Rockets, sky diving, and other tidbits

To say that the infertility and IVF journey is a roller coaster ride is an understatement. It really feels more like rocketing to the sky when it's a good day, and plummeting down as if you're sky diving on a bad one.

As a low responder, my first ultrasound after 4 days of stimulation brought me to new highs last Sunday. I was told at a previous baseline ultrasound that my antral follicle count(AFC) was only 8, thus leading to my aggressive antagonist protocol and max drug dosage. At my first ultrasound after stim, my AFC shot up to 22! Although this was not a promise that this many follicles would mature and the same number of eggs would be retrieved, I was ecstatic. To my dismay and sudden drop from ecstasy, two days later at my second ultrasound session, there were only 3 measurable follicles. (Along with 15 smaller ones.) I tried not to lose hope, but being shot up with crazy hormones, it was difficult! My solution: stuffed my face with pizza and chicken wings.

This didn't end my obsession to google every number, every outcome, and every detail I have about my  cycle. So to put my obsession to good use, here are some useful information that I've gathered.

My previous reading on Antral Follicle Count lead me to believe that having more was good, and that it gave me a better chance at retrieving more eggs:

Experience, however, tells me that your AFC will vary. I've read cases of girls having a AFC range of 6-25. Having a low AFC will likely mean you will get less eggs, but having a higher AFC doesn't guarantee you a basketful either... 

Your follicle count at ultrasound usually begins, 4-7 days after you begin your stimulation. From my excessive googling, I've read cases of girls at certain clinics where monitoring doesn't even begin until day 7, or some that will start as early as day 1. From what I've read in general, REs expect your follicles to gain 1-2mm per day while on your drugs. It needs to get to >15mm for them to get really excited. Having a good size follicle again, does not guarantee that it will contain a mature egg. There is a possibility that an immature one can be prompt to grow in the lab, but overly mature eggs are not good. Therefore, consistent and good size follicles are what we like to see. But the human body works in funny ways. 

At my day 7 ultrasound, only follicles >9mm made it to my chart, and I had 3. This does not seem to relate to my AFC of 22 at day 4 scan whatsoever! What else can the infertility gods throw at us?

Yes, the dreaded E2 number. Too low and you're not responding well, too high, and you're at risk for Ovarian Hyper-stimulation Syndrome (OHSS). Although low responders, meaning ladies with low ovarian reserve, are not at too much risk for this. OHSS also doesn't happen until the trigger is administered and will get worst if the transfer leads to a pregnancy. (Yes I googled that too.) A bit of bloating though is normal, as I've been feeling super bloated.

For low responders, just getting to egg retrieval is a big deal. It involves a lot of trial and error to find the protocol that you respond to best. Then, with a bit of luck, maybe we get a few to put back the oven. I've been talking to my follicles and begging them to grow. I'm not out of the woods yet... 

Ever wonder what a tummy looks like after 8 days of injections?

You would think that I would have had enough needles to last me a century... but I went in for an acupuncture appointment today. Studies have shown pregnancy rates to increase with acupuncture on the day of the egg transfer. (Studies have also shown no change in pregnancy rates with acupuncture!) Yes, it is a controversial treatment and it's not for everybody. My appointment gave me a taste of what acupuncture feels like and if this is something I would want to do on my ET day. I must say that I am skeptical. However, if there is a possibility of better success, what's there to lose? (Except hard-earned money.) I won't ever be able to say, I got my positive because of acupuncture. BUT I won't ever have to think, I could have gotten a positive if only I had done acupuncture.

Ready Set Jab! First day of Stimulation

The much anticipated Aunt Flo arrived 2 days early~! Whoohoo! I've never been so excited to see it come early. So, I'm starting my stimulation schedule and my retrieval could be just less than 2 weeks away! (Fingers, toes, hairs, eyes, everything crossed!) Number of days that I will need the injections will depend on how I respond. When the ultrasound/bloodwork shows that I am ready, I will take a trigger shot, and 36 hours later is the egg retrieval. The transfer will depend on how many we get and how many was fertilized. Also, we signed up for taking the embies to day 5 if possible. The RE said this will up our chances to 50% for transferring two day 5 embies. Wowzers!

Now let me share some insights on the Puregon pen and the Repronex injection:

This is the Puregon pen process

I just love it love it love it! It's so easy and pain-free. You buy these cartridges and they come in amounts of 300, 600, and 900. The nurse shared with me that each cartridge actually has an extra 100iu of medicine in it! Plus, they are the same price per unit. (Meaning, the 600 is double the prices of the 300 etc...) This is awesome because you actually get more for your money if you buy the 300iu. This just works very well in my case because I am on a 400iu dosage, which means I just use 1 cartridge per injection! Ask your clinic next time if you are using puregon to see if you can save money by working it out. (You may have to jab yourself twice though, if you have to change cartridges in-between...)

I'm just joking... Don't jab your dog... (Ooops I got caught... And there's actually no needle in that, don't panic or call the animal abuse centre)

Here's Puregon's great website with video instructions on using the Puregon pen: Puregon Pen Instructions

Now that you know how to use a Puregon pen, go ahead and have some fun and jab something!!

Here's the Repronex Preparation Process

It's not an instructional video or whatever. But it's just a quick glimpse. I'm actually missing a step where I get 1mL of the diluent from the grey vile and inject it into the purple vile (this is the vile with the medicine). And the in the third picture, I get all the mixed solution back into the syringe. This is easier with practice. It's not as easy as the Puregon but it's not rocket science! 

Some stuff that's helping me survive injection:

- ICE!!!! Ice the area of injection for like 10-20 seconds before you do it. (Also clean the area with your alcohol swab after you do ice it.) It reeeeally reduces the pain and I can't even feel the needle going in. (Injecting the stuff is another issue of course)

- Inject SLOWLY... And try not to be shaky... I couldn't stop shaking and I ended up with a little bruise...

- Drink lots of fluids! That's what the nurse told me anyway!

- Blame everything on the injections. (You can basically get away with anything!)

My Jab Schedule:
Nov 23 - Nov 26 Daily
 1. Puregon 400iu / Repronex 75iu @ 5:30pm
 2. Decadron pill @ bedtime

Nov 27
 First Ultrasound and bloodwork appointment

Now, hopefully the side effects are minimal and I won't be crying every 30 seconds or breaking everything in my house. More updates later!

I NEED my syringe NOW (I swear I'm not a drug addict)

Today is the first injection of my Orgalutran (250ug/0.5mL). Of course I was all excited as I gathered the goodies and arranged them neatly on my desk.

Hmmm I feel like I've forgotten something...

And of course it's the good 'ol ice cube to numb the area. 

Yeah the ice cube is just a precaution. You jab-veterans don't laugh at me now. I am a noobie. 

Injections for Dummies (And those with needle phobia)

Areas of choice for injecting Orgalutran

OK so... injection area this time lower tummy as seen in this wonderful diagram.
   Step 1. Wash hands - check
   Step 2. Cleanse area with alcohol swab - check
   Step 3. Unwrap syringe/Remove needle cap - damn it we can't inject with the cap on? check...

I couldn't help but upload an eerie picture of the syringe...

   Step 4. Carefully push the syringe upwards so that a small droplet appears on the end of the needle - OOPS! you'd think that I was reading directions when I was doing this... Yeah, I forgot to remove the air bubbles....
   Step 5. Pinch the area under the tummy where you will inject. - Mmmm my fat rolls come in handy
   Step 6. Hold syringe so needle is close to skin
   Step 7. Keep holding it for 5 minutes because you are too chicken to jab
   Step 8. Just do it already!
   Step 9. POKE... Ouch, scream, cry, whatever... Inject and hold it there for a few seconds after to make sure all the medicine is in.
   Step 10. Remove syringe and press down with a tissue.

There, I did it! That was easy and didn't take me 10 minutes... sure....

Here's me posing for the camera... (You wonder why it took me 10 minutes..) Come on, it's a memorable experience!! I have to document it!!

Until next time!!! Which is precisely tomorrow November 19, 2011 at 10:00 am, which is when I will say, I NEED MY NEEDLE!

 

Mr Penguin: Oh yeah we totally conquered that one!

Christmas in a paper bag (or two)

Today was my BIG day! I finally picked up  my meds and had the injections 101 talk with my nurse. The whole experience was very pleasant and the nurses and doctors are just so nice!
I was unsure about what and how much stuff I was actually going to be picking up today so I showed up in front of the pharmacy counter, said hello to the friendly pharmacist, and said, "I think I'm suppose to be picking up something here." Of course, she gave me a big smile and dug out 2 big lovely white paper bags filled with pointy goodies. Was it that obvious that I'm a first timer?

How exciting~~~!!

The pharmacist then took out each and every single item, telling me what they are. Then of course, it was time for the bills... Ek! Let's ignore that. (What credit card debt?) She also introduced us to our nurse and she took over from then. 

The nurse took us into a room and gave me my lovely jabbing schedule and walked through each injection with me. Just when I thought I was home free, she asked me to do a mock-jab (is that even a word?) just so I know how it feels and that she can see I am doing it correctly. (Uh oh!!) Pinch, jab, and inject, she says! (Let's hope I don't pass out) In the end, that was a bit unexpected but it turned out lovely because it actually didn't hurt as much as I thought it would. 

So my schedule starting Thursday: 

- Estradot patch every other day until CD1

- Orgalutran starting Friday morning for 3 days (Just 1 jab - easy peasy!)

Then the real deal: stimulation starting next CD2

- 400iu Puregon daily

- 75iu Repronex daily (Jab jab - at least I can alternate sides!)

CD6

- U/S and Bloodwork

- Start Orgalutran again on top of Puregon and Repronex (JAB JAB JAB - aaaaah! I'll be wishing for more jab-able surface area!)

As weird as it might sound, I was a kid at Christmas when I got home, dying to rip open my present. (A very expensive present, mind you!) 

Ahhh I couldn't wait to get my hands on these~ 

Now I'll have an excuse to be nasty! :p

So, I've added a reminder on my iPad everyday I have to do a patch or injection. Like I'll need it though! I'll probably be sitting next to my iPad with a needle in my other hand, waiting for the alarm to go off, then it's ready, set, JAB!!!!! Me talking about the burning sensation from the Repronex will be the highlight of the evening at the next gathering. Prepare to smile and nod while I bitch about everything~ You've been warned! :)

We are not alone (and I don't mean aliens)

I've been trying to stay positive since we began. It is hard sometimes, I must say. I guess most people my age isn't dealing with when they will ovulate or looking forward to daily injections. (Unless they're drug addicts maybe but I don't hang around those types of course!) Heck, most people my age are probably doing the exact opposite of what I'm trying so desperately to do, which is trying NOT to get pregnant.

You'd never think that this will happen to you, until it does...

Sometimes it's hard dealing with people that doesn't understand your situation. It's hard not to have anyone to talk to about your protocol. (What the hell is a protocol?) Most people really only know how the mechanical aspects of the birds and the bees work (and by mechanical I mean, all he needs to know is where to put it in) and not the inners working of things. I'm surprised how much I know now compared to what I knew before. (But boy am I glad I paid attention in high school bio, it sure came to good use!)

I hope by keeping a blog that I'm at least educating some people out there about infertility. And what's more important is that I'm also reaching out to those who are going through the same thing and to let you know that, hey, you're not alone! Right now I'm going google-happy with anything and everything IVF related. I'm guessing that I may not be the only that's this way. (That's right ladies, don't tell me you didn't google what BFP/BFN meant)

Day 9 Positive!

Woo Hoo! It's Day 9 and the results are positive! I'm not sure why I'm so excited because it's not even a pregnancy test! But at least something is going right and I got a positive result for SOMETHING!

I love smiley faces!!

Another step towards a positive end result!!

Now I won't need to do these tests anymore! I looked forward to them every day! (That's sad...)

Pixy Stix you pee on

SO... I went out and bought my Ovulation Kit today. TA DA~

My gosh they were expensive! $55.95 for 7. Of course, we went for the digital since I know if I get those ones with the lines, I'll be staring at the stick for half an hour deciding if a faint line means positive.

SO, it tells me to start testing on day... 7... I'm so tempted to start now even though I'm only on day 3! Hahaha! Although... I'm not sure why the doc wanted me to do these tests. How is when I ovulate this month important when I haven't even started my injections? Hmmm well, I'll leave things up to the pros. I trust you doc!

On another note, these stick packs sure look like Pixy Stix candy!! Mmmmmmm...

Even Beans thinks so~

Beans - "Mommy can I eat this?"

No, dear... stop staring at me...

My new beginning - The first day of the rest of my life

Yup. It's Day 1 in many ways. It's the first day that I'm finally off work and more importantly it's also the first day that dear Aunt Flo came to visit. What a nice coincidence!!! There's excitement, there's hopes, there's dreams, and there'll be the sound of pee hitting a stick and trickling down the toilet in the morning. Isn't that lovely!

After months of waiting and many surprises. We've finally made it to Day 1. The doctor appointments seemed endless and the waiting was worst. First it was waiting for the 6-month Lupron to wear off after surgery. Then, it was waiting for blood work, ultrasounds, semen analysis, and more blood work and more ultrasounds.

As I was have having severe pain again the past few months, I had another baseline ultrasound done and of course they found more cysts! (Two again. Somehow they like to come in groups of 2? The return of Bertha and Norm!?!?) Fortunately, they are small and will not interfere with my IVF! I'm gonna hang cloves of garlic up in my house! STAY AWAY!


So my RE finally give me the OK on the start of my cycle! Yay!

My Day 1 finally came along and I called in. The nurse then called me back within a few hours and told me to purchase a Ovulation Kit and use it until I see a positive result, then call again.

Hmmm These things don't come cheap!
Shopper's Drug Mart, Here I come!



My next appointment is on November 15 at 1:00, at which time the nurse will teach me how to injection crazy hormones in my body, which will probably make me a witch for the next 30 days.

I'm also finally done with work. Hats off to all those people dealing with this crap and working full time at the same time. I just couldn't do it. I was in pain, I'm also studying part-time, I had to get time off too frequently for appointments, and my stress level just went through the roof. So I made a decision and quit. It's nice to finally be able to focus on myself, to try be more healthy, stress-free, and focus on my IVF cycle and school for the time being. I'm sure school will keep me plenty busy as I have an exam this Saturday. Oh wait, why am I blogging here when I should be studying?

So... more to come... peeing on a stick, jabbing myself with needles, and me turning into a nasty old crab! Yay! Aren't you excited?