IVF Part One: Stims

Hello family, friends, and fellow infertility sisters! It’s the night before my IVF egg retrieval and it just occurred to me that I should write a blog post about the stimulation phase of IVF. I don’t know if everyone out there is as obsessive as I am about this kind of stuff, but once I’m tucked into bed every night I turn into a Google addict… I am pretty certain that I have read every blog out there about IVF and found the answer to hundreds of medication related questions via my iPhone. So, I am writing this, because I am assuming that there are other people out there like me that actually care to read about the nitty gritty details. If you aren’t considering or currently undergoing fertility treatment, WARNING you may be bored to tears reading this.

After Ben and I decided to move forward with in vitro, my doc put me on birth control to quiet my ovaries down so that we could a) minimize cysts and b) control the timing for my next menstrual cycle. I was on active pills for about six weeks straight. (TMI, but I was bleeding for almost three weeks in a row and terrified that I wouldn’t have anything left by the time I was actually supposed to get my period, but the clinic continued to assure me that breakthrough bleeding is normal in cases like mine.) I took my last daily desogen on October 26th and counted the next day as CD1.

Meanwhile, my $3000 worth of medications came in a huge cooler in the mail and I was overwhelmed sorting them all out, reading the instructions and warnings for each, counting out the needles, and cross-referencing my protocol calendar. I decided at this point that taking the process one day at a time in little bite sized pieces seemed like a good idea, because minimizing stress during this month was one of my top priorities and so I’ve had to make a daily conscious effort to not stress out too much. The clinic gave us a lesson about how to mix up and inject the meds, but it all went way over my head. Thank heaven I have Ben and his newfound EMT experience to depend on for all of that!

IVF Meds

Introduce Injection #1: Cetrotide

My very first injection was on my 25th birthday! My daily AM shot, Cetrotide, to keep me from ovulating naturally. The reason is because it would be dangerous for me to ovulate on my own after growing so many eggs and it would also ruin the timing for the retrieval, so yea. The injection was actually a breeze! Preparing the needle was a bit more complicated for a first-timer, though. I will say that I’ve never had a problem with needles and even “liked” getting shots as a kid, so I wasn’t ever too nervous about that part, but even I was surprised with how easily it all went. The only negative side effect from the Cetrotide was that the injection site swelled up a tiny bit, got itchy like a bug bite, and then went back down in less than an hour each time I had it.  I think that’s pretty normal, though.

First shot!

Pill #1: Folic Acid

For the entire cycle I’ll be taking 1mg of folic acid in the AM each day. Folic Acid is a key component of any standard prenatal pill, I think they are just taking extra precautions to prevent spina bifida in IVF babies by requiring a prescription strength supplement.

Baseline Ultrasound

We went in on the first day of stims for our baseline ultrasound to make sure everything looked generally good enough to proceed with the treatment. My lining was nice and thin at only 3mm, but I still had a lot of tiny follicles on each ovary thanks to the PCOS. This wasn’t necessarily a bad thing, but they did adjust my medications right off the bat to avoid hyperstimulation. I’ll admit that I doubted the doctor at this point a little. I thought to myself that I was willing to get sick and feel as bloated as I needed to in order to grow as many follies as possible… I was also extremely tempted to add a few extra drops of fluid to each injection! Thank heaven I sucked it up and followed the doctor’s orders, because it turned out that he did actually know what he was talking about and I grew plentyyyy of follicles even on half of the meds. Also, OHSS is no joke.

Injections #2 and #3: Gonal F and Menopur. To my understanding the two of these meds do pretty much the same thing, stimulate the ovaries. I started with Gonal F 225 in the PM everyday and then added Menopur 75 in the PM on stim day 3. I won’t pretend to know the difference. Supposedly Menopur is more “natural”. I actually read an article about how menopur came about from the PURified urine of post-MENOpausal nuns! Gross... I know! Something about the hormone levels in post-menopausal women and the risk factor of them not being pregnant. I’m not totally sure if that’s the story still today or if it is more lab-made now, but I also don’t want to really get into all of that. I will say that the Menopur burned going in! Not like terrible, but it definitely got me to wince each time. The Gonal F didn’t burn at all, but I think the needles for that one may have been slightly duller, because it felt like we really had to punch them through the skin more than the others??

By day 4 of stims the injections must have caught up to me, because I was SO TIRED. I slept until almost 10am… woke up and tried to be productive for a few hours… took a nap from appx 1-3pm… did the same thing again… and then went to bed early. This was kind of the schedule actually for the next few days. I figured that if my body wanted rest that I wasn’t going to fight it! I also developed a dull headache and felt bloated all of the time, but it wasn’t anything that would keep me from work or running to the grocery store or anything like that. I also got better at the injections and even did a few all by myself. I never mixed them alone though, Ben would take care of that for me and leave it in the fridge all prepped and ready to go if he couldn’t be home.

Day 5 I had another ultrasound appointment. The doctor asked me how I felt and I told him that I had expected to be more bloated by now. He literally laughed out loud and said “don’t worry you will be” ha! Doc counted 38 follicles at that appointment. 28 were growing, measuring between 10-14 mm and the rest were still just tiny. Uterine lining was at a 10.  He knocked my meds down AGAIN, cutting them in half. I was grateful and confident that my body was responding well to the drugs and excited for the weekend… in all six of my Clomid cycles I had never seen my uterine lining over 10mm and rarely saw more than one follicle growing over 10 mm, so this was a really great day for me!

I continued Cetrotide, Folic Acid, Menopur, and Gonal F through the weekend and came back for another ultrasound on both Monday and Tuesday.Tuesday’s appointment they counted a whopping 45 follicles that were all growing over 12mm! The biggest one measured 22mm and by then I could definitely feel that my ovaries were enlarged and I was bloated around the clock. My uterine lining was also continuing to grow, now measuring 15mm thick. I didn’t realize exactly how high my antral follicle count was until the doctor started referring to my ovaries as a world map and the clinic manager literally said “holy shit” when she read my paperwork! Doc warned me that with so many follicles at least half of them were probably immature and that I was still at high risk for OHSS, so I would need to be careful about that.

Snapshot of my ovary

I developed some cold-like symptoms (sore throat, stuffy nose, sneezy…) on this day so after my ultrasound I went straight home to rest and pretty much did that for the next two days in paranoia. Drank a lot of Powerade Zero and had a This is Us marathon with myself.

Introduce Injection #4 aka Trigger Shot:

Tuesday night Ben gave me my trigger shot, Ovidrel, at exactly 10pm to induce ovulation. We could barely keep our eyes open and I was emotionally drained after spending my last day with my sister, Shae, before she left to enter the MTC and serve an 18-month mission in Thailand, but the injection was super time-sensitive and had to be exactly 36 hours before egg retrieval. We were seriously BLESSED that the timing worked out perfectly for our retrieval to be on Thursday, because that was the only day that Ben was scheduled off. Since he is a rookie, time off is pretty much impossible to come by, so if it were Wednesday or Friday we would have had to do a frozen sperm sample situation… Much better that Ben can be with me and offer up a fresh (TMI I know) sample on the same day. Then I can tell my future kids that their dad and I were at least in the same building when they were conceived!

Today is Wednesday, day 10, and I am feeling very blah. I still have a cold and I think that’s giving me some anxiety about being in optimal health and whatnot. I can also feel my ovaries when I twist, cough, sneeze, or anything like that and have been tiptoeing around like the hunchback of Notre Dame all day. I’m really excited for tomorrow though, the big day! Even MORE excited for embryo transfer five days after that! While this process does make you feel a little bit like a fat, exhausted pin cushion, it has already been so worth it! Just knowing that my chances for success are exponentially more this month than any other month that we have been trying for the past three years is enough to keep a smile on my face day in and day out. I feel so much less stress this month and just overall trust in the process it’s actually been pretty fun! Fingers crossed for lots of plump, healthy eggs fertilized tomorrow and I will update ya’ll again after the procedure. xo mace