Vegas Under the Influence of IVF

I’m sitting at the Las Vegas airport waiting for my flight home to Chicago. I’ve been here since Tuesday and it’s been a really nice break slash bit of work.  Vegas has been experiencing quite a bit of rain and cloudiness, and it only seemed to be that way when we had free time, so alas I’m not coming home with a tan but I did have a great time. My best friend was coincidentally in town so we were able to have a mess of time together and who doesn’t like time with their bestie.  We had tapas, went to the pinball hall of fame, did bits in a 99cent store and ate too much frozen yogurt.  Quality. Time.

Tuesday night I stood in my swanky hotel room (again, it was a gig, so the room wasn’t on my dime) looking out over the glitzy, neon-laden strip and shot ganirelix into my belly.  This made me feel especially…..Vegas-y. Vegas is a place where I have historically been prone to participate in the big party while this time I’ve kind of put myself on lockdown.  So, I pretended that the ganirelix was a full on party drug and that I was super hardcore.  I know, clearly not p/c but I have a fairly active imagination and you gotta make fun where you can…especially when you’re shooting yourself up with fertility drugs in Sin City.

Sidenote – I put the syringe of ganirelix in the bin at the airport along with my note from the doctor figuring I was going to have to explain it.

They.

Did Not.

Blink an eye.

Am I wrong? TSA has stopped me and made a huge production when I’ve tried to go through with a YOGURT….but apparently needles are on the up and up.

Whatever.

By the way, I had to surrender that yogurt.  What a waste.

So on this gig I was with a group of folks and there was alot of “let’s get a drink”……which again is super cool, until you’re the gal who’s been known to drink and then suddenly without telling anyone has pretty much stopped drinking.  I had a small “skinny” margarita the pool, 1/2 a glass of wine at a bar and some sips of samples at a liquor tasting.  Talk about head trips – I felt guilty about all of them. However, The Russian told me within all of this that she believes patients still need “to live” and that as long as things aren’t in excess, it was fine.  So…I figure if this IVF doesn’t work it really would not be caused by a small skinny margarita, 1/2 a glass of wine and some liquor sips.

I just gotta let that one go and not sweat it.  And, that’s the last drinking I’ll be doing, hopefully for quite awhile.

Oh, I met Tom Arnold earlier today on the gig I was doing – could not have been a nicer, more accessible guy. I thanked him for his openness in the media regarding he and wife’s trip through infertility, adding that it’s such a support to the community.  We talked for a bit, he asked were I was with everything and wished me luck.  One of my colleagues nudged me later and asked, “so what were you and Tom talking about?”  I flat out lied to that girl.  I pulled something out of my butt about some movie of his that I liked.  Someday down the road I’ll tell her what the conversation was really about, but for now: lies!

I took my last birth control pill on Sunday night and got my period today, so I go in tomorrow morning for the first monitoring appointment of my cycle.

And then….stims for IVF #2 will start Friday or Saturday.

It begins.

Buckle up.

 

 

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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.

IVF Scans 3, 4 & 5 An Ambling of Tortoises

Three days, three scans – thank goodness The Russian’s office downtown is only about 20 minutes away (depending on what Lake Shore Drive looks like) and I’ve found a sneaky free parking scenario at a nearby grocery store that offers 90 minutes parking with purchase….I think you see where that’s going.  It’s Chicago, you learn to break the rules a little.

Following last Friday’s bummer scan I was very hopeful that Monday’s scan would a) show progress and b) be done by my regular tech.  I got both my wishes, was told I’d likely be on stims for a few more nights and to make an appointment for Tuesday, as The Russian was going to be in the office and wanted to have a look herself.  One change to meds for Monday night: done with the Lupron and adding Ganirelix – maintaining dosages of Follistim and Menopur.

Tuesday’s appointment (scan 4) with The Russian also went well, though there wasn’t much progress from the day before, the largest follicles were around 15.5 or so….but The Russian seemed happy enough and said “I think we’ll get 8-10, they just need a little more time to grow.”  How can I doubt The Russian?

I was asked to come back already today for scan 5, as we’re getting super close to hitting that lead follicle 18mm mark that signals time to trigger.  I was back with my regular ultrasound tech, who totally laughed at the way The Russian had taken her measurements and got down to business.  We’re looking at lots of follicles – likely to be 8-10 mature-ish for ER and a bunch of “little squeakers” as the tech calls them.  

In the end they’re having me stim again tonight – day 13 (lucky 13!) and I’ll go in again tomorrow, where likely a few of these little guys will have hit the 18mm mark and we can move forward.  I joked to The Russian’s Right Hand regarding the fact that these guys seem to be taking their sweet-ass time and she said that that’s just fine, as long as they’re growing and growing steadily, and that this (hopefully) ups the chances that the eggs will be healthier.

And to boot, I’ve been fighting one of those highly annoying summer colds. I’m trying not to take anything internally, even though they told me I could, it just seems like one more thing.  It’s not awful awful and it’s only a cold so it won’t kill me, and as long as it’s gone by whenever we do embryo transfer, it’ll be a win.  Two nights ago I DIYed the saline solution in my Neti Pot — oh the burn, y’all, the burn — imagine eating the biggest wad of wasabi and you’re close.  Last night and tonight I’ve been smearing on a mentholatum mustache – so sexy….so….so….sexy.  I also have some eucalyptus oil so I’ve been adding that to a bowl of hot water and inhaling the steam.  

I mean, I was doing way too well with the stims….feeling very few side effects – I pretty much asked to catch a little somethin’ somethin’.

So that’s that…..just sitting here chuggin’ along, full of snot, my abdomen host to a race where our contestants are  sauntering towards the finish line.  

Hopefully some news on next steps at tomorrow’s scan.

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