September 2016 - IVF #4, Shots!

I started the estrogen pills on Wednesday, Sept 7, after a good blood test showed that I had in fact ovulated.  Yay!  If I hadn't, they would have tacked on some progesterone pills on top of the estrogen.  Thankfully, I just had to contend with the estrogen.

The estrogen pills are called "Estrace"...and Estrace and I don't get along.  These are the same pills I took during the androgen priming for IVF #2, and they give me pretty awful, breathe-deeply-or-you-might-hurl nausea.  I missed work on Monday this past week because of this luckiness, camping out near the bathroom just in case.

My cycle started on Monday night, after only 5 days of the Estrace.  They had told me it would likely be 7-10 days until my cycle would start.  After a check (ultrasound and blood test) on Tuesday, my doctor told me I should start shots Tuesday night.  This cycle will look like this:

• 300 units Menopur and 300 units of Gonal-F daily (2 separate shots at the same time each evening).  These are what they call the "stims" or stimulant medicines.  This is the same mix I took in round 1 and round 3.
• After a few days, and once my estrogen and LH blood levels rise to a certain level, I will be instructed to add in 1 shot of Cetrotide at the same time each day as the stims.  Cetrotide is an ovulation antagonist, which helps keep me from ovulating the eggs I'm growing.  
• When the follicles are all in the right range (usually ~20mm in diameter for as many of them as possible), then they will tell me to take a set of trigger shots.  This time, we are doing 2 Ovidrel shots (as we've done for the last two rounds), and this time we are adding in a shot of Lupron. 
• If you remember from past rounds, the purpose of trigger shots is to help finalize the maturity of the eggs inside the follicles just before retrieval.  Usually only mature eggs will successfully fertilize.  
• Its also during this final step in maturity where the chromosomes in the egg cell split, and they need to split properly and evenly in order to be high-quality, chromosomally normal eggs.  
• Trigger shots are very time sensitive, since they will prompt ovulation between 38-40 hours after being administered.  My retrieval procedure is always scheduled for 36 hours after they tell me to take the trigger shots so they can extract the eggs at their height of maturity, but before they are released into the fallopian tubes (where they can't be retrieved).
• Retrieval procedure will follow and will be the same as all of my past rounds.

I was very happy to start shots earlier than expected, and that baseline check on Tuesday showed that both ovaries had some small follicles already forming, but none so big as to threaten to be a dominant follicle (like in round 2).  

Friday's check went well, and already showed 2 follicles in the 8-9mm diameter range (one on each side) with a few smaller ones in the background on each ovary.  I was relieved to hear we had several showing up, and that they were all in fairly close range with the smaller ones in the 5-6mm range.  If they all keep growing with a similar pace we might end up with a better total follicle count going into retrieval.  

I've been asked if I'm nervous about starting shots again.  In the first round, the shots were definitely the most intimidating part.  This time, I'm happy to be back to the shots.  First of all, the estrogen pills were so unpleasant that I would rather be stuck with needles, but also moving on to the shots / stims means that we are actually growing eggs!  Plus, the fear of the needles is essentially gone now.  I don't even need to ice before the stim shots anymore.  (For future reference, I reserve the right to change my tune on ice when / if we get to go to an embryo transfer...that will mean intra-muscular injections of progesterone oil into the buttocks muscle, which I have heard is an actual and severe pain in the ass.)

For now, being back in the routine of shots feels like a good thing.  I'm trying to take it one day and one check up at a time.  This coming week, I'm booked in for ultrasounds and blood tests on Monday, Wednesday, and Friday.   I already have the familiar quarter-sized bruise on my right elbow from the two blood draws last week.

For some extra info, see my post from round 1 that explains the IVP process as a whole.