May 2017 - FET #2, Neupogen Infusion (Last Week) & Transfer Tomorrow

This one jumps back in time about a week and is a bit up-close-and-personal.  Just a warning for those who prefer not to read about my plumbing.  I'm documenting this in a bit more detail because it's not a very common procedure, and there are others in my IVF network that have been interested in how it works and what it's supposed to help.

Earlier in this cycle, I wrote about the Neupogen infusion option that my RE recommended we try, depending on the results of my first lining check.  Neupogen is a liquid medicine that stimulates the growth of healthy white blood cells.  It is often used in cancer treatment to stimulate bone marrow production of white blood cells in someone whose immune system has been weakened.  How does this apply to my uterus?  Good question!

Both the Neupogen and the Plaquenil were changes to my protocol which would help address undiagnosed issues with immunologic implantation dysfunction (IID).  There is a lenghthy 3-part explanation of IID that can be found here, and if you're into that level of detail, go for it!  The short version is that there are a few different ways a uterus might reject a healthy embryo.  The common underlying response is an immune response that either prevents implantation or attacks the embryo as it tries to implant.

There's a set of tests one can take to prove the presence of one of these factors, however, to head that off, my RE simply added the Plaquenil (to head off any autoimmune causes) and the Neupogen intrauterine infusion, to stimulate the production of the welcoming and healthy, welcoming, embryo-friendly white blood cells in the lining of my uterus.  Doing these two things have little to no negative effect, and have the potential to offset any existing IID issues.

At my first lining check, he reemphasized that there is no evidence (like a thin uterine lining) to indicate I need the Neupogen infusion, but in the spirit of doing everything AND the kitchen sink, he recommends trying it because it could only help things.  I agreed.

I was to go get the prescription filled ($389, since my prescription coverage doesn't approve this use of the drug) and bring the medicine for infusion ~3 days before starting my progesterone. So last Tuesday, I marched into the office with my chilled Neupogen in hand, in the bulky bag I got from the pharmacy. My doctor tore open the bag, and inside was an orange plastic pill container container of a larger than normal size. Inside that was a plastic bag, and inside the plastic bag was a teeny tiny vial of liquid. "Is that it? Well, that was anticlimactic!" I said. "Yeah, you'd think for that price there'd be gold flakes floating around in it, right?" Dr. S chuckled. 

Similar to the transfer procedure, after positioning a speculum, he used a syringe and a small catheter to infuse the medicine through my cervix into my uterus.  I stayed flat on the exam table for ~15 mins afterwards to ensure the medicine had time to sit in place, then it was done!

7 days after the infusion -- 21 estrogen pills, 2.6 estrogen patches, 14 Plaquenil pills, 5 progesterone IM shots, 2 sub-q Lovenox shots, and 2 acupuncture sessions later -- we are now at the eve of our transfer, which is scheduled for 12:15pm, Wednesday, May 3.  It is a special day because one of my closest IVF friends had her transfer on that day 2 years ago, which led to the birth of her twin girls.  Good vibes right?  Let's hope so.

For the moment, I feel somewhat at peace with what is going to happen.  Maybe because we don't have the 24 hr genetics this time and already know The Lone Ranger is normal.  Maybe because we've done this once and it's not as new and scary.  Maybe, as Michael put it, because all our chips are on the table, our cards are shown, and we've done everything we can to make this hand a winner...we just have to wait for the river.  We have thrown everything and the kitchen sink at this transfer.  No regrets.

This feeling of peace may very well disintegrate into anxiety and impatience over the course of the 9 days of waiting following transfer.  The goal is to hold out on POAS (peeing on a stick) as long as possible.  Last time the false positive threw me for a loop, and testing starting on day 6 was in fact more stressful than waiting.  That said, it's incredibly difficult to think that you're flushing potential evidence of success down the drain...

In the meantime, we still need TLR's thaw to go well tomorrow, and we need the transfer to happen according to plan (i.e. no peeing on the doctor with my full bladder).  A little ironic to start out terrified about peeing, then over the course of a few days it's everything you can do NOT to pee on something?

That is the question...