May 05 2011

IVF Part Four: Stimulation

Published by at 3:23 pm under Infertility,IVF,The Man

Stimulation is the phase of IVF where you are ramping up for your oocyte retrieval. It’s where you use some of those drugs you’ve been accumulating to kick your ovaries into overdrive (but not TOO far into overdrive) so that you’ll hopefully have a bountiful harvest on the day you go in for retrieval.

Day one of stimulation for me was jam packed with excitement. For one thing, I had to have an ultrasound and bloodwork done in the morning. And my RE’s office is oh…two hours away. And I had to be there between 7:15 AM and 8:15 AM. That means The Man and I got up at 5 AM and hit the road at 5:30, all so we could spend 30 minutes in my doctor’s office and turn around and drive back home. When we got home, my last shipment of drugs (which contained all the ones I needed that very day) was waiting for me on the porch, so that was a big relief…until I opened it up and was confronted with needles that were about three times the size I was expecting. Most of the drugs for stimulation are taken subcutaneously (meaning under the skin, meaning little needles). What I had were big honkin’ needles for drugs that had to be delivered intramuscularly (which I would need later, but not now). When Kris called to tell me that the results of that morning’s tests indicated that I was good to go and could start my stims that night, I asked her about the needles, and she said yes, those were the wrong ones, but I could go to any pharmacy and get the right ones.

Let me tell you, that turned out not to be the case. First of all, we went to Walgreen’s, simply because it was handy. When I told them what I wanted, the pharmacy tech collared the pharmacist and like…at least one other person, and they went on a manhunt (or needle hunt) for about ten minutes. And THEN they came back with six syringes and were like “This is all we’ve got, and we have nothing in the other size you also need”. They advised us to try Wright and Filippus, which is a medical supply store. So, we drove across town to this medical supply store, only to be told that they are the kind of medical supply store that deals in braces and CPAP machines, not syringes. I was starting to get desperate, because it was 3 PM and it’s not like I had an unlimited amount of time to dork around looking for syringes. The nice people at Wright and Filippus advised us to try Healthway Pharmacy, a little compounding pharmacy that was located on one of those side streets that no one hardly drives down because it is all medical specialists. We got to Healthway and when the woman at the counter asked what she could do for me, I blurted out “I have injectable drugs that I’m supposed to be taking tonight, but my mail order pharmacy totally sent the wrong size needles and we have been looking EVERYWHERE for the right ones. Do you have syringes here?” And she said “Oh man, that is terrible! We DO have syringes. What do you need?” And ten minutes and nine dollars later, I had new syringes.

So, for the first five days of stimulation, I was taking 150 units of Menopur and 150 units of Follistim. The Follistim came with a pen that allowed me to insert the cartridge and then use a dial on the unit to select how large of a dosage I had to take. The Menopur was a little more complicated, since I needed to mix a sterile liquid with two different vials of powder, mix it all up, and then put an injection needle on the syringe. I don’t want to get into too much detail because I don’t want this to be a “how to mix your meds” post. If you don’t know how to mix your meds, CALL YOUR DOCTOR. Mine gave me step by step instructions from the drug company telling me precisely what I had to do to prep. It really helped that The Man was with me, reading out the instructions so all I had to do was get the drugs ready, and not switch back and forth between doing something and reading the instructions. He also handed me the things that I needed, like ice and alcohol swabs.

The last part of taking the drugs is obviously doing the injection, and of course this is the part that worried me the most. I, like most people, am not fond of needles, even tiny ones. However, the worst part of the whole thing was just psyching myself up to actually do it. Once I just took the plunge, so to speak, there was absolutely no pain. I didn’t even feel anything. I did use a little ice beforehand, and that may have helped.

On the sixth day, my Follistim dose was upped to 225, and I got to add a new injection to the mix: Ganirelix. This one, I was told, had to be taken at precisely the same time every day. Therefore, I now had two alarms set. There was one to tell me to do my Follistim and Menopur, and to take my prenatal vitamin, and another one to tell me when to do my Ganirelix. We also moved down to the hotel on day six, since this was when the doctors appointments went to every other day. It was either get a hotel or get up at 4:30 AM and drive for two hours every other day (and eventually it would be every day). With gas prices around $4.10/gallon, this was not a tough decision.

The other part of stimulation is the doctor’s appointments. They started me out slowly. I had to go in on day one of stimulation, and not again until day four. Then I had to come back on day six. Then, on day eight. After that, it was every single day until retrieval. The appointment consisted of a transvaginal ultrasound and a blood draw. They wanted to make sure that my ovaries were being stimulated enough, but not TOO much, and that my hormones were staying within acceptable levels. (On day six, I was told that my left ovary “had kicked in”. I guess it was a slow starter.) These appointments all take place between 7:15 and 8:15 AM, hence the second reason we moved into a hotel two blocks from the doctor.

On day 7 I started noticing…not cramping exactly, but more of an uncomfortable feeling in my abdomen. By day 9, this was more pronounced and also constant. One of the nurses told me to start drinking more fluids (anything non-caffeinated) and two or three protein shakes per day. She told me this would not only help with discomfort but also help to stave off ovarian hyperstimulation. I like chocolate quite a bit, so I chose Boost High Protein Shakes in the chocolate flavor (15 g of protein each). They were relatively tasty and it was good to know exactly how much protein I was taking in without having to check serving sizes and labels of all of the regular food I was eating.

One part of stimulation that was rather nerve-wracking was that, as I started getting to the end of my stimulation period, my drugs of course started running out. My doctors ordered for me the minimum amount of drugs that they believed I would need, to help prevent us from spending money on unnecessary drugs. However, since my dosages were increased on two of the drugs I used (Follistim and Menopur) partway through stimulation, I didn’t have enough drugs to make it to the end. But whenever I called Kris to find out if I should order additional drugs, she told me no, she would give me enough to get me through to the end. She did not want me to spend more money on drugs. This was, of course, HIGHLY appreciated by both me and The Man. I’m not sure if this is normal behavior by IVF clinics, but what I read on the internet leads me to believe that it is. There are several anecdotes online detailing free “tide over” drugs being given out by clinics and doctors.

I was initially told that stimulation would last for anywhere from 10-12 days. On day 10, my daily ultrasound was conducted by Dr. Singh, who wanted to see personally how I was progressing. That afternoon, I got a call that I was to take my HCG or “trigger” shot that night at 7:30. This marked the end of my stimulation – the HCG shot is meant to force the oocytes into their final maturation. Retrieval takes place 36 hours after the trigger shot is administered.

I was nervous about the HCG shot for two reasons: it is an intramuscular shot, so it is given with a much larger needle, and also The Man was going to give me this shot because the location for the shot is in the “upper buttock”. The ultrasound nurse, Michele, drew us a bulls eye so The Man wouldn’t have to guess where the shot went. I laid down on the bed in our hotel room, he numbed the area a bit with some ice, and then I felt a tiny poke…that was it. I really had no idea that it was over until I asked him.

The next morning, we went in for another ultrasound and more bloodwork, and we got our “final instructions”, which meant we were ready to go for retrieval.

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

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