And Then We Were Stimming

6tag_111014-213354The next step in the IVF process is called stimming. Once my body has been sufficiently suppressed, through the use of birth control and lupron, my doctors will then introduce drugs that will cause my ovaries to create multiple eggs. See, every month most women start the first few days of their period with several small follicles on each ovary. During this time one follicle (sometimes 2 or more, hence natural fraternal twins/triplets, etc) will pull ahead of all the rest. This follicle will go on to mature, then around day 14 of your cycle you will ovulate and release an egg. For IVF, we want more then 1 of these follicles to grow and mature, but NOT too many. We also want to control when we ovulate, so that the Dr may retrieve all of the eggs and they are not lost into the abyss.

Needless to say, this is where things get pretty serious. Based on your baseline results, your diagnosis, and your age, your Dr will prescribe you the dosages of these medications. You will then typically start taking the injections daily (stimming takes 8-12 days on average), with your first follow up ultrasound and bloodwork on day 3 or 4, and then every other day, or quite possibly every day up until your retrieval. There are numerous blood draws to watch and make your your estrogen levels don’t get to high too fast (estrogen indicates how many mature growing eggs you have), as well as LH and progesterone to make sure you don’t ovulate on your own. Timing for all of this is very critical. If you produce too many follicles and/or your estrogen gets to high you risk something called ovarian hyperstimulation syndrome. OHSS on the low end is just very uncomfortable, and on the extreme end is life threatening. So, kind of a big deal. You also don’t want to stim too quickly, as this can result in poor quality eggs. So it is a very delicate balance.

15494578012_df0c2a2849_oAt my baseline I had a very high antral follicle count (about 45-ish small follicles on each ovary) and an okay estrogen level (110). Because of these facts, combined with my age, and my mixed diagnosis of unexplained, suspected tubal factor, they have put me on a very, very low dose of stimulants. I am currently taking 75IU Gonal-F and 75IU Menopur, along with a lowered dose of 5IU Lupron.

Yesterday was stim day 5 for me, and also my first ultrasound and bloodwork. Currently I am responding well, with 8 measurable follicles, 4 on each ovary, and an estrogen level of 378, making me a high responder. Because of my high follicle counts, and my high response to low doses of meds, I get to continue on with the low dose of medications and I have a repeat ultrasound and bloodwork tomorrow to see how much further along I am.

InstagramCapture_81696fc1-6d5f-40d1-9a50-a355123fa353Today marks day 6 of meds and so far my side effects have been:

  • Bloating
  • Cramping
  • Mood Swings
  • Fatigue

Right now I am guessing I will stim for 9 days total. Making trigger Monday and retrieval Wednesday morning. That is just my current guess based on my research and current response to meds. Tomorrows scan and bloodwork will be alot more telling as far as how on target I am.

 

On to the Lupron

InstagramCapture_4ca8c823-b460-40b0-8e2f-1f4ef8f8f913Continuing from my last post, on the 26th I began injecting myself with 10 units of lupron every night. Out of all of the injections, this one is the easiest being that it is administered with an insulin syringe. The biggest downside to lupron is that it has some of the gnarliest side effects. But you kind of expect that from a medication that puts you into menopause. So far my side effects have been:

  • hot flashes
  • sleeplessness
  • headaches
  • lightheadedness

All in all not horrible, but definitely not enjoyable. The injections themselves hadn’t even been too bad until the past 2 evenings. For all of my abdominal injections, they are done around the belly button, in the fat of your stomach, and you switch sides each evening. The past 2 evenings the injection has hurt going in, and then bled after the injection. I noticed this afternoon it also bruised on that side today. Not sure what’s going on with that, only thing I can think is that it started when my period started. Who knows though.

Now that my period has started, I am starting the actual cycle. Friday morning I go in for baseline ultrasound and bloodwork, then I should receive my instructions to start stims that evening. So fingers crossed I have no cysts, a high antral follicle count, my lining looks good, and my estrogen level is okay. As long as everything checks out, and it should, we are cleared to start stimming!

IVF Starts With Birth Control?

InstagramCapture_7f72d7c4-3ec4-48c1-ad72-258cdf46d64bAs several people noticed last week when I posted the picture on instagram, the official kick off to IVF #1 began last Wednesday night when I took my first ever birth control pill.

I got some questions about that, both in person and online and figured this would be a great start to explaining how an IVF cycle works. Or at least, how my cycle will work.

An IVF cycle starts when your Dr decides the type of protocol you will follow. What this means is there are several different drug combinations that can be given, and choosing one is the first step in the IVF process. Your Dr bases the protocol you will use off of your diagnosis and/or response in previous cycles. The go to protocol for most women is what is called a long lupron protocol. It is most often the first protocol a Dr will try, despite your diagnosis.

This is the protocol I am being put on. One other thing to keep in mind is that each clinic has it’s own variation of a protocol. They typically use the same meds, or types of meds, but might use different dosages or start them on different days. It often even varies by patient. This is one of the more confusing aspects of an IVF cycle, as each woman has different instructions and different things she is taking at different times.

Anyway. To start a long lupron cycle, your Dr will start by putting you on birth control. This is to basically reset your ovaries and to help prevent cysts from forming. Sometimes it is also used to sync you up with other women at your clinic, as some clinics like to have everyone on the exact same schedule so that all retrievals and transfers occur around the same time period. My clinic is simply doing it to suppress any cysts.

So for the first time in my life I am taking birth control. Which is… odd? I will be on the pill from the 17th until October 1st, at which point I will stop taking them and expect a withdrawl bleed, or period within 3 to 4 days.

The next step of the protocol starts on the 26th when I will begin injecting 10 units luprolide acetate every evening. This will be one of the easier injections I do, as it uses an insulin syringe and is a subcutaneous injection. From there it will be getting more bloodwork and another baseline ultrasound on CD1 when my period starts and then I will be given the schedule for my stimulation, which should start sometime around October 5th or 6th. That is when the real crazyness will begin.

We’re A Go for IVF #1

After my last post, I decided to call the previous RE I had seen, prior to my most recent RE and after my RE from hell. Turns out they don’t regularly do local monitoring for a travel IVF cycle, but they were more then willing to do it for me. So this past Tuesday morning I made the long haul up to Beachwood at the ass crack of dawn, wait, before dawn to be there bright and early at 6:15 am for my date with Mr. Transvaginal ultrasound wand. After that I went downstairs to sit and wait for my blood to be drawn. I then made the hour treck south to work and waited for my call with my calendar and instructions. Except when that call came it was just telling me that while my STAT order for my ultrasound results had arrived, my STAT bloodwork had not.

Peeved I ended up having to call them this morning to get transferred to the lab customer service line to get them to call my results over. Which also means I have to watch my insurance like a hawk and make sure they don’t charge me for a stat order that wasn’t processed as a stat order. At any rate, all bloodwork came back good. I got the thumbs up to proceed with this cycle.

So. Monday I got my meds in, which when all sat out is really intimidating to look at:

WP_20140915_18_17_06_Pro

As far as the schedule goes, right now I am set to start birth control tonight and take it until the 1st, then start 10 units of lupron nightly from the 26th to the 5th.

Commence me freaking the hell out.

The Hunt for Local Monitoring

So. Here I am, 10-ish days from my first baseline ultrasound and bloodwork for IVF #1 and I STILL do not have somewhere local for my monitoring. You’d think this part would be easy. I have a local RE. Neither the ultrasound, nor the bloodwork require the RE. My IVF clinic will fax the order’s to them. My insurance covers this portion. All should be well. But it’s not.

jesse-pinkman-seriously

My previous RE recently left the office I was going to, and the RE I now have basically told me that since I am not cycling there they won’t do anything for me. Despite talking him into doing my HSG and my saline ultrasound (And after the fiasco that has turned in to, I’m not sure I want him doing it anyway).

While this sat as a draft I did hear back from the other hospital system and they will do it, but not at the facility 15 minutes from me. They’ll only see me at the facility an hour from me and 2 hours from work. Thanks guys.

So worst case, I can go there. Still waiting to hear back form the closer private clinic. I hadn’t gone there as they were a client at my previous job and that cold have been awkward. If they say no, not sure what I will do. Not sure I can push 3 hours late to work every other day for two weeks at work. Anyone else ever done a travel cycle and if so, how did you manage your local monitoring?