Day 8

Another day closer, and it's all I can think about. Today I was back for more blood work and an ultrasound scan. I lost track of how many follicles they measured, but the biggest two were 17mm. Now I wait for the call. I'm trying to busy myself with work, but I'm tired and uncomfortable. I'm lying on the couch with my laptop, but still… It's lunch time so I could justifiably get up and make something to eat. I feel guilty about how unproductive I've been this week, but I'm just so tired. I sleep really well, and feel great in the morning, it's the afternoons that are the worst. Also, the injections are getting harder not easier. The Puregon is pretty easy still, but the Menopur burns more each time, and the Orgalutran seems harder and harder to get in. 

6 days in...

I've taken my 6th day of shots today. I am officially feeling like a human pincushion. Also, I found that the thicker tummy flab is more comfortable than grabbing a thinner spot a little lower. Maybe that's why there are so many different experiences with these shots, it depends partly on our adiposity. I have enough to go 4 more days but I really hope it's only 3. Yesterday I started to get a little uncomfortable. Today, I am officially uncomfortable. Especially on the left, which is weird because while the follicles are pretty close to even on both sides, the biggest one is on the right by 2mm.

Yesterday was my second monitoring scan. At my first, 12 antral follicles were counted (7 on the right and 5 on the left). Yesterday, on my 5th day of injections, I still had 12 follicles, but 6 on each side?! There is one bigger one on each side, measuring 13 & 11mm, and then 5 on each at roughly 8mm. But that was yesterday and they grow on average 2mm per day, so when I go back in for monitoring on Friday, they should each be 6mm bigger. So that explains the discomfort, and I just expect it to get worse over the next few days as I count down to trigger. It reminds me a lot of the discomfort of late pregnancy, ironically. Also ironic, I've lost 5 lbs in 3 days while on these injections, but I'm so bloated and uncomfortable I can't fit into anything anyway.

Jelly Belly

Good ole belly fat - finally you come in handy! Today is the second day of IVF injections. Each day, so far, is two needles in the belly. The anticipation is worse than the shot, and as the days go by that should improve too. At 4pm I get out my gear. I lay out all the bits and pieces for each of the two shots. First I do the Puregon 225 units - my FSH shot. That's easy, it's a preloaded injection pen, I just attach a fresh needle, dial it up to the right dose, and jab away. Second is the Menopur, 1 vial - FSH/LH combo shot. That one involves mixing and I swear I spent 10 minutes fussing over an air bubble in the syringe. It also has the reputation for "burning" but it's really mild. I'd say yes they feel different, and if I had to characterize one as "burning" that would be the one, but I expected worse. So jabbing myself with needles every day is not as scary as I thought. 

Fun facts: Menopur is made from the urine of post menopausal women. Rumour has it they could be Italian Nuns. Before you start cringing, basic hormone replacement therapies are made from horse urine. The Puregon is vaguely described by Merck Pharmaceuticals as "produced from mammalian cells". Is the mammal in question a protected trade secret? Is it multi-mammal, like a 100% "meat" hotdog? I don't know. I'm not sure I want to know. All I know is it's bloody expensive. Roughly $2400 for 10 days, vs $750 for 10 vials of Menopur. I guess urine is cheaper than mystery mammal.

Last day, next step

Yesterday was my last birth control pill. I had an ultrasound on Thursday, and everything looked good, ovaries were "quiet" and endometrium was thin. We're one step closer! I feel a bit like getting ready to launch a space shuttle. I'm not sure where in that analogy is "lift-off", maybe my first FSH injections? Last Thursday was like the "all systems ready" green light, and next up is the clear weather forecast.

I took my basal body temperature periodically through this birth control pill stretch, and it was very "luteal" which tells me my progesterone has been holding steady, so now I'm just waiting for it to crash back down. Should be interesting to temp throughout this cycle, but then I won't know if I'm pregnant because I'll be on supplemental progesterone after retrieval. As the day gets closer, I'm nervous and excited, and very very hopeful!

Countdown!

There are so many milestones along this IVF journey, and today I'm getting excited about the next one - the end of the oral contraceptive down regulation. Bright and early, two days from now, I will have an ultrasound to check and make sure I don't have any cysts. It's the next step to beginning medication injections, which could start in as little as a week! I'm just so excited I want to bounce off the walls! The next few weeks will be like a child counting down to Christmas!

The hormones...

One week into my birth control pill protocol, and I feel horrible. My boobs hurt. I'm really irritable. I'm tired. Yesterday I was nauseated. It's everything of a luteal phase, but without the "yay, maybe this is a pregnancy symptom". I took the pill for about 10 years, and I don't remember any of this. Maybe because I took it so long I don't remember. Maybe because I was pretty young when I started (17-ish?). You know what is ironic? I've had these luteal symptoms for about 4 years. I call it "four years of morning sickness and feeling like I'm pregnant". I didn't remember feeling any of it before I really was pregnant, but maybe I just didn't know what it was. When I was pregnant, I remember thinking, hmmm, this morning sickness is a lot like what I've been calling "migraine" for most of my life because it was a nauseous dizzy headache. Although sometimes it is vertigo too. All very hard to differentiate. Until I started tracking my cycles trying to get pregnant, and lo and behold, it was progesterone! So I went to my doctor for some tests, back before I was actively trying to conceive complaining of these symptoms to my doctor. First off, he didn't believe I wasn't pregnant. Second, and this is why I went when I did, I also had intense pain around one kidney which he was convinced was an ectopic pregnancy. Turns out it was a UTI, even though I didn't have any symptoms. But the progesterone symptoms didn't go away. The doctor suspected it was cyclic (because I said it was) and offered to put me on birth control pills. His reasoning was that it was ovulation related symptoms. Which it was, just not the act of ovulation. Birth control pills work by disrupting the endocrine system and often it's just by tricking your body into thinking it's already pregnant. With progesterone. That is what inhibits ovulation naturally happening again within a given cycle or when you actually are pregnant. So I have to say, I'm not surprised that the symptoms of birth control pills are the same as the sucky feeling of early pregnancy or luteal phase in general. Long story short (too late)… I can't wait for this part of the protocol to end.

I have also answered the question of why birth control pills, and what role they have in an IVF cycle. The goal is to make sure the estradiol level at the beginning of the stimulation cycle is low. There is no consensus on how low it should be, my clinic likes it under 200, and the birth control pills for a few weeks will do that. There seems to be some debate about the importance of a further GnRH antagonist for a few days before FSH shots start, but I need to do more reading on that. The argument is that a further few days of Lupron or something like that to manipulate the pituitary improves ovarian response to the FSH, but that probably depends on the individual. It's not about quantity, it's about quality, and 4-6 good quality eggs is what my clinic wants. I read a study that found outcomes were best if 6-15 were produced, any more or less and the success rate was not as good. I don't remember if the outcome was clinical pregnancy or live birth, I suppose I will have to look it up and post it here.