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!!!

Re-entry Syndrome - like a car crash

I have been back almost a month now from Ghana, but it has taken this long for things to settle down and for life to get back to a semi-normal state.

Re-acclimating to home after being abroad has been quite tough.  Especially after being abroad in a developing nation and being exposed to things I could not help with or change.  Ghana was a life changing experience that was amazing and wonderful, but at the same time heart wrenchingly sad and depressing.  Returning and re-entering into my own country in just 14 short hours door-to-door was a complete culture shock - bright lights, consumerism galore, excessive waste, loud noises, an array of different smells... even the cleanliness was overwhelming.  Trying to acclimate back into my "normal" life was hard.  I felt sad for all those in Ghana whom I left behind that had so little.  I felt guilty for how much we have in our country and how over-indulgent we are without apology.  I felt isolated because no one I know here can actually understand what I have been through and then there are others who are purely not interested.  I met up with one friend who said she wanted to hear all about my trip, but then talked about her life the entire time.  It felt surreal - like all this was not really happening to me; as if Ghana never happened.  It was a sudden jolt, like a car crash, back into my life that I have known for a year, but yet, it was all different.  I am now different.   

This is what is called re-entry syndrome.  It is a real, psychological response that many people - aid workers, soldiers, prisoners - experience when returning to their former life.  It is quite an adjustment.

To top it all off, I came home to find out that my husband was not leaving in the middle of October like we thought, but rather 3 short days later.  That was a hard pill to swallow.  I ended up crying for 3 days straight.

The day my husband left was my first official day of IVF.  I dropped my husband off at the airport in the morning and then went for my IVF counselling alone.  My RE and her nurse were beyond supportive, giving me big hugs and trying to make me laugh.  It was so sweet that they were there for me when I was at my lowest, feeling so alone and bereft.  

My RE took a look at my ovaries via ultrasound (US) and found that my right one had a dominant follicle.  Even though I was taking OCPs, my body was still trying to ovulate.  This was going to postpone the beginning of my injectables and my egg retrieval.  My RE gave me another prescription to take - Aygestin, a progesin - daily with my OCPs to further suppress my follicular development for another week and 3 days.  I have had 2 more US since then and my follicle has slowly decreased in size with my estrogen levels lowering as well.

Today, I had another US and my follicle, which was 20 mm, is now 16 mm and collapsing in on itself.  My estrogen levels are down as well, and that means we are good to go to start the injectables!!!

I start my Lupron, 10 units subq, tonight and then 10 units in a.m. and p.m. until Saturday.  Then Saturday is D-day where I begin my Gonal-F and Menopur.  All fingers and toes crossed for a successful egg retrieval around 8-10 of November and embryo transfer 3-5 days later!

Wow.  This month has been a whirlwind.  I have struggled with transitioning back to my life from Ghana, then 3 short days later I had to re-transition to living life without my husband, my best friend, and finally now - almost a month later - I am getting back on my feet, I am feeling like things are flowing again, and I am having hope for the first time that I may just get lucky and have a baby in 2012.