to our normal routine, and Michael gave me the inaugural Lupron shot right at 7:30am this morning!

Here we go (again)!

May 2016 - IVF #3, All the Pills!

7 days of birth control down!  On day 8 today, and I will be taking the eighth dose this evening.  Started out with some nausea during the first few days, mostly due to the double dosage, but that has faded a bit.

I have mentioned it before, but it is worth reiterating.  One of the daily tasks I will be most happy to get rid of once this process concludes is ALL THE PILLS!  Unlike the shots and the fluctuating hormones, which come in waves, I am taking these all the time.

This part isn't all that miserable, but I am throwing myself a mini-pity party at the moment.  In addition to the no-fun diet, it is a constant, tedious, and sometimes gag-inducing reminder that the process is still dragging on.  It's almost to the point that if I'm drinking something, I feel like I should be swallowing a pill along with it.  For the daily prenatal vitamins

Just to recap, I'm taking a variety of supplements, both over the counter and prescription that help make my reproductive system as cooperative and fruitful as possible for IVF.

Here's an outline of my current daily dosage:

• Birth control (2 pills)
• Prenatal + DHA vitamin (2 pills)
• 4000 IU vitamin D (2 pills)
• Baby aspirin (1 pill)
• Chinese detox herbs (6 pills) - purpose: detox, digestive regularity as hormones come back in line
• These are temporary, and I will stop them before the shots start.
• Antioxidant supplement (3 pills) - purpose: egg quality
• L-Argenine supplement (3 pills) - purpose: circulation, improve response to stims
• Ubiquinol (2 pills) - purpose: egg quality, circulation, uterine lining
• DHEA (3 pills) - purpose: egg quality and quantity
• Royal Jelly (2 pills) - purpose: egg quality, uterine lining
• Inositol (4 pills) - purpose: egg quality, sleep, stress, metabolic stability

Total: 30 pills / day

For a visual, here's a picture I took last week (before adding in the birth control pills):

So many pills.

2x Birth Control pills at bedtime not included.

Most of these are pretty sizable ~1" long capsules, many of which contain air, making it particularly difficult to swallow.  For these, my strategy is to tilt my chin to my chest so they float to the back of my throat before swallowing.  Even then, they often get stuck and feel like they are lodged there until the next set of pills can push them down.  I have gotten to the point where I can take 2x at a time for the big ones, but either way, once I get them down they feel like they are floating in my stomach for about 20 mins, until their coating fully dissolves.  

I'm really just tired of it.  Of keeping up with it, and of forcing them down.  I really look forward to the day I can retire that awful 28 bin pill container!!!  I just wish I knew when that would be so I could see the light at the end of the tunnel!  Argh!

Ok, pity party is over.