Our Medicine Is Here!

Here it is! I wonder if the UPS man had to make two trips. This seems a little excessive to me!

And this, my friends, is what $4,500 of medication looks like. Luckily, our insurance covers most of these medications. Our total copay was $327.86. Thank God for good insurance! 

Suppressing My Cycle

While I'm still taking birth control pills through January 8, the first medication I'll start is the Synarel nasal spray. Beginning January 3, I will spray this nasal spray into alternating nostrils twice a day and will continue it until the night of my Ovidrel trigger shot. Synarel suppresses ovulation. I start it while I'm still on birth control pills to ensure that when I stop the pills my body does not start selecting follicles for ovulation. That would prevent me from making lots of follicles and eggs for retrieval. 

Stimulation

I'll start stimulation on January 13 by taking daily injections of Bravelle and Menapur. Right now my protocol is for 3 vials of Bravelle and 1 of Menapur each evening, but that could change after my first ultrasound which is scheduled for January 17. Hopefully these drugs will make me produce lots and lots of eggs!

Ovulation, Egg Retrieval and Embryo Transfer

When my doctor determines that my follicles (with an egg in each one) are mature, I'll stop stimulation and take my Ovidrel shot to trigger ovulation. My egg retrieval will be scheduled for 36 hours after I take my  trigger shot. I'll start a Z-Pack of antibiotics the day after my Ovidrel shot to prevent infection from the egg retrieval. The day after my egg retrieval I'll start a medication called Medrol. It is a small dose steroid that prevents the body from rejecting the embryos that will hopefully be transfered 5 days after the retrieval. I'll also take a baby aspirin each day (not pictured).

Implantation Support

After the transfer I will take several medications to help support the implantation of our transfered embryos. I'll wear a Vivelle dot, which is an estrogen patch. I'll also take Prometrium and Crinone, which are progesterone supplements. 

Now that we've got the goods, we're just waiting for our orientation on January 10 and our ultrasound, mock transfer, and medication teaching class on January 11! It's finally starting to seem real. :)

Well, That Was Fast

 I started my Bravelle shots on Thanksgiving night.  While it has been anything but pleasant, it wasn't too terribly bad.  I feel so blessed to have a supportive, patient and gentle husband who was willing to give the me the injections!

Today I went in for my appointment to check my follicle growth. My doctor monitors follicle growth two ways: ultrasound scan and blood work. Today we got some good news from my check up, and some bad.

I'll start with the good news. First, my AMH levels came back from my blood work last week and my level was excellent. AMH is a marker for ovarian function and reflects egg supply and quality. My level was a 2.96 and my doctor said that they see the most pregnancies in women whose levels are between level 2 and 4. My Estradiol levels today showed that there was lots of activity in my ovaries and my ultrasound showed that I had a 19 mm (full-grown) follicle on my left ovary! I was directed to take my trigger shot tonight to induce ovulation and get busy in the bedroom. When I heard this I said, "Wow! That was fast!" The plan was to stimulate for 7-10 days and I've only been on my injections for 4!

The reply I got from my doctor leads me to the bad news. Apparently my dosage, while very conservative, was too high and my follicles grew too fast. The doctor said that when follicles grow too quickly, they often don't release high quality eggs. We'll just  have to hope for the best and see what happens. Basically, it was just a nice way of saying, "Don't get your hopes up." That's the tricky thing about these medications--everyone responds to the injections differently and the doctors don't always get it right the first cycle. It's just a guessing game the first go around. We'll be doing the dreaded "Two Week Wait" from Wednesday until December 14, which is the earliest I can take a pregnancy test. I feel frustrated and defeated already, and I haven't even ovulated yet.

There is always a silver lining, though, and there are a few good things that can come out of this (assumedly) failed cycle. For one, I didn't end up using much of my medicine this month. Hopefully we can use what we have left for our IVF cycle to cut down on the cost. Secondly, I will know if I'm pregnant or not before Christmas. Also, we were a little worried that if I had a particularly long cycle this month, it could make it difficult for us to start our IVF in January. We would have had a very small window between this cycle and the date we will need to start birth control for our IVF cycle, but since I'm ovulating so early this month there should be plenty of time.

We're not giving up hope just yet, but we're definitely not as optimistic as we were this time last week.

Shots, shots, shots, shots, shots, shots

You get brownie points if you get the reference of the title for today's entry. Hint: think Lil' Jon.

Today we went back to Dr. D's office to get the results of yesterday's blood work (all which was normal), be trained on how to give our injections, and have a baseline ultrasound done.  Our nurse was wonderful and really took a lot of time with us, not only explaining how to give the injections, but teaching us how the medicine actually works.

She told us that all women have a hormone called follicle-stimulating hormone (FSH) that tells their ovaries to produce follicles. Women who go through menopause have much higher FSH levels than younger women.  This is because their body is not producing any more follicles, so their brain goes into overdrive and tells their body to make more FSH in an attempt to keep producing more follicles. My medicine, Bravelle is derived from the urine of menopausal women because they have such high FSH levels in their bodies.  Crazy, huh!?  It comes in a powder form that we mix with water before injection. I'll start my shots tomorrow and will take them once a day for about 10 days.  I go back for more blood work and an ultra sound on Monday (and tentatively Wednesday and Friday) of next week to monitor my hormone levels and follicle development.  They will adjust my medicine accordingly.

The injectable medications have similar side effects to Clomid and Femara--nausea, headaches, dizziness, irritability, hot flashes and possibly (less than 1%) Ovarian Hyper Stimulation Syndrome. This usually happens after ovulation, when follicles that did not release an egg fill will fluid. Having one or two of these cysts is no big deal, but if you have lots it can be very painful and can even require hospitalization.  The bottom line is that cysts are common, but too many can be harmful. My ultra sound today actually showed that I had a cyst on my right ovary.  The nurse was not too concerned, and said that we should still start our shots tomorrow.  It was probably left over from our last cycle on Femara and will go away on its own.

Our medicine is coming in the mail through a pharmacy that works closely with fertility clinics and ships overnight. We spoke with a representative from the pharmacy on the phone today and they informed us that our insurance would cover $1,006.16 of our medication! We were only responsible for $95. This was great news!

It seems a little sad and strange to be starting our shots tomorrow, on Thanksgiving day.  At our last OB appointment when I was pregnant in April, we found out that our due date was Thanksgiving day.  It's hard to think that here we are, eight months later, still not pregnant. But we do know that we are very blessed to have the love and support of so many people, and we are definitely very grateful for that!