IVF Prime Time aka Sweet Talkin’ Those Ovaries

It’s week 3 (outta 5) of BCPs (birth control pills) and Monday I added testosterone patches (Androderm) and estrogen pills (I take estradiol, the generic of estrace) to the mix.  We are in: the priming cycle.

I look at it as time to stroke my ovaries’ egos.

“Look how pretty you are, little ovaries.  My you look nice today. Hey….how’s about some of this testosterone, it’ll make you feel real nice.  Oooo….have some of this estrogen….see isn’t that good. Wow, you are just the best little ovaries. I bet you could make lots and lots of follicles if I asked you real nice.”

Ew.

I just creeped myself out.

What is a priming protocol you say? Yeah, I had to research it myself.  There’s actually not a super ton of info on this online but I was able to find some – and, I’ll be able to ask some more questions when el hubbo and I go in next week to sign all the consent forms.

Here’s some info I found on Estrogen Priming Protocol (EPP) at http://estrogenprimingprotocol.blogspot.com/:

  • Like BCPs in longer IVF protocols, estrogen is used in EPP to down-regulate FSH receptors. By providing external estrogen, the hope is that the pituitary gland will think a follicle is developing (follicles produce estrogen) and will thereby reduce the amount of FSH (Follicle Stimulating Hormone) it pumps out. This “break” in follicular development give the ovaries a little time off at the spa, and allows the RE (Reproductive Endocrinologist, aka puppetmaster) to take control of the woman’s cycle. In addition, it will promote estrogen dominance in the follicular fluid, which is believed will help protect the developing eggs
  • EPP is an aggressive form of an IVF Antagonist Protocol. It is used for low/poor responders — often women with high FSH and/or over 35 years of age. It’s a sort of “slow burn” methodology — the hope being that they slow you way down and protect egg quality while allowing you to stim longer. In addition, the slower stimming allows the hope that all active follies can catch up to each other, allowing for as many mature eggs at retrieval as possible.

There’s less information regarding testosterone priming, but I did find the following posted on the forum page at fertilitycommunity.com – it is one woman’s experience with testosterone (and a bit on ganirelix, which I’m also using) and her RE’s information:

  • “…..my RE felt that our egg quality may improve if we could increase the amount of estrogen reaching the follicles prior to stims. Based on his research, there has been some success in increasing natural estrogen levels by using nightly testosterone patches. We also used ganirelix/cetrotide during the week before stims to ensure that no lead follicles developed (which would have deprived the remaining follicles of estrogen/stims). So we were tackling two problems at the same time – the testosterone was purely for quality issues, while the ganirelix (plus a higher dose of stims later) was designed to increase the number of eggs retrieved.” 

But that’s all the science. What’s the day-to-day like?

Last time I had no side effects from either the testosterone or the estrogen, and I’m expecting that’ll be the same again this cycle. The estrogen (estradiol/estrace) is a tiny blue pill that super easy to swallow.  The Androderm patches have a sticky surface and you just slap them on and leave ’em ……IN THEORY.

I’m not sure if I mentioned it last cycle, but those Androderm patches would not stay on my person all by themselves.  The first morning I woke up and that sucker was stuck to the sheets. The stupid little two-timer was already cheating on me. I had to use medical tape to tape it to myself, which is fine, except that when you take the tape off it leaves that sticky gross residue that dust and dirt and other crap just clings to.  So basically, I spent/will spend a few weeks having lots tape residue gunky splotches all over myself.

Not the sexiest….unless grundy Pigpen is your thing.

Also, I had more discomfort pulling off the tape every night to switch the patches than I did from most of the shots. Just sayin’.

I was told the patches can go on your belly, your thighs, your fanny can, even your back – just make sure to rotate them around so that you’re using a new patch of flesh over the course of the week – i.e. don’t use the same place twice in one week.

Alright, enough of this, I gotta get back to complimenting my ovaries.

“Hey there ovaries, ooooo damn, you lookin’ SO FINE.”

Yep.

Still ew.

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IVF2 starts with Birth Control, Brownies & Breaking Bad

So I’m on the ole birth control pills (BCPs) once again – and started last week pretty disappointed to learn that the doctor wanted me to do 5 weeks again this cycle.  I’d been super excited (like, SUPER excited, teenage-girl-might-get-Bieber-tickets excited….okay, clearly not quite that excited) when her assistant mentioned that I’d likely only need 2-3 weeks of BCPs this next go around.  And of course, since I’m Irish, I had a knee-jerk reaction, got ticked and emailed The Russian’s Right Hand (ala WTF?!) instead of taking a breath to think rationally. She was as patient as always, conveyed my concerns, came back with an answer….including that the doctor would move up the timeline, but it was not what she’d recommend.

Well of course I’m going to do what she recommends – but I did find out WHY the 5 weeks, because really, we all just want to know WHY any of these things are being done, right?

Essentially, I’m on a longer priming cycle to give the Androderm (testosterone) and Estrace (estogen) adequate time to prime my ovaries in hopes of producing a better response this next cycle…I am 42…lady needs some primin’.  When I asked about the lengthy time on BCP I mentioned that I was worried about over-suppressing my ovaries (something I’d picked up by surfing the interwebs) – well, turns out that the BCP don’t suppress THE NUMBER of follicles that are stimulated throughout a cycle, which had been my concern.

So, last week and this week BCP only, and starting the 19th I’ll be back on the Androderm patch and taking estrace orally once a day for 3 weeks, for a total of 5 weeks prep time…..WHICH SEEMS LIKE AN ETERNITY!

Tom Petty was totally right, the waiting is the hardest part.

With IVF #1, once I actually started stims things really flew, the 2ww even flew…..so I just gotta suck it up and make these next weeks fly by.

My husband was off visiting friends in Detroit over the weekend, so I was hunkered down with the dog, catching up on Breaking Bad before the premiere (which was….WOW) and being a little mopey….happens.  Anywho, I somehow got the urge to make a few dishes from my childhood to perk myself up.  I made a tuna/mushroom soup/peas & biscuits casserole that reeks of the 1970s but is very very comforting and nostalgia inducing. We literally only ever called it “That Casserole That Mom Makes.”

I also made a batch of brownies following the Better Homes & Gardens recipe that my big brother and I bastardized when we were kids:

2 Tbsp Cocoa powder**

1/3 cup butter**

1 cup sugar

2 eggs

¾ cup flour

½ tsp baking powder

½ tsp salt

1 tsp vanilla

**original recipe called for 2 oz Chocolate (Baker’s squares) and 1/3 cup shortening, but we grew up in a house that never had those items, but always had cocoa and butter

Heat oven to 350 degrees and lightly grease an 8x8x2 pan (glass if you have it)

Melt cocoa and butter together over medium heat.

Remove from heat and add sugar and eggs, beat on med/high for one minute (or by hand if you’re a kid and you’re trying to be quiet)

Combine flour, baking powder and salt – gradually add to cocoa/egg/butter/sugar mixture.

Stir in vanilla.

Pour into prepared pan and bake for 30-35 minutes.

Because of the substitutions these turn our a bit “blonder” than a standard brownie recipe….so likely will not please any folks who expect their brownies to be über fudgy – however these things are friggin chewy and delicious and I CAN’T STOP EATING THEM.

We head to NYC on Thursday for a few days of fun with my hubbo’s siblings and I’ll get to see a few of my besties as well, one of which is 5 months pregnant with her 2nd. I never saw her preggo with #1 so I’m excited, especially since she’s a tiny little thing and says she already looks real real pregnant, so it’ll be fun to see a short über pregnant lady who has a sassy mouth to boot.  (oof, that’s quite a run-on sentence…..don’t judge me). She knows what we’re going through and has been an amazing source of support.

So, at least the rest of this week should fly on by…..making it 2 down and 3 to go.

 

 

IVF Meds for Smarties and Dummies

So….What’s in the Box? (my day-to-day protocol coming once I have it)

IMG_20130607_111344_832 (1)

First, for the smarties:

Androderm – testosterone patches, potentially helps low responders or gals with high FSH (i.e. low ovarian reserve) to respond better to stimulating meds (taken for 2 weeks before starting all the stimulating hormones).

Estradiol – helps maintain the endometrial lining of the uterus, making a nice home for an embryo to implant

Follistim – mimics FSH (follicle stimulating hormone) in the body.  FSH tells the oocytes in your ovaries to grow and mature. (subcutaneous injection)

Menopur –  This hormone is responsible for ovarian stimulation for the development of egg-containing follicles. (subcutaneous injection)

Pregnyl – mimics the hormone LH (Luteinizing hormone) in the body.  LH is the hormone that triggers ovulation. (subcutaneous injection)

Ganirelix – prevents the usual hormone exchange that causes follicle production and ovulation by suppressing the pituatary stimulation to the ovaries.  This lets the Follistim stimulate a more uniform development of multiple follicles.  (subcutaneous injection)

Leuprolide – suppresses the hormones LH and FSH to keep a woman from releasing immature follicles and eggs. (surprise, also a shot)

Progesterone (in oil) – stimulates the uterine lining (endometrium) to continue to develop so that an embryo that implants will have a thick, supportive environment to nourish it.(intramuscular injection) – I’ll start this a few days before egg retrieval

Doxycycline – antibiotic, reduces the risk of infection following egg retrieval.

And,

a metric crap-ton of syringes and needles.

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Now for anyone whose head is exploding (like mine), look at it this way:

Some things help you make eggs, some things keep you from ovulating those eggs, and other things help you ovulate the eggs when The Russian deems them ready.

My REs assistant explained it like this:

In a typical month there’s a race where a number of follicles run, but a “lead” follicle gets ahead.  That follicle matures an egg which (hopefully) will ovulate. One egg. Per month. Some ladies might pop a few. Who knows.

Anywho, with fertility meds you get a number of follicles lined up in the blocks. They start running but instead of one getting way ahead and winning, a whole mess of follicles all join hands, sing Kumbaya, run the race in the spirit of fairness and good sportsmanship, and all cross the finish line together.  Meaning, many follicles produce many eggs that the RE, in my case The Russian, can retrieve.

At least that’s what you hope.

And then you hope that just one of those little suckers fertilizes, implants and then grows into something you will be terrified of birthing through part of your body that doesn’t seem like it will allow for those circumstances.

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Here are some websites I used in compiling this list.

http://www.conceiveonline.com/articles/7-most-common-fertility-drugs

http://infertility.about.com/od/infertilitytreatments/a/fertility_drugs.htm

http://www.ivf.com/ivf_meds.html