Triggers and Bonus Medications

Yesterday, at 5, I got the word that I would need to take a trigger shot that night.

The nurse confirmed that I was still hyperstimulated, and that my estradiol, at 6,774, was too high.

So last night, in addition to lupron, dexamethasone, and, and the intramuscular trigger shot, I also had to stick a pill called dostinex up my vagina. I will have to take this for 8 nights. (This is exactly what the nurse said, "Stick it up your vagina,")

Starting tomorrow, I will also have to inject myself with cetrotide.

If you are scared of having your loved ones give you intramuscular injections, note that you can pay an RN to drive to your home, or, in my case, your hotel room, where she will mix and provide the injection.

My retrieval is with Dr. Minjarez at 9 a.m. tomorrow.

If you happen to be reading this at 9 a.m. Mountain Time, send thoughts of quality embryos.

High Anxiety

Earlier today, I was looking for some instructions on how to mix Menopur, when I stumbled on this preface to the requisite document:

At Ferring, we understand that having to mix and administer your own medication may seem overwhelming, and increased stress and anxiety levels can potentially hinder your treatment. We want to make it as easy and stress-free as possible.

In a survey among members of RESOLVE, The National Infertility Association, patients who were prescribed multiple injection methods (needle and syringe plus pen) experienced higher levels of anxiety when handling, preparing, and injecting their medications.

And in fact tonight, as I prepared for shots #2 and 3, I did feel stress and anxiety.

Shot #2 was 300 of Gonal-F. It's a pre-loaded pen, so it does not require any mixing. But I found it difficult to push the button that administers the medication, and once I did push it, the result was more painful, in a stinging way, than any of the other meds I am taking this cycle. I have a vague memory of repronex also being painful in this way.

Shot #3 was Lupron, down to 5 units.

So for the day:

a.m.

One Folgard pill

Two vials of Menopur, injected

p.m.

One Folgard pill

One prenatal vitamin

One baby aspirin

One dexamethasone

5 units Lupron, injected

300 Gonal-F, injected.

3 squares Green and Black Organic chocolate

Thirty Days of Lupron

I remember the days when I was starting my second IVF cycle and thought that two weeks of lupron was torture. I was naive then.

If my current cycle goes as planned, I will be on Lupron for 30 days.

But let's review.
As you may remember, I started lupron back at the beginning of June with the idea of doing a retrieval at the end of that month. Sadly, my period did not arrive on schedule and thus, I ran into the one week of the year they close the lab, and I was unable to move forward. So that was 11 days of lupron for nothing.

Now, I have been on lupron since Day 24 of my cycle, which was July 6, and since my body decided to gift me with an unprecedented 38-day cycle, I have now been on Lupron 16 days, and I have not even started my stimulation shots. AF came yesterday, so I called CCRM and we set up a "calendar" and I bought my ticket to travel there on Monday.

This morning I went in for an ultrasound, looking forward to starting my stimulation shots and generally getting on with my life.

The ultrasound showed plenty of follicles: 14 on the left side and 12 on the right. The local doctor said he also saw an old, ruptured cyst, but that it would not affect my stimulation. I got my blood work done, and started waiting for the phone call from CCRM.

The CCRM nurse said that the cyst was borderline and my estradiol was slightly high at 66, so, while they weren't going to cancel my cycle at this point, I would have to stay on Lupron until Friday, when I will have another ultrasound and bloodwork to see if the cyst has shrunk. If it has not shrunk, it would interfere with the stimulation, so they would cancel the cycle.

The protocol calls for me to be on Lupron all the way until I take my trigger shot, approximately 10 days after I start the stims. So if my math is correct, that's 30 days of lupron. And that is not counting the 11 days from my last failed attempt.

I am tired of being on lupron. I am tired of shots, and I haven't even started the thrice daily regimen of lupron, menopur, and gonal-f.

I put in a request with Bear for some of his fool-proof puppy play therapy, but he, too, is tired of the effect Lupron is having on the mojo of the house, so he chose to rest on this chair instead.

Tonight, more Lupron, more dexamethasone.... Wish me luck!

I am not a Chemist

I admit, I did not appreciate my belly. It wasn't always perfectly flat, or perfectly toned. But it was mine.
Now, my belly is unrecognizable.
It started with my surgery, which left a set of scars and a belly button that looks like it is frowning. The belly button is frowning because the doctor went in laparoscopically, and the way they minimize the total number of scars is to go in through your belly button. There is no scar on my belly button, but the skin did not heal the way it was, and now my belly button is sad. It is pessimistic. About four inches below my belly button there is a one-inch scar, like an upside-down crescent, which also looks like it is frowning. There are two small scars about eight inches apart, and between my belly button and this new upside-down crescent. If you connected the three scars and the misshapen belly button, you would make a diamond. And unlike my emotional state, which can be brightened temporarily by, say, a puppy with an ice cube, these sad scars are permanent.
And now, my three-shot a day regimen is furthering altering the tectonics of this landscape.
Allow me to get you up to date. In the mornings, I am taking 150 iu of Repronex. I wipe down all the vials with alcohol preps and unwrap one very long needle-syringe combo and one short needle. Using the very long, and, I must say, intimidating needle, I inject 1 ml of sodium chloride into one vial of powder, and I let that dissolve, and then I suck that mixture up with a needle and inject it into another vial of powder and let that dissolve. Then I twist off the long needle and twist on the short needle. At various points in between, I am holding my needle and syringe up to the light and whacking it with a pen, trying to get the air bubbles out and thinking of the movie Trainspotting. I am not sure what would have happen if I missed an air bubble, but I am sure I do not want to find out, especially since there was an episode of House that posited that such a thing could kill you, even if you previously gave voice to Darth Vader.
Every time I do this mixing and wiping and switching needles, I think of my tenth grade chemistry teacher, who told my mother that I was a terrible multi-tasker, and that this meant I would never be a chemist.
This Repronex shot seems to be the one my body likes the least. I have now given myself three shots. I am supposed to give myself a shot somewhere in the region below my belly button, avoiding a two inch radius of the four points of the diamond of scars, which, as you will recall, includes the belly button. The problem is that every time I give myself one of these shots, a raised, red, swollen patch develops, measuring about 4 inches in diameter. I have three of these so far. For Erin's amusement, I took out a tape measure and measured the available terrain. From hip to hip, I've got 14 inches. From belly button to crescent scar I only have 3.5 inches. And every night, I give myself two more shots, the previously mentioned Lupron, and 225 ius of Follistim. These other two shots don't seem to be causing any problems at the injection site, but if these raised, red patches don't start to subside, I'm going to run out of willing injection sites.

Cold Feet, More Needles, and the Idea of Eleven

A few days ago I went to my first appointment with my new acupuncturist, and was contemplating the number of needles to which I am willing to subject myself to have a genetically-linked child. If I had a more mathematical bent, I might actually try to estimate this, but instead, I like to think of it as the overwhelming number it is, like stars in the sky or plankton in the ocean. Actually estimating the number might make it seem less overwhelming for some people, but I prefer to simply forget about the needles until just before I have to deal with them. This must be why I forgot about the number of blood draws there are for IVF. I forgot that the skin on the inside of my elbow starts to form a little scar on the phlebotomist's favorite spot.

I have been giving myself shots of Lupron for two weeks now, and I am scheduled to begin the follicle-stimulating drugs tomorrow, so I had the pleasure of going to the doctor to have my ultrasound and bloodwork.

Today was only my second blood draw of this cycle, and I have a lot more to come. I find it comforting that the phlebotomist is friendly, and named Rihanna, and admits to being afraid of all needles that do not leave a ink or a piercing behind when inflicted on her. I also appreciate that she remembers to use a butterfly for the blood draw, because no matter what phlebotomists say, the butterfly method is less painful and results in bruising less often.

After the blood draw, I went into an examination room, where I undressed from the waist down while my husband sang what he says is the music one find in porn. This, as you can imagine, made me feel very sexy, particularly as I left on my socks on, climbed on to a very erotic examination table and covered what the truly educated term the vajayjay with a square of paper.

And to be honest, I considered getting off the exam table and putting my Ugg boots on over the socks, because my new acupuncturist reminded me that cold feet are very bad for fertility, particularly for someone like myself, with a cold nature and too much dampness in my system. My acupuncturist in California said this meant I needed to wear socks constantly, and that was California, where it is temperate and dry most of the time, and the question is, if I just had to wear socks before, what will it take to stay warm, dry, and fertile in Oregon?

Before I could act on this idea, the doctor came in and the three of us had a conversation about various parts of the protocol while I modestly crossed my legs. Now, dear reader, if you have not been through fertility treatment you may find this a little strange. Let me put your mind at ease At this point, so many medical professionals have had a look at my vajayjay, I didn't even think about the square of paper until the doctor moved to the side of the room so as to better address both me and my husband, and I realized that my backside was fully exposed, because I was wearing a sweater and a square of paper, and not a robe, or some other garment. Anyway, I chose to let this issue go, because what with the infertility, and the death of my father, and the fact that my mother is now staying with us and my in-laws are visiting, and the chemical menopause symptoms of persistent headaches and weepiness, the indignity of a bare backside is really not worth my time.

After we had our conversation we went on to the real reason for the doctor's appearance: the ultrasound. (This is the thing that Erin's doctors should have been doing to monitor her during all her IUIs.) This is how today's ultrasound went: The doctor pushed a special ultrasound probe up the aforementioned vajayjay and the three of us took a good look at the ultrasound image of my ovaries and the associated follicles. No ovarian cysts, which is good. And eleven developing follicles on each ovary. "You seem," said the doctor, "like a woman committed to the idea of eleven."

This afternoon, I got a call from the nurse saying my bloodwork showed a level of estradiol of 38, which means I'm ready to decrease my Lupron for today and start my follicle-stimulating shots tomorrow. Next appointment: November 11.

Long Long Lupron

And now a bit of the practical. I have started the Long Lupron IVF protocol.

For most people, this protocol begins with going on birth control pills, and I had already started to take them after a surgery I had to remove uterine fibroids in August. (The fancy name is a laparoscopic myomectomy.)

I have recently moved to a small town in Oregon, and there is only one fertility doctor in town. He uses the birth control pill and and an injectable called Lupron to get everyone in the current protocol on the same calendar. This allows him to organize his time so he can do all the egg retrievals and embryos transfers in the same week, which apparently leads to better results.

If you don't count the time on birth control, I am on day three of my protocol. If you want to know the nitty gritty of the process, here's my current nightly fertility regimen:

1. The birth control pill
2. A prenatal vitamin
3. A baby aspirin (the purpose of which is, I think, to increase blood flow to my ovaries.)
4. 10 units of Lupron in shot form (with a needle, not a glass.)

The idea is that this use of Lupron puts you into chemical menopause for two weeks before you start the other shots, the ones that stimulate the growth of the follicles that produce the eggs. Erin, are these the right verbs to use?



Chemical Menopause: "Egads," you exclaim. "The whole point of this is to beat menopause! To outsmart my infernal biological clock!" You might be agitated, and cranky, and you have not even started the Lupron yet. Well, I will share that so far, chemical menopause has not been as terrible as I feared. I don't know about you, but I mostly associate menopause with hot flashes. What I have had is more akin to the feeling you might get from a warm brandy. This is not a problem right now, as I am adjusting to a cooler, rainier climate here in Oregon and have not had alcohol since the day my father died. (One token glass of white wine with my mother at a restaurant, when she couldn't bear to head home to an empty house.) But the warm brandy flush might be alarming if you were not expecting it, or if you were giving yourself Lupron shots in Texas in August. The only other symptom I have so far, which has little to do with the weather, is a headache. Not a migraine, not a sinus headache, nothing too out of the ordinary. Just another hormonal headaches like all of the other hormonal headaches I have had in life. Irritating and persistent, but manageable. I have not had the crazy mood swings or nausea, or any of the highly unpleasant symptoms other women have reported on other blogs. But there is still time!

After all, it must be called the long Lupron protocol for some reason other than the charms of alliteration...