IVF Cycle #1, Part II – Trigger Shot Shit Show

So, I left off right at the trigger shot at the end of my last post. Here’s my description of Part II of the IVF Cycle.

IVF Cycle #1 -Part II: The Trigger Shot Shit Show

The trigger shot ended up being one of THE most stressful parts of the IVF process for us. For anyone who has  actually done IVF, this might seem strange – there is nothing obviously stressful about the trigger.  The nurse gives you idiot-proof directions on how and when to inject, since the timing of the IVF trigger shot needs to be exactly 36 hours before retrieval. Our trigger shot was 11:20 PM on Saturday, and our retrieval was 11:20 AM on Monday morning.

Everything was going swimmingly until the morning of the trigger. The weekend nurse on duty gave us our instructions – which went well all except one tiny detail.  The nurse kept mentioning that we would trigger with two shots: Lupron AND Pregnyl/Novarel.  I had a silent panic attack at this point, because we only had ONE trigger shot at home. I stopped her, and said “We only have a Lupron Trigger in our meds. Should we have Pregnyl?” She repeatedly assured me that some doctors only use Lupron, and that I shouldn’t worry about it.

Fast-forward to 2:00 that afternoon. Alex and I are getting ready to go to a local zoo with our niece, when I get the typical follow-up call from a nurse to go over my meds. She starts to review my trigger protocol with me, and once again mentions that I will be using TWO trigger shots – Pregnyl and Lupron.  Now I start to panic. I tell her I only have Lupron. The nurse keeps asking me if maybe I just missed it in the box (HA HA – really? I’m the crazy person who sits down the minute my meds are delivered, takes inventory, watches how-to videos, and organizes everything on a shelf in my linen closet). Once I get out the invoice from Cigna, and tell her it is not even on the invoice, she starts to believe me.

To make a long story short, everything worked out OK in the end. But in the meantime, I had convinced myself our cycle would be cancelled and that we had gone through the whole difficult process up to this point for nothing. In the end, it was a few hours of stress and uncertainty. Thanks to the nurse on duty, we were able to get some emergency meds from the specialty pharmacy at a fairly local Walgreens. We did have to pay out of pocket, but it was worth it so that we could continue with the cycle. It turns out that Cigna totally screwed up our order, and just left the pregnyl/novarel OUT.  So, I will be filing a claim with them to try and get reimbursed for their mistake (and all the headaches it caused us!).

The Trigger Shot – FINALLY

We had to do our trigger shots in two parts.

11:20 PM, Saturday Night: Two Shots –  Novarel & Lupron.  This should have gone a little smoother than it did. I know I am lucky that my shot wasn’t at 2AM or something. However, I’m an old lady and fall asleep on the couch by 9:30. I should also mention that my cousin’s wedding was the night before. I was tired, man! So, I tried VERY hard to stay up, and Alex assured me that he would wake me up at 10:40  if I fell asleep.  I was so nervous about not injecting on time, I figured that I’d draw up the meds and prep the syringe well ahead of time. I realize now that I was being ridiculous. Well,  I fell asleep, Alex got distracted, and I woke up on my own at 11:00 and FREAKED OUT.  I like to blame what happened next on the great amount of fertility meds I was hopped up on. The shots got mixed & injected on time (by me),  but unfortunately all this was accompanied by the soundtrack of me hyperventilating and crying and yelling at Alex “I don’t have enough TIME! I can’t do this! Why didn’t you wake me up!!”  Yeah, I totally deserve the wife of the year award for that one.

Post-Injection, I calmed down and apologized to Alex. He is the most patient person ever, but even he has his limits. And the scenario above is definitely above and beyond what any husband should have to deal with. But, unfortunately for him, the Trigger Shot Shit Show was not over.

2:30AM- Saturday Night – I wake up with excruciating pains on my lower-right side, by my ovary. Sometimes I get super-sharp pains in this area around my period, but they go away quickly, and I’ve always assumed they are gas pains exacerbated by pre-menstrual hormones or possibly endometriosis. Those pains are  sharp enough to take my breath away for a sec, but they only last about 2-5 seconds.  The pains the night after the trigger shot were even more intense, and instead of lasting a few seconds, they just would not let up. It hurt to move and it hurt to breathe. So, cue me crying (once again) and telling Alex we need to go to the emergency room.  I think I was worried my ovary ruptured or something.  Luckily, Alex kept his calm and googled Lupron side-effects — according to him, sharp pains like the ones I was experiencing are one of them. We put on the TV in our bedroom, Alex broke out the tylenol and heating pad, and we settled in to wait them out. I was up for about two hours, but eventually the pains dissipated enough to convince me that my ovary hadn’t exploded and that I didn’t need to go to the emergency room. In all seriousness, Alex deserves the husband of the year award.

11:20 AM, Sunday Morning: Lupron Trigger #2 – We do a follow-up  lupron trigger shot. Thankfully, this one goes off without a hitch and Sunday remains free of drama.

IVF Cycle #1 – Almost Done?

It seems nuts, but we are already almost done with our first try at IVF –  because it was turned into a “Freeze All” cycle. It is a little surreal to be on the other side of it already.  Well, we’re not done quite yet: I had my egg retrieval this past Monday and 15 eggs fertilized with ICSI.  Now, we are waiting to hear how many embryos make it to freeze on Day 6.  I’m trying not to think about it too much, because I inevitably start to worry that none will make it to freeze. But, that’s not positive or constructive, is it?

So, here’s a breakdown of the STIMMING portion of our first IVF cycle:

We were on the antagonist protocol, and did estrogen priming with estrace pills (no birth control). I started estrace on Day 20 of my previous cycle.  Once my period came, I stopped the estrace and came in for  monitoring on CD3.

Cycle Day 1: Period starts. I go through my medications one more time, just to make sure I have everything.  I notice there is a 1.5″ needle & syringe that doesn’t seem to correspond to any medication.  As far as I know, you would only use a needle that big for mixing medication or MAYBE for an intramuscular injection, which I won’t be doing this cycle.  I call my nurse just to make sure I haven’t missed something, but she seems unconcerned. This will come back to bite me in the ass later.

Cycle Day 3:

  • Baseline ultrasound & bloodwork. Everything  looks good.
  • Start medications: 200iu Follistim & 1 Menopur Powder.

Observations: I decide to inject Menopur first because I’ve never used it before. Menopur comes as a vial of powder that you have to mix with sterile solution, then draw up into the syringe. So, that was new, but fairly idiot-proof.  I was used to injecting myself from my IUI cycles, so that part wasn’t a big deal. You really can’t feel the needle go in. However, you can feel the Menopur as you inject – it definitely burns/stings. But it is TOTALLY bearable, even for a wimp like me.  I don’t even bother icing or trying to numb the injection site. It burns for 30 seconds, and then you’re done. The Follistim was a piece of cake (as I already knew from my IUI’s) –  seriously, you can’t even feel it. And it comes in a PEN. No mixing, no drawing up. Just pop on a needle tip & dial up your dose.  Is it odd to have an enduring and unadulterated love for an injection pen?  

Cycle Day 4-5: Continue with same dosage. At first I think I’m getting headaches as a reaction, but later decide this was just my end-of-menstrual-period headache.  I don’t have any other noticeable reactions to the medications.

Cycle Day 6-7:

  • Day 6 Ultrasound & Bloodwork: No follicles growing yet, at least 10 small on each side.
  • continue same dose of follistim & menopur

Observations: Notice some mood swings & over-emotional reactions. How much of this is the medication and how much of this is just “me being me” is still a mystery.

Cycle Day 8-9:

  • Day 8 ultrasound & bloodwork: start to see follicles growing in 11-13 range. Most of them are in my right ovary.
  • Start Ganirelix / Continue same dose of Menopur & Follistim

Observations: I had read on other blogs that the Ganirelix needle was hard to push in.  However, it looked just like the pre-filled syringe of Ovridel (which I took for my IUI’s) so I kind of disregarded this info.  Just a word of advice: Injecting with a quick jab (all at once) is much better than slowly inserting the needle. The follistim & menopur needles go in pretty easy, even if you do them slowly. Ganirelix, not so much. I also found that I had a small skin reaction to the Ganirelix – the skin about an inch around the injection site became red/bumpy in the hours after injection. This usually went away by the next morning.

Cycle Day 10:

  • Day 10 Ultrasound & Bloodwork: Follicles are still growing, with most in my right ovary.  I think I have close to 15 follicles between 11 & 16. I lost count.
  • Continue Ganirelix, Follistim, and Menopur. Menopur dosage is brought down to 175iu.

Observations: This ended up being my last night of stimming.  It also happened to be my cousin’s wedding (for which I was a bridesmaid), so this was my first experience of doing my injections at a public place.  I had done them at a friend’s house before, which wasn’t a big deal. But figuring out how to inject all three while wearing a bridesmaids dress was a tad difficult.  I had hoped the bridal suite would have its own private, single-room bathroom. However, there was only a multiple-stall public bathroom across the hall, which was going to be opened up to all wedding guests.  The stalls were TINY, with no place to put my medications except for the top of the toilet seat.  I know that some people do their injections in public restrooms, but I couldn’t imagine doing all three (including mixing & drawing up) while wearing a bridesmaids dress in a tiny bathroom stall. I was terrified I’d drop something in the toilet.  I considered injecting in the car as a last resort, but that also was not ideal, considering my long bridesmaid gown was covering my stomach, and it was getting dark. So, I decided to take my risks and just do my injections in the bridal suite, in the hopes that no one would come back up so early in the wedding. I recruited my sister to help me – she basically handed me alcohol swabs & gauze. It was a success, but I was so nervous someone would walk in.  We got lucky though – it wasn’t until I was just stowing the medical sharps container back in my tote bag that my cousin’s maid of honor walked in.

Cycle Day 11: Trigger Time!  We get to monitoring bright and early the morning after the wedding. Since it’s the weekend, our local monitoring location is closed, so we end up going to our practice’s swanky central office. There’s a glossy sign at check-in introducing the “newest addition to the team” with a huge photo of another young doctor. This doctor also happens to be on monitoring duty this morning, and I get him for my ultrasound. I think this is kind of hilarious:  Hey patients! This is the guy that’s going to be looking at your vagina today!  Not that I’m at all phased by the whole trans-vaginal ultrasound thing at this point –  I’ve had so many different doctors and nurses and ultrasound techs down there, it has become pretty blase.  Alex still gets a little awkward, though. The first time I asked him to come into the room for a follicle check, I seriously had to be like “Dude, the only person who is feeling at all awkward here is you. And you are neither getting a probe stuck in your vagina, nor are you probing anyone’s vagina. So get over it.” That was a lot of vagina’s in one paragraph.

Anyway, onto the results: The lead follicles are in the upper teens (and maybe a few in the lower 20’s? I don’t remember). We are told to trigger tonight at EXACTLY 11:20. But more on that in the next post.

Final Thoughts: Overall, the stimming part of the cycle was not as difficult as I thought it would be. Every day I worried about how  I would feel the next day, especially with the wedding looming. But I never really developed any significant symptoms, aside from my usual emotional moodiness. I didn’t have a lot of bloating. And while I could feel my ovaries a bit by the end, it never became that uncomfortable, and I was fine throughout the whole wedding.  The morning monitoring can be a drag, but doable – I mostly went in every other day, only going in daily right before the trigger & retreival. The fact that I was on summer vacation made this much easier on me. And, last but not least, the injections: The injections aren’t scary, they aren’t a big deal, but they did start to get old by the end of the whole affair. Having three injections complicates it, because you start bruising and it becomes difficult to find an un-bruised spot to inject. By the last few days, I had quite a few bruises and sometimes saw a few drops of blood after I injected, which never happened with my IUI’s.  So, IVF stims can be a pain-in-the-ass (er…stomach?), but MUCH, MUCH, MUCH easier than I thought they would be. The worst part was just anticipating what was to come, since it was my first time.