Hormones and Needles and Tests - Oh My!

We've put another six weeks of the stork adventure under our belt, which was full of injections, pills, and anxious waiting. Of all of the parts of the process to date, this has been the most active in a day-to-day sense. From they day we left off of the last post, I've been on a constantly changing regimen of leuprorelin (Lupron), estradiol (Estrace), and progesterone in oil (PIO).

Now I'll be the first to admit that I can be a little OCD sometimes, and I take far too much pride in accurately following directions and doing a good job. But this ever-changing menagerie of dosages and drug combinations over a 4-week period is enough to make my head spin, and my subconscious constantly wonder if I took the right medications at the right time. To calm my inner Monica Geller, I found this nifty little pill organizer on Amazon, filled it with my oral medications for the upcoming week, then put dummy markers in each appropriate slot to remind me to do an injection on that day and time. The over-achiever in me beamed with pride.

It's probably time to address the elephant in the room: "How bad are the injections... really?" The Lupron was in a small insulin syringe with a tiny little needle (the small one in the picture). As long as the needle isn't dull in any way, you really don't feel it going in, and I really didn't feel the Lupron dispersing for the most part. The tough part about the Lupron injections is watching myself stab it into the skin. Even in the last few days of doing those, I would catch myself hesitating, hovering over the pinched skin, and have to talk myself into it. So all in all, the Lupron injections weren't terrible. The Lupron side-effects, on the other hand, were not as kind. I started with 10 units per day, and within a few days I had hot flashes and a slight headache. After a week, I was in a full-on battle against the INSANE weight gain, and I was noticeably slower in my thought processes. Lupron seriously made me dumber. By the time I stepped down to 5 units, I was in a hate-hate relationship with the drug, and threw myself a little party on the last day that I had to take it. That happened to also be the first day that I took the infamous PIO.

PIO gets a bad rap in the IVF world because it comes with (comparatively) HUGE needles, has to be delivered deep into the muscle, and is in oil - not a great solution for dispersion into the muscle. I read some great tips online from other IVFers before attempting any of the PIOs, and my dear, sweet husband, Scott, watched some very helpful YouTube videos with some professional tips. As most people recommend, I warmed the oil in the syringe to help it disperse once it's injected.

Buzzy Injection Pain Blocker

I also applied ice and vibration to the injection site for about 15 minutes. Ellie and Matt purchased a Buzzy for me to help with this part, for which I love them dearly! The rest of the work is Scott's to deal with. I place myself face down, he finds the right spot on my tush/hip, delivers the medication and does a wonderful job of massaging the area with the heating pad afterward. I've concluded that this is true love; someone that is happy and willing to rub my bum to keep it from hurting me the next day. What a catch. :)

Not all injections go according to plan, or with the luxuries of home, however. Shortly after starting the PIO, Scott and I had to attend an evening dinner party out of town, and we didn't have time to stop at the hotel to do the PIO injection first. Instead, I found myself with my pants dropped in the backseat of his pickup, because, well, you gotta do what you gotta do. While slightly more painful without ice or heat, Scott still did a great job, and I didn't end up with a bruise or a lump afterward. In fact, the only lump and bruise that I've gotten from the PIO injections came at the hands of our IVF nurse immediately following the transfer. Scott wasn't able to go with me, so she did the injection before I left the clinic that night. I knew it was going badly when I felt her pinch the skin instead of pulling it taut, and again at the end when she said "Wait here and hold very still. It's bleeding quite a bit, so I'm going to grab some tissue and a band-aid." I was thinking "BLEEDING??? Scott never makes me bleed!?" As I type, some 15 days later, I can still feel the distinct lump from that injection. If ever in that situation again, I think I'll take my chances and do the PIO on myself.

Did someone say "transfer"?? Ah yes, there was that exciting little event stuck in there in addition to all of the medication fun. :)  In fact, Matt and Ellie flew into town early in August to prepare for Ellie's egg retrieval. As we went through August, she had multiple visits to the clinic to check on her egg production progress, and I had two visits to ensure that the oven was fully pre-heated and ready to bake a sweet little bun. All of our appointments went great, and by the day of Ellie's retrieval, we were getting good news left and right. The RE ended up retrieving 9 eggs, 8 of which were mature, and all 8 fertilized into embryos through intracytoplasmic sperm injection (ICSI). We continued to be encouraged by day 3 when we learned that 6 of the 8 were still doing well.

On day 5 there were 5 excellent embryos, so Matt and Ellie decided to do preimplantation genetic diagnosis (PGD), and we pushed the transfer back a day to allow results to come in. On day 6, I traveled to the clinic in my lucky green shirt and my shamrock socks. I arrived with a full bladder as instructed, and was informed that the PGD results were not in yet. So I settled into the waiting room, only to find that the other woman in the waiting room was also a gestational carrier waiting for PGD results in order to transfer. We struck up quite a conversation over the 2 hours that we waited, trying to ignore the pain of the bladders that were ready to explode. Finally the results came in, showing that Matt and Ellie had 2 normal embryos from the 5 tested; 1 boy and 1 girl. We proceeded with the transfer of the best looking embryo of the two, and froze the other one. Thus began our intense wait.

Four days after the transfer I took a home pregnancy test, but nothing showed up. I retested on the fifth day after transfer and there was a faint second line - woohoo! Ellie and Matt were very encouraged to hear the news, while I was working hard to hold down my breakfast each day. Day 6 post-transfer brought the same faint second line, which made me a bit nervous. I was expecting it to get darker, but, as you all know, patience isn't my forte, so I chalked it up to being over-anxious to see progress. I tested again the next day, knowing that on the 8th day after the transfer we would have our first beta HCG blood test. The line was exactly the same as the previous two days, and as the day wore on, I felt less nausea than I had in over a week. I reported everything I knew to Ellie and Matt, so we were all cautiously optimistic going into the blood test. When the clinic called with the results of the blood test, it was only 2 mIU/ml, which is barely pregnant. If the pregnancy was viable, it should be have been above the single digits, so the clinic told me to stop all medications and allow my body to reset for a new cycle. Of course, Ellie and Matt were heartbroken, and I found myself in a combination of sad and mad at no one in particular. I was mad that we had all done so much work, did everything "right", received great news at every check point, and transferred a PGD normal embryo, only to have a failure on our hands. How does that happen!?!? The question is rhetorical of course, but that was the level of frustration that I had reached. I went home to tuck all of my medications and IVF supplies away in the closet, and found that Scott had brought me sushi, my favorite amber ale, and espresso ice cream to help me feel better. Have I mentioned that he's quite a catch? So Matt, Ellie, and I decided to Skype a few days later to discuss what happened and start to plan our next step. Based on our clinic's schedule, our options will be to transfer the one remaining frozen embryo in early October or mid-December. Regardless of which date is chosen, may the fertility odds be ever in our favor.