Friday, September 7, 2012

Drug Roll Call

Yesterday Ian and I attended our IVF Injection Class and I feel a lot more informed about all the different things I'll be ingesting in various ways over the next months.   So, here's everything, broken down into the who, what, where, when, why and how.

The first thing I had to take was this course of antibiotics, called a Z-Pak.  Ian also had to take it.  I'm still not 100% sure why, but my understanding is that it will kill off a variety of infections in either of us that could potentially prevent implantation.  

On day 2 of my cycle I started taking these here birth control pills.  Oh irony.  This is the only thing I am currently taking and I will take 14 days worth of active pills.  A lot of people (myself included) are initially confused about the use of hormonal birth control during IVF, but it does actually make sense, I swear.  They just want to have control of my cycle timing in terms of when to start all the other meds I'll be on.  It also helps prevent ovarian cysts that would make us have to cancel the cycle.

Next we have the Leuprorelin.  The brand name normally associated with this drug is Lupron, but what I have isn't brand name, although I generally still refer to it as Lupron.  Anyhow.  I start the Lupron on Monday and take 10 units every night for 11 nights after which, if all goes well at my baseline appointment, I'll switch to 5 units a night.  Lupron is measured in Units, like insulin (as opposed to ml or IE (international units), which other injections are measured in), so I use insulin needles to inject it.  It has to stay in the refrigerator, so this is the one that I'm carrying onto the plane with cold packs.  Lupron is used off-label for IVF and is generally used in cancer patients.  Its use in my treatment, though, is to prevent ovulation before we want it.  We are trying to force my ovarian follicles to grow and grow and grow in order to mature 10-20 eggs, as opposed to the normal 1 egg.  We don't want any of them to pop out of my ovaries.  We want to go in and get 'em when they are all cooked!  So Lupron helps with that.  

After 11 nights of Lupron, I go in for a baseline appointment where they will check my levels of Estradiol in my blood and do an ultrasound.  If everything looks like they want it to look, that night I will change my Lupron dose from 10 units to 5 units and I will add two more injections, both of which stimulate my follicles to encourage them to continue to grow.  The aptly named Follistim that you see here is literally a man-made version of Follicle Stimulating Hormone (FSH) - the same that my body naturally produces.  So, I use the pen device to inject myself with this one.  150 International Units per evening.  Each cartridge contains 300 IEs, so I can use it for 2 nights.  Those little plastic things with the pink caps are needles.  So those go in the pen, the cartridge of meds goes in the pen, the dose is "dialed" into the pen and I needle it up.  As a true lover of ink pens, I feel sad about the pen that contains needles instead of ink. 

The same night that I begin the Follistim and reduce my dose of Lupron, I also start Menopur at 150 IUs a night.  Menopur is FSH  (like Follistim) and also Luteinizing Hormone (LH).This one works differently from the others (of course).  I have to mix 1/2 a vial of liquid with two separate vials of the hormone (which is a dissolving pill like thing in its vial) in order to get my full dose.  

So, for those keeping track at home, at this point I'll be doing 3 different injections done 3 different ways with 3 different sorts of needles each night.  I'll do that for at least a week, during which I'll have a blood draw and ultrasound every couple of days.  After a week, that may change to every day.  At this point they are monitoring everything very carefully to decide when to schedule my retrieval and transfer.  

At some point they'll tell me to stop taking each of the above drugs, I presume.  They may also tell me to take either of these drugs, which I know nothing about how/why/when (maybe it's even later - after embryo transfer?  they told us to not worry about these ones, cause they'd let us know when we needed 'em).

When they decide that things are looking good, and it's time to move forward, they will give me a very very precise time to take this Novarel, which is a brand of hCG.  hCG is the same thing I was injecting during my IUI cycles to trigger ovulation, so it's the only one I've actually used before.  It is measured in mL and has to be mixed similarly to the Menopur.  It's the same hormone our bodies produce when we are pregnant that is being measured in pregnancy tests.  In this case, we need to be quite precise with the timing, because we want the hormone to finalize maturation of the eggs in the follicles in the ovaries, but we don't want them to actually be released (no ovulation).  So, I'll give myself this injection at whatever time they tell me to on whatever night they tell me to, and exactly 36 hours later I'll go in for my retrieval.

The retrieval is done under IV twilight anesthesia. . They use a needle through the vagina to empty the follicles (which hopefully all have amazing healthy beautiful eggs).  Don't really want to think that much more about that.  It should be sometime in the first week of Octoberish.  Ian "produces" and embryos are (hopefully) created.

Three days later I take a Valium and head back in for the transfer, when they will put 2-3 embryos back in my uterus in hopes that they will implant and become a viable pregnancy.   They will freeze any good looking leftovers.

Starting sometime soon after that, I will, for several weeks, insert this progesterone gel, Crinone, every morning.  I will let you use your imagination on that one, but if you are a lady who has had a yeast infection, it'll be a lot like that.  This is to help the uterine lining and aid in implantation.  Often a progesterone injection is used, and this is the shot that people dread most.  It is a much much larger needle than all the others, and is given in the butt.  It is pretty painful, apparently, and would have to be done every day for weeks.  I asked about this gel because I had read about it somewhere, and the doctor was happy to prescribe it instead.  Apparently, in fresh cycles, it yields the same results.  It is messier.  But ya know... fewer painful shots FTW.  If I ever end up doing a frozen cycle, I will use the progesterone shot, because for some reason with frozen embryos, the shot yields better results than the gel.   In our class yesterday Ian and I learned how to do the shot just in case.  We got to use a fake butt to practice.  I am kind of regretting not taking a photo of it.  It was a gelatinous meat cutlet like thing in a carrying case.

Two weeks later I take a pregnancy test.  If it's positive I take another one a couple of days later and make sure levels are going up, not down.  Two weeks after that I have an ultrasound.

If not, I decide if I want to do it all over again.   

Ian is already calling my stomach my pincushion. 

And I'm off tonight to Ohio to see important people.  Especially these ones.  Am trying my darndest to make them another cousin!


  1. Good luck! Looks very familiar.. but a few I haven't seen. The gel was awful for me - I preferred the injection.

    1. ick! well, i've now heard equally from ppl who preferred the gel and who preferred the injection, so we shall see. fingers crossed. i just couldn't stand the thought of more needles at this point.

  2. My heart starting racing just looking at those meds. Maybe some PTSD. I wish you the best for your cycle and am glad you're feeling prepared. Just an FYI about the Crinone in case they didn't tell you. It stays up there and you should do a finger sweep each day to clear it out before you put the new stuff in. It will come out looking like a wad of wet toilet paper. At 10 weeks after I stopped it, I still was finding bits of the stuff. of luck this cycle!

    1. woah weird! they definitely did not tell me that. thank you for the information! and for the luck! folks like you give me hope and i really appreciate it.

  3. "Ian is already calling my stomach my pincushion."

    NO DOUBT! Wow! Good luck!

  4. wow you look like a pharmacy. I had no idea so much was involved! We're thinking about one maybe next year or so. not fun....But hopefully the results will prove fruitful. :)

  5. "They will freeze any good looking leftovers."

    I have no doubt you will have an incredibly handsome set of embryos.

    1. ha. i think they'll be quite sexy, actually.