Is there an IVF Value Menu?!?!

I was texting back and forth with a fellow IVFer the other day and we were discussing the different protocols for IVF. She seemed a bit frustrated about her protocol and jokingly stated that she wished there was a menu to pick from for IVF. We are both Micro IVFers and with that comment I began thinking to myself how I wish there was a Value Menu for IVF. A little of this, a bit more of that and all with the full blown IVF results. Fairytaleitis right? I mean when you are a SELF PAY IVF patient...the cost is VERY real! Why can't there be a Dollar Menu at least for the meds?

Seriously though, it is amazing the wide array of protocols for infertile women undergoing IVF. The different Stimulation meds, steroids, shots, pills are very overwhelming. Not only are there different types of meds but there is a huge different in the dosage amounts ranging from large to small doses. I am fortunate to be "good responder" and small doses work just swell for me! Since I did Micro I was on the Micro dose of Gonal F for my stims. My HCG Trigger Shot was pretty painful in the arm but obviously it did its job producing 15 eggs.

The Sher Institute has their protocols down to an art and they know what you need. Hence the extensive blood work you must undergo before starting your cycle. I love that they keep you on meds following your Egg Retrieval. Progesterone in Oil shots in the hip are torturous and the vaginal suppositories also no fun but each of these help with egg implantation and that's what we want in the end! So Bring It On!

Although our next cycle is 7 months away I am already looking forward to getting down to business with the shots and meds and making this baby! I always like to hear about others' protocols if you feel like sharing feel free to comment below or email me at ashleybwrites@gmail.com. Or if you just want to vent about how sick you are of your meds and shots- I am always an open ear and heart to my fellow IVF Heroes.

6 weeks & 12 pounds later....here we go!!

It is no secret that women who undergo IVF put on a few pounds before and during their cycle. With the fertility meds, injections and steroids in addition to the no exercise rule it is just inevitable. Sadly, I fell victim to the IVF weight gain...after 6 weeks of no exercise, meds, and injections I gained 12 pounds. Very disheartening when I had worked so hard before my cycle to lose weight and I had lost 15 pounds in two months.

I went for my first run Thursday and I was pretty much devastated at how out of shape I was! 6 weeks ago I could run 3 miles easily...NOW...I made it half a mile and had to walk the rest. I am hoping it's just because the progesterone is still in my system and I am still weaning off steroids BUT STILL how sad! I worked so hard to get in shape and starting is just UGH! But I know I can do it and I know I have to do it!

My goal is lose 50 pounds (yes I said 50 and yes I could certainly lose 50) by our cycle in July. This is completely realistic to do in 6 months. I am totally determined to reach my goal and be the healthiest I can possibly be. Being overweight is detrimental to your IVF success and even though I am not unhealthy I could certainly stand lose a few pounds. I am Hispanic so I have always been "curvy" but I know when I was 24 years old - two years after having my second child- I weighed 120 pounds and I would LOVE to be that weight again!

So back to the trail I go- running every other day and doing The Shred every other day. Greens, high protein and portion control. It is really simple when you think about it- just eat less and move more! I am blessed to be able to stay home and work from home which gives me plenty of time for exercise and meal planning. Thank you Lord for making that possible and giving me a husband who works hard to provide for his family.

As I embark on my weight loss and IVF prep journey I will share my tips and tricks on my blog. Losing weight is about A LOT more than just physical stuff it is emotional/spiritual too so I will be touching on that as well...there will be tears...so bring your kleenex! The strength to keep going will come from God and I know He will carry me through this journey as He has done from day one. It will be hard and there will certainly be times when I want to quit or give up but I know with my faith at the forefront I will win this battle.

Until next time friends, family and fellow readers...I am going to finish my Kashi Cinnamon & Honey Oats and Turkey Bacon then get Shredded with Jillian Michaels...that should be interesting!

"Trust in the LORD with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight." Proverbs 3: 5-6

73 Shots Later Equals New Found Heroes

I try my hardest to be upbeat and positive no matter what the situation. I admit I have my downfalls when I just want to complain and whine about everything. But mostly I keep that attitude in check and pray through whatever it is that is causing me to have the whine syndrome. That being said, I need to whine and complain a little bit- just to get it off my chest!

First of all, I want to say that all you IVF and IUI moms and women out there are now my new found heroes. I have talked to many women who have been through 1, 2, 3 or more IVF cycles. I do not know how you do it. This is HARD STUFF there is nothing easy about the shots, the hormones, the emotions, the retrieval, the bloating, the discomfort, the waiting, the waiting, the transfer....and the waiting. I think if I did not have my hubby, family, friends and God I would probably cry everyday. Luckily I have only cried a handful of times but I do have to admit I get misty eyed more often these days due to the hormone injections and high emotions.

I counted today and so far I have received 73 shots either in the tummy, thigh, arm or hip. Hands down the Progesterone in Oil shots that I started the night of the retrieval are the most painful horrible awful shots EVER! My Hubby deserves the medal of honor for being such a trooper about the shot giving and always being positive when I feel like I just can't take another shot! The PIO shot is supposed to help my uterine lining thicken because IVF shots can thin it out. This will prevent miscarriage so I am doing them and I am going to do it with a thankful heart! This shot continues until I am 8 weeks pregnant...Lord give me strength! Right now both my hips are so sore I cannot even sit down without cringing. (see pic of my hubby getting ready to give me a shot)

Also this bloating and discomfort is for the birds! My ovaries are so swollen you can actually see them protruding from my stomach. At first I was scared maybe I had Ovarian Hyperstimulation Syndrome but I am still peeing, pooping okay and I am not retaining water so I think it is just because I had 24 Follices and they are now filled with fluid which takes 7-10 days to leave your system. Wow! I look huge! How do women work before, during or after IVF? I cannot imagine! You cannot even wear your clothes. Prior to the retrieval I looked about 3 months pregnant and now I look about 5 months. I told Hubby its a good preview at what I might look like in the months to come! ;) I have to pee every 5 minutes and it hurts like I am going to burst every time! The burping and passing gas is out of control- my poor Hubby and in laws- I am so glad they love me and don't mind my issues!

I did the Micro shots of stimulation meds (although with my amount of eggs you wouldn't think so) so my hormones and emotions were not too bad but I could certainly tell my patience wearing thin with my kiddos. I really did feel bad for them...it's like one day your mom is one person and the next day she wakes up and she's Roseanne Barr on crack! I am certain this time apart they have found a new love and respect for me regardless of how I was acting when I left. So I am at peace about that behavior however rash and uncalled for. I was totally open and honest with them about the shots and how they made me feel so maybe they took it with a grain a salt. I can only hope. For all you IVFers and infertility warriors who did the full blown stem shots and meds- you rock and you amaze me!

After all the yucky symptoms, side effect, aches, pains and shots I have to say I am still so very thankful for the experience and to have 11 healthy embryos growing! Yes we got our FERT report today and 11 of the 13 have made it to the next stage of growth. The nurse said 5 are growing on track and are almost ready now. We are planning our Egg Transfer on Tuesday November 16th. The day after my birthday and before our 3 year anniversary. We are so blessed and we know it! I cannot wait to be home and pregnant (hopefully with twin Bryant Babies).

We are still having a good time in Vegas with my in laws! I hate to see them go tomorrow. (see pic of my hubby and I at Hard Rock Cafe today). We've taken in lots of sights and yummy food!

One Week In

Here I am...one week in...on fertility meds. Quite honestly I am surprised I have not transformed into a mad woman but there have certainly been side effects I am not fond of. I have also stopped using the birth control pill as of Tuesday (which did cause some major mood swings) and Aunt Flow has come to visit me. She hasn't been to town since August because of the BCP so it's not been a fun last few days. I am ready for her to leave! Thanks!

So let's talk meds and side effects.

Dexamethasone: my daily steroid I take in the morning. Bloating, cravings and sleeplessness are the main side effects. I have had a little all of three but nothing major. I have had two sleepless nights. I think my cravings might be caused mainly by Aunt Flow. But I am determined to continue my weight loss so I am keeping all that eating under control!

Lupron: my morning injection of hormones. YES I do get hot flashes and I feel dry and thirsty pretty much 24/7. At church last Sunday I was in hot flash city, thankfully the Bulletin program came in handy and was my fan all during church and lunch. A friend of mine and her mom were actually chuckling at me during lunch because they knew what I was going through. I am doing my best not to become a sweat ball so this nice cool Fall weather is very welcomed at my house! I have been increasingly tired and I feel like by 5:00 I have HIT THE WALL for the day and the couch is calling my name! But usually my workout curves most of this.

I still cannot give myself my shots but Hubby has been a TOTAL TROOPER and gives me my shot every morning before he goes to work. We've gotten over any little bumps and he is confident and a shot giving pro now! I am super thankful and proud of him! I love him dearly!

Amidst the hormones, hot sweats & tiredness my son broke his arm Tuesday at school. I was very proud that I did not have an emotional break down. But I have to admit after 4 hours at the hospital going through xrays and waiting to get a cast, that doctors office was getting smaller and smaller and the bickering back and forth between my two children was quickly wearing thin on my patience. Thankfully their dad showed up the last half hour for the casting and the kids starting behaving better. Whew! Never thought I'd be glad to see my ex husband but that day...I WAS! Dax chose a PINK cast for Breast Cancer Awareness...that made me super proud! I have awesome kids!

I got up at 5:30 this morning and drove to Owasso to get my E2 Level blood work done. I was back by 6:45 and the kids got home from their overnight visit with their dad at 7:00. So I am patiently waiting the results of that STAT lab work and hoping for good numbers. I am not sure what it means if the numbers are not good and I hope I don't have to find out. But things seem to be rocking along quite normally and for that I am entirely grateful. My prayers have daily been focused on asking for God's will in this entire situation. It really calms me knowing He is in control and His will be done in this no matter what the outcome.

Needles, Injections, Hormones, Stimulation, Viagra, Vaginal Suppositories? Yikes!

Just giving a little personal humor and delight to my never ending list of my IVF Meds! I mean who can say they have taken Viagra vaginally? I will be sure to check that off my bucket list...be jealous my friends as I embark on the hormonally roller coaster ride of hormone and stimulation meds! I will go ahead and warn all my friends and family that I cannot be held accountable for anything I say or do in this time period! If someone tries to commit me or arrest me I will be sure to give them the link to blog so they will understand...I am just overstimulated and super hormoned up!

Dexamethasone 0.75 mg Tablet or Prednisone 10 mg

A lovely STEROID tablet (Gotta love Steroids). This little pill is going to help fight off inflammation or my body's need to fight off the embryo thinking it is a foreign invader of my body!

• Potential side effects are insomnia, increase in appetite and bloating. (these 3 together sound a little scary!)

Lupron (Leuprolide Acetate)

This is wonderful drug suppresses my "Pituitary Hormones" What are these you might ask? Stuff like the adrenal and thyroid. Even though my Ovaries are connected to the pituitary hormones my Ovaries will NOT be suppressed...Whew! Relief! This is another lovely stomach shot- yay me! We get to use "insulin syringes"

• The most common side effect is hot flashes, this will be relieved by the start of your hormone medication (i.e., E2V or Gonal-F or Follistim (Hot Flashes sound like I'm going to get a preview into menopause- good practice I shall never forget!)
  

E2V = Estradiol Valerate = Delestrogen

Basically a shot in the "buttocks" that gets my Stimulators primed and ready for Stimulation. Women who have had a hysterectomy take this for hormone supplements. I am going to venture to say that this medication is ONE of the meds that will probably make me feel like hormonal crazy mess! When I Googled It the med is described a Hormone Replacement Therapy.

Folic Acid 1mg tablet

This is one medication that I actually knew the functionality and have taken before as all pregnant women or trying to conceive women should! It prevents Spina Bifida.

SDF (Viagra) Suppositories (Let's Get the Party Started)

• Given to increase blood flow to endometrial lining
• Take vaginally 4 times daily (Really?!?!)
• No side effects, except possible vaginal irritation from so many suppositories. (No side effects? Irritation in the HooHaw is a big side effect in my opinion).
  

Terbutaline 5 mg Tablets

• Given to relax the uterine muscle which will allow more blood flow through the uterine vessels
• Starts with SDF suppositories. (I had to look this up- this is a suppository that goes in your HooHaw- I was hoping I was done with this part at the Viagra- guess not!)
  
• One tablet three times a day
• You will experience the side effects of nervousness, shakiness and a racing heart! If your heart rate is over 120 beats per minute, please skip a dose
• Your body will adjust to the Terbutaline in 2-5 days and you will no longer experience the side effects

I don't think I need to anything to this med- it pretty much says it all in the outline above! Sounds like this one is going to be LOTS of FUN!

Gonal F / Follistim

From what I have read this is the BIG DADDY in the stimulation meds. This is the medication that kicks your follices into overdrive and helps your woman business produce LOTS of EGGS! Yay for Eggs- we love Eggs!

Luveris

So what is exactly is a "pure Lutenizing Hormone"? Well I Googled It (imagine that). Here's what I got: A hormone used to support Follicle Stimulating Hormone (FSH) therapy.

It is always taken with Gonal F. So basically it is a booster for stimulation! Got it!

Read more: http://www.drugs.com/luveris.html#ixzz10XyZ8KxF

Don't forget the Important Warning: Contact your healthcare professional immediately if you experience severe pain or bloating in the stomach or pelvic area, severe upset stomach, vomiting and / or weight gain.

Progesterone in oil

This syringe and gauge process is enough to make my head spin! Use the 1 1/2 " this or that and 3ccs of this or that...I am confused- are you?

Injections sites

Intramuscular injection sites- this looks painful...all I'm saying!

Subcutaneous Injection Site (use upper thigh or lower abdomen)- never had a shot in the abs before this should be interesting since mine are obviously covered by layers of stretched marked skin! This should be fun!

So my fellow readers- what do you think of all this, as I like to call craziness, JICK JACK? It's amazing what medications can do to our body and how doctor can manipulate my entire reproductive system to make a baby! I feel like a science experiment! But a good one!

A LOT To Take In (Not for the faint at heart or weak at stomach)

I am going to be brutally honest and just say that yesterday when my nurse emailed me with my list of meds and then the pharmacy called to confirm my list of meds- I got a little dizzy and nearly had a panic attack! Just look at the names of these things? When the pharmacy called I was jotting down notes in Microsoft Word thinking the spell check would correct them and I misspelled over half of the meds! I got a little worried when the email came and this is what it said: (Keep in mind my hubby will be the one administering these shots!!!!!)

The Sher Institutes for Reproductive Medicine

Medication Administration Guidelines

________________________________________________________________

Tips:

• An ml = cc
• Needles are STERILE, do not touch them before using them to inject and only use them ONCE
• Rotate injection sites from one side of the abdomen to the other, and from one thigh to the other
• With a multi-dose medication vial, swab the top of the medication vial with an alcohol swab before each use
• When in doubt about medication dosage or injection, PLEASE call the office for clarification. DO NOT GUESS!
• There is a nurse on call through the service after office hours. Please call 702-892-9696 before 11pm and the service will promptly page the nurse on call
• Read all of the medication labels before taking the medication to ensure that you are taking the correct medication
• Report all medication errors and unusual reactions to your coordinator as soon as possible

Dexamethasone 0.75 mg Tablet or Prednisone 10 mg

• This is a steroid tablet
• This is given to decrease inflammation and reduce the inflammatory response of your body to foreign bodies (your embryo) before embryo transfer
• Take once a day in the morning with your breakfast to decrease GI upset and other potential side effects
• Potential side effects are insomnia, increase in appetite and bloating.

Lupron (Leuprolide Acetate)

• Lupron is taken to suppress your hormones at the pituitary level, it does NOT suppress your ovaries
• Injection to be given subcutaneous in either the upper thigh (up by panty line) or in the abdomen (stay 1 inch away from belly button) in the AM (between breakfast and lunch) with a few hour flexibility between days (See diagram on page 5)
• The medication comes in a multi-dose vial
• Use the insulin syringes with the orange cap to draw up dose and inject
• Refer to your calendar for dosage and measure units (U) on the syringe
• The most common side effect is hot flashes, this will be relieved by the start of your hormone medication (i.e., E2V or Gonal-F or Follistim
  

Ganirelix/Cetrotide

• To be taken like Lupron, subcutaneous in AM
• Also like Lupron, it is being taken to suppress your own hormones and has a better long term effect with fewer side effects
• Given at ½ dose (125 mcg) rather than prepackaged dose of 250 mcg (same as 0.25 mg)
• Ganirelix:
• To split Ganirelix (prefilled in a syringe) use a 1 cc syringe that does not have a needle and pull down plunger to 0.25 cc.
• Then inject 0.25cc from the prefilled Ganirelix syringe into the 1 cc syringe you have just prepared.
• Place a 27 gauge ½ inch needle on the 1 cc syringe to inject.
• Save the remaining 0.25 cc in prefilled syringe for next morning’s shot.
• Keep refrigerated.
• Cetrotide:
• To split Cetrotide fill the vial of powder with the prefilled water (1 cc) in kit.
• Now you will have 2 doses in vial.
• Use same orange cap syringe that you used for the Lupron and withdrawal 50 Units (½ cc) of Cetrotide for first morning’s injection.
• Save the remaining 50 Units (½ cc) in vial for next day’s injection.
• Keep refrigerated.
• Second dose may only measure up to 35 or 40 Units. This is normal, do not mix up another vial just inject whatever is left for the second dose.

E2V = Estradiol Valerate = Delestrogen

• Not all protocols involve E2V, so if this is not on your calendar then omit instructions.
• This is given to “prime” the receptors on the ovaries to improve response the following week to the stimulation medications.
• This is an IM (intramuscular) injection given in the PM (between dinner and bedtime) in the upper outer quadrant of the buttock (See diagram on page 5)
• Give while lying down to relax the muscle
• Verify that your Delestrogen concentration is 20 mg/ml
• Use a 1 cc syringe without a needle (NOT a Lupron syringe) and attach a 18 gauge 1 ½” needle to draw out the medication to 0.2 cc or the dosage in which you have been instructed to take. Switch needle to a 22 gauge 1 ½” to then inject intramuscularly.
  

E2V 2 mg suppositories

• Not all protocols use the Estradiol Valerate vaginal suppositories
• These are given to ensure that the uterus is being supplied with enough estrogen
• Insert vaginally at bedtime
• These may or may not be continued after CD9.
• Make sure you are inserting the E2V 2mg (Estradiol Valerate) suppositories NOT the suppositories used after embryo transfer which are Estradiol Valerate 1 mg/ Progesterone 50 mg suppositories (or E2V/ P4). If you use the latter in error your cycle will be immediately cancelled.
• Keep refrigerated

Folic Acid 1mg tablet

• Prescription strength folic acid dose (over-the-counter dose is only 400 mcg).
• These tablets are taken to prevent Spina Bifida-type problems in fetus.
• No side effects and can be taken anytime.
• You may opt to take a Prenatal Vitamin instead of straight Folic Acid, this is fine as long as it is prescription strength

SDF (Viagra) Suppositories

• Given to increase blood flow to endometrial lining
• Take vaginally 4 times daily
• No side effects, except possible vaginal irritation from so many suppositories.
• Place the suppositories over the course of a day (with the last at bedtime, unless you are taking E2V suppositories as well) and that it doesn’t have to be exactly a certain amount of hours apart.
• You may wish to wear a panty liner since not all of the wax absorbs and you may experience slight oozing.
• You should try to at least be sitting for 15 minutes after each insertion.
• Keep refrigerated

Terbutaline 5 mg Tablets

• Given to relax the uterine muscle which will allow more blood flow through the uterine vessels
• Starts with SDF suppositories.
• One tablet three times a day
• You will experience the side effects of nervousness, shakiness and a racing heart! If your heart rate is over 120 beats per minute, please skip a dose
• Your body will adjust to the Terbutaline in 2-5 days and you will no longer experience the side effects

Heparin 5,000 IU / Lovenox 30 mg

• Only use if indicated on your calendar
• Twice a day injections, to be given in the AM with Lupron/Cetrotide and in the PM with stimulation medications/hormone injections
• Subcutaneous injection given with a ½ cc or 1 cc insulin (Lupron) syringe
• Verify the concentration of your Heparin. If 10,000 units/ml then your dose twice a day is 5000 units or ½ ml (which is equivalent to 50 units on the insulin syringe).
• You may also use Lovenox 30 mg one a day subcutaneously anytime in the day in lieu of heparin.
• You may experience some bruising at injection site, do not rub vigorously

Gonal F / Follistim

• This is FSH (Follicle Stimulation Hormone) or stimulation medication
• This is given subcutaneously anytime in the evening anytime between dinner time and bed time
• Please refer to packet instructions for reconstitution as can come in multidose vial, single dose vial and Pen form
• Your coordinator will go over instructions with you or you may contact Fertility Lifelines (1-866-538-7879) for Gonal-F product support 24 hours a day
  

Luveris

• This is pure Luteinizing Hormone (LH)
• To be given as a separate injection in the PM with your stimulation medication
• This is given subcutaneously
• The dose is always 1/2 vial (37.5 IU) as indicated on your calendar
• Use the 3ml syringe with 22 gauge 1 ½” needle to draw up 1 cc of diluent
• Inject full 1 cc into vial of powder (this is now 2 doses)
• With same syringe/needle, withdrawal only ½ cc (0.5 ml) and refrigerate remaining ½ cc for next evening’s dose
• Change needle to the 27 gauge ½ “ to inject subcutaneously.

Progesterone in oil

• This medication will be given in one of two dosage amounts, 50 mg (1cc) or 100 mg (2cc). See your calendar for your dosage.
• This is an IM (intramuscular) injection given in the PM (between dinner and bedtime) in the upper outer quadrant of the buttock (See diagram on page 5)
• Give while lying down to relax the muscle.
• Use a 3 cc syringe with an attached 18 gauge 1 ½” needle (or 20 gauge) to draw out the medication to the dosage in which you have been instructed to take. Switch needle to a 22 gauge 1 ½” (or 25 gauge 1 ½” needle if your product is made in ethyl oleate oil) to then inject intramuscularly.

Final Comments

• On CD9 (cycle day 9 when monitoring in our office begins) you will be given a new calendar and instructions once we have determined how you are progressing
• There will be medications you have received that are not on your calendar at this point (i.e., Cipro, hCG 10,000 units, progesterone in oil, Clindamycin suppositories, E2V/ Progesterone suppositories). These will be used post CD9.
  

______________________________________________________________________

Injections sites

Intramuscular injection sites

Subcutaneous Injection Site (use upper thigh or lower abdomen)

I WILL DISCUSS HOW I FEEL ABOUT EACH OF THESE AND THE OUTRAGEOUS COST IN MY NEXT BLOG......I THINK I'VE SHARED ENOUGH FOR ONE BLOG POST :)

JUST A LITTLE THOUGHT: "HOW DOES ONE TRAVEL WITH A CARRY ON THAT COULD BE PASSED OVER FOR A DRUG LORD WITH SYRINGES AND ENOUGH FERTILITY MEDS TO KNOCK UP A SMALL ARMY?" JUST WONDERING!!!