Additional needling

Ganirelix is used as part of a treatment program for certain fertility problems in women. It is generally used in combination with other hormones (FSH and hCG). Ganirelix works by blocking the release of a certain hormone (luteinzing hormone). It helps delay ovulation and increases the chance of producing fertile eggs. 

Side effects for this drug include: Redness or pain at the injection site, headache, mild nausea/stomach pain and tiredness. This medication may cause a condition known as OHSS, this condition may occur during or after treatment. Rarely, serious OHSS causes fluid to suddenly build up in the stomach, chest, and heart area. You should seek immediate medical attention if you develop the following side effects: severe pain or swelling in the lower abdomen, severe nausea/vomiting, sudden/rapid weigh gain, change in amount of urine.

 

Menopur Day 6: 1 ml saline solution dissolved into 2 vials of Menopur powder (150)

Follistim Day 6: 300 iu injection

Ganirelix Day 2: 1 syringe (.5) This drug is also quite simple to inject, it comes ready to go. The medication is in they syringe with the needle attached. All you have to do is wash your hands, use an alcohol swab to clean the injection site and then insert the needle making sure to only inject the amount prescribed by your doctor. 

Follie Check

 After 4 days of injecting medications I had an appointment to see how things were going. Dr. W found 10 follicles growing at about the same rate. This is a good thing. :) It is hard to see the numbers but my right side is listed first with the measurements for each follicle followed by my left side. Seems that they are pretty even with each having 5. I also got my blood drawn to check hormone levels.

Dr. W has decided to increase the dosages of my injections
Menopur Day 5: 1 ml saline solution dissolved into 2 vials of Menopur powder (150)

Follistim Day 5: 300 iu injection

and we have added a third injection

Ganirelix Day 1: 1 syringe (.5)
which will be taken 12 hours after the other medications (I will intro this drug tomorrow)

Just a prick

Menopur Day 4: 1 ml saline solution dissolved into 1 vial of Menopur powder

Follistim Day 4: 225 iu injection

Subcutaneous Needling

Menopur Day 3: 1 ml saline solution dissolved into 1 vial of Menopur powder.

Follistim Day 3: 225 iu injection

Don't let the name fool you

there is a needle in that pen!

Like Menopur, Follistim is a follicle stimulating hormone. It is a man-made form of a hormone that occurs naturally in the body. This hormone regulates ovulation, the growth and development of eggs in a woman's ovaries. It is used to induce the development of multiple follicles. Follistim has a slew of possible side effects as well: headache, mild numbness or tingly feeling, runny or stuffy nose, sore throat, acne, skin rash, pain in the lower stomach, nausea, vomiting, bloating, feeling short of breath, swelling in hands or legs, weight gain, urinating less than usual. If any of these symptoms are beyond mild your doctor should be contacted immediately. 

Menopur Day 2: 1 ml saline solution dissolved into 1 vial of Menopur powder.

Follistim Day 2: 225 iu injection. Injecting Follistim is easier than Menopur because the solution is already prepared. The Follistim pen twists apart and you load the cartridge of medication. Prepare the injection site by using an alcohol pad. On the bottom there is a window which shows how much medication you are injecting, you turn the yellow dial till the desired dosage is in the window. Uncap the pen and attach the needle, then insert the needle and push on the bottom of the pen until the window shows a 0. Follistim has to be kept refrigerated, I took it out about 25 min before my injection time and immediately put it back into the fridge.

And we meet again

I am no stranger to Menopur and its ways. 

Back when we did IUIs #4, 5 & 6 Menopur was one of the medications I was on.

Menopur contains follicle stimulating hormones and luteinizing hormones. These hormones stimulate healthy ovaries to make eggs. Like all drugs there can be side effects such as: OHSS, headache, stomach pain, hot flashes, bruising or redness at the injection site, it may cause you to become pregnant with 2 or more babies at the same time and other serious health problems which are rare. 

 

All injections must happen at the same time each day so I had to pick a time that I could be extremely consistent with before beginning any injections. 

Menopur Day 1:  take out sterile needle and draw 1 ml of saline solution into the syringe then inject the saline into 1 vial of Menopur powder, once mixed draw up the mixture into the syringe making sure to tap all air to the top. Change the needle to a 27 gauge and push the air out of the syringe. Prepare the injection site with alcohol wipe then inject the mixture into your upper thigh or abdomen. Cap the needle and dispose of it in a sharps container. 

Follistim Day 1: 225 iu injection (I will intro that drug tomorrow)

Delivery

My drugs arrived packed in an ice cooler with some of the medications being strapped to ice packs as a few of these must remain refrigerated  These should last me for a month. As I begin to use each type of drug I will explain what it is and why I have to take it. But for now realize that this is a lot of drugs which cost a ton of money! Get ready to strap on your seat belt folks we are in for quite a ride. 

Check-up

The week following my surgery I went in for a check-up. Dr. W did a sonogram to check and make sure that everything was still looking good in my uterus as well as making sure I didn't have any cysts on my ovaries.

We got the all clear to proceed with treatment!

Vials of signatures

In the 2 days following my surgery we had to finish up some additional testing and get all of our 30+ pages of paperwork completed and notarized before moving forward with treatment.

Surgery Day

We woke bright and early to get ready for my procedures. I was told not to eat or drink anything past 10pm the night before. I was uneasy about being put under (the last time I was given anesthesia I was 16!). We got all checked in and sat down to wait, and wait, and wait (always feels so much longer than it actually is). They always have HGTV on in the lobby so it was good that we also brought our ipods to take advantage of the wi-fi.

The nurse called my name and I said see ya later to Paul then followed her into the back. I was asked to change into one of those adorable hospital gowns and then to go empty my bladder. They got me all set up in the procedure room and the anesthesiologist  found a vein right away and got my IV all hooked up. Once Dr. W came in I was told to take 3 deep breaths -- and that is the last thing I remember.

As I slowly came out of it I shifted onto another bed that was wheeled in next to me and then taken to recovery. I was still quite groggy but awake enough to realize how insanely dry my throat was. I was offered some water or apple juice and I drank it down fast. I was parched! It was like I couldn't get enough liquid in me fast enough. Paul was brought in to sit with me for awhile while I woke up a bit more and they made sure my vitals were stable. Because my fingers were so cold the alarm on the heart rate monitor kept going off saying my heart wasn't beating enough.

Finally I was given the all clear to head home with pain killers and some individual heat packs. We got home and I sprawled out on the couch for pretty much the remainder of the day other than getting up for a drink or some food.

My soreness lasted a few days and the bleeding continued on... as I was beginning a "new" cycle since I stopped the BCPs the day before, even though I had just gotten my cycle a couple weeks before. Fun times :/

We were told everything went well and even given some photos of the procedures.

Prepping

As I mention Dr. W said at our consult that our best chance to conceive meant I should have a Hysteroscopy and a D&C to clear everything out. To prepare for these procedures I began taking Doxycycline an antibiotic twice a day for 3 days.













The day before the procedures I also took 2 Misoprostol in order get my body ready for the procedures. I stopped taking my birth control as well.

Square One

A couple more weeks after our consult I finally started a new cycle. This was it -- we were starting!


I called HRC and spoke with Nurse G to let her know. I was instructed to begin taking birth control the following day, the first of 10 days.










Of course in addition I am also taking a prenatal, folic acid, DHA, fish oil, baby asprin and iron.

Counterproductive

It is comical the looks I get when I say before you start IVF you are put on birth control pills. 
Yes, I realize it sounds crazy and counterproductive... 

From a fertility blogger who summed it up quite well,
You’ll be on birth control pills from 14 to 21 days. Taking these may seem counterproductive, however they do an important thing. They help get your hormones under some kind of exact control in the cycle just before your actual IVF cycle. Using them has proved to also reduce your chances of Ovarian Hyperstimulation and ovarian cysts, therefore increasing your chances for a successful IVF.  As mentioned before, not all women will be given birth control pills.  An example would be a patient with a lower ovarian reserve (fewer eggs).

So, now you know that it helps to time the IVF cycle, get hormones in check and possibly help OHSS to not happen. 

Consultation

A couple weeks later we headed back to HRC for our consult with Dr. W. He reviewed our chart with us, talked about options, told us he felt we had a good chance at becoming pregnant and then did an ultrasound to check out my innards. Since Dr. W was so positive about our odds, had all the correct credentials and great statistics we decided to move forward with this clinic. 

Dr. W said that my ovaries looked good but that I had ‘debris’ and tissue in my uterus. He explained that if we wanted to become pregnant that we would need to take care of this issue. He said our best chance was for me to have a Hysteroscopy and a D&C to clear everything out. I was instructed to call the clinic as soon as my next cycle started. I was given prescriptions for an antibiotic and birth control pills. We were also given 30 pages of legal paperwork and some orders for tests that would need to be completed before beginning the IVF process. 

We have been at a stand still for so long that it felt like we were boarding a bullet train with all of the information and instructions we were given.