Saturday, October 29, 2011

Tonight's the Night

And it's going to happen again and again.  It has to happen.  ~Dexter

No turning back now.  It is injectable time!  And it is going to happen again and again, every single night until the 2nd week of November.

First up is Lupron - 10 units both a.m. and p.m. subcutaneous (subq).

Next is Menopur - 1 ml of NaCl reconstituted with Menopur powder each p.m. and injected subq as well.

Last, but not least, Gonal-F (similar to follistim), 375 IU each p.m.

Ta da!  All the injections lined up and ready to go.

Surprisingly, they did not hurt.  The middle one, the Menopur, was a bit sore due to the volume of medicine, but otherwise all went well.  I did experience a bit of a metallic taste after I injected the Lupron on the first day, but that went away after the second day.

My drug counter - sharps container, needles, alcohol pads, meds, prenatal vitamins, B-12 and folic acid chewables, my IVF calendar - everything I need to have a baby. 

The following is a diagram drawn by my doctor to show what happens with the IVF cycle.  Birth control pills are used to suppress my own hormones so that the RE can hijack my system and tell my body to mature more than one egg for this ovulatory phase.

Lupron is synonymous to GnRH, Follistim/Gonal-F is analogous to FSH, and Menopur is similar to LH.  These meds are given over a 8-12 day cycle with every other day US and estradiol levels drawn to see how many follicles are developing and to monitor hormone levels in my blood.  When the time is right and the eggs are at the right maturity level, an HCG trigger shot will be self-administered, and approximately 35 hours later an egg retrieval will take place.

My RE believes I'll produce around 10-12 eggs per my age.  Those eggs will be fertilised with ICSI - intracytoplasmic sperm injection - where 1 sperm is directly inserted into the egg, and the fertilised eggs will be watched as they grow from 2-4 cells on Day 2 to 4-8 cells on Day 3 to a blastocyst on Day 5.

Transfer will take place either on Day 3 or Day 5 depending on how the embryos are developing and the quality of the embryos.  Each embryo is given a grade - A, B, C - and those with a higher grade, such as A or B, are the ones that have a greater chance of implanting and becoming a baby.  Anything below C will be discarded.  My RE hopes we have grade A and B embryos and that she will be able to transfer at least 2, maybe 3 embryos if we do a day 3 transfer.

If she transfers 2 embryos, there is a 35% chance we will have twins and a 1-5% chance we will have triplets.  Any other extra embryos we have (hopefully we will have some!) will be frozen to be used in the next cycle should this one not be successful.  Only 50% of embryos make it through freezing and rethawing, so we do not have a high chance of having extra embryos due to my age and low amount of eggs that will probably be retrieved (younger people can have up to 20 or more eggs retrieved).  I am hopeful though that I will have enough eggs at retrieval and that we will have enough good embryos to have a successful transfer.  Having a few good embryos for cryopreservation would definitely be the icing on the cake!

After the embryo transfer, I will have to wait 2 long weeks before I will be able to know if I am officially pregnant.  I will have to give myself daily IM injections of progesterone for at least 6 weeks and then I can switch to progesterone suppositories.  I am definitely not looking forward to that part as I heard it is quite painful and also difficult to give yourself IM injections in the buttocks.  Usually the woman's partner gives the progesterone injection, but sadly I will have to do it myself.  Worse case scenario, I can ask my midwife preceptor to give it to me.  

Let's hope I am ambidextrous with a needle and highly skilled in self-administration of IM injections!  

PS - Did you know that IVF was this involved??  Even as a labor & delivery RN and now soon-to-be Nurse Midwife, I had no clue what all was involved with IVF.  I also had no earthly idea about the costs (to be discussed in a future post).  After spending $3500 on these meds, they better work!!!


  1. I don't like to even look when I get blood drawn... can't imagine giving myself a shot! Glad they weren't painful!

  2. So far, so good. Some are a tad sore depending on the spot I choose, but that quickly goes away. I have not felt any of the reported "hormonal" problems - I've been happy and amorous (too bad for me that my husband is away!) - but no irritability or other foul moods. Fingers crossed for a good outcome!