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!!!

Micro What?

If I had a dollar for every time I have been asked WHY we have to do IVF...I think we could easily pay for our fertility meds!

I always have to go into the big spill about having a tubal ligation but since everything is fine with us but my "plumbing" we are eligible for Micro IVF also called Mini IVF. What does Micro IVF mean is another popular question????

Micro IVF is offered at only a select few fertility clinics- none in Oklahoma. It is designed specifically for couples like the Hubby and I who do not need to be pumped full of high power fertility meds to procreate we just need some help getting the sperm to the eggs! Which is exactly what IVF does. With Micro IVF I will take a low dose of fertility meds which means I will not produce as many eggs, but that is fine because my eggs are healthy and Hubby's sperm is healthy so it shouldn't take A LOT of eggs to get that one healthy embryo or maybe two...we will see!

When I discovered Mirco IVF I knew this was the way to go for us. 1- because I hear Fertility Meds make you crazy and I don't help in that department so a low dose will do for me and 2- the cost of Micro IVF is considerably less than the full blown IVF.

Sure we are still dropping around $10k but that number looks better to me than $20k.

Let The Testing Begin

I know I know, I already have two kids, I should know all about how this baby making stuff works. After doing a crash course of IVF- let me tell you- I knew very little leading up to this point.

Just to get the go ahead to do IVF you have to undergo a few tests. Well, not a few, ALOT! Starting with blood work. Not just normal blood work but specific blood work in addition to both of us having a full CBC and getting tested for every genetic or sexually transmitted disease under the sun. The specific blood work is when things get a little confusing for me as a female.

Let's talk FSH- Follicle Stimulating Hormone- this is a BIG DEAL in the world of IVF. This determines how "young and fertile" your eggs are and how healthy your follices are. Your FSH can only be measured correctly on the 3rd day of your cycle. To let you know how clueless I was about everything- I had to ask my nurse the dumb question- "when is the 3rd day of my cycle?". Um that would be the third day of your period for those other reproductive challenged folks out there. the magic number for FSH greatness is any number below 6 above 1. I am a lucky 5! This means you will stimulate easily or normally when you undergo fertility medications. There are also is another test that coincides with FSH and determines your egg quality it is called Estradiol. This test determine what shape your Ovarian Reserve is in. They want the numbers below 80 and mine is 64. Looks I passed the blood work test with flying colors- praise the Lord!

Just to whine a little- the blood lab chic poked me 7 times, blew 3 veins and bruised me in three places to get the 14 VIALS of blood they needed for all the testing! Not for the faint at heart! Be prepared future IVFers- get those veins plumped up!

Then comes the FUS test- this is a fluid ultrasound of your uterus and uterine wall cavity. Being the challenged individual that I am I had to research this a little more to understand exactly where they would be putting a catheter and inserting fluid for an ultrasound. The research scared me to death- it looked very invasive and very painful...and IT WAS! BUT all was well with uterus and uterine cavity and the doc said he was impressed because I had had two children before and there were no scars in that area from C-Sections or carrying a babies! WOO HOO! Great news!

Then came basic physicals saying we are healthy enough to do IVF and of course a normal pap- that was cake! Check Check- we are healthy and ready!

Lastly, but the first test that we did because the hubby could go anytime to do his- he doesn't have to work around a "cycle"- the Semen Analysis. He had to do the test because he has no children- which he says- he took preventative measures NOT to have children UNTIL he was married- what a smart man! Let's just say- his swimmers are above average! His numbers were off the charts and right on target for baby making! YAY Hubby! (I'm sure he's going to love this blog).

So we conquered all the testing and we were overjoyed that everything came back normal! Truly an answer to prayers! Who knew how important all these numbers and crazy terms were to make a baby?!?! I am thankful that our chances of a successful IVF are excellent and I am counting down the days (46) to Vegas...BABY!

It's SHER to be a Baby!

When looking for an RE (Reproductive Endocrinologist) or for betters terms baby making doctor or IVF doc, your choices can be very overwhelming. Let's face it the infertility business obviously is booming because these RE's are everywhere!

One very cool thing that made our search easy is that the Center for Disease Control monitors all IVF clinics and their SUCCESS RATES! Not only do you get an in depth look at how successful their IVFs are but you also get to see how many IVFs they do each year. In my opinion, the more experience- the better.

Being the blogging, discussion board, online junkie that I am and always will be my curious brain and fingers descended upon the internet. I read, discussed, searched and studied all the ins and outs of IVF doctors all across the country. I would print out materials pertaining to each doctor and clinic and the hubby and I would discuss what we liked or did not like.

At the end of the 3 year research span it all came down to one man and one man only- DR. GEOFFREY SHER founder of the Sher Institutes across America. We had pondered staying a little closer to home by using the Dallas Sher Institute but Dr. Sher was in Las Vegas so that was where we needed to be. In addition to his 16,000 successful IVF procedures he also has perfected the art of Micro IVF which is a perfect for couples like the hubby and I!

Dr. Sher will be the man to make our Bryant Baby. I could not be more confident in a successful outcome being in the hands of a world renowned IVF expert!

He writes an awesome blog I encourage all infertile couples to visit www.ivfauthority.com you will find all the answers to your questions, doubts and concerns. He covers all the bases for infertile couples and keeps it real when he talks making babies! This man is a genius and I cannot wait to meet him face to face on November 8th!

8 years ago

So I started my "Infertility" focused blog yesterday. But really this journey started 8 years ago for me. In June 2002 I had my daughter, precious baby girl, Madison Rae. At that point and time in my life, I was 22 years old, trying to finish college and in an unhappy abusive marriage. I knew without a doubt I did not want anymore kids with my husband at the time and I thought if we ever divorced (which was inevitable in my mind) no good man would ever want to marry a woman with two kids. So I had a tubal ligation and by choice made myself infertile (sad face here but I have forgiven my younger self for my indiscretions). This was the best option for me at the time.

A few years later I was single and absolutely not looking for a husband of any sort. They always say when you are not looking- you will find THE ONE- well that saying is true! I met Dustin Bryant in July 2006 but we were just friends until December 25, 2006, when we started liking each other in a more than friends way- weird how that just happens. June 13, 2007 we got engaged and November 17, 2007 we were married! What a whirlwind romance!

We love him and he loves us- all 3 of us- he is truly my knight in shining armor!

Now to the complicated reality of an infertile marriage...

I was clear in the beginning that I had a tubal ligation and we knew if chose to have children it would be a complicated, expensive process. Of course we knew we would have children because 1) I love him and would love to have kids with a good man whom I love and he loves me I have never had that before and 2) he does not have any children! And we want a Bryant Baby!

So for the last 3 years and 9 months we have been researching our options- IVF (In Vitro Fertilization), IUI (Artificial Insemination) and Tubal Reversal (a surgery put my tubes back together). I weighed the pros and cons, researched success rates, read blogs, participated in discussion boards and did LOTS of praying. It came down to this MICRO IVF would be the best option for us. (Don't worry I will expand on Micro in a later blog).

So we knew WHAT we were going to do to get pregnant but WHO would be the perfect man or woman IVF doc for the job?

Hhhhmmm....an entire world of options awaited us....

Life's New Twists & Turns

I am almost embarrassed to admit how long it's been since I've updated my BLOG! Here is my excuse: I have been too busy writing blogs for everyone at work that I have neglected my OWN! It's an inherent trait I am convinced only females and mothers have (putting everyone else's needs before their own)...but anyway- I have failed at blogging my life away and I am committing to STOP putting work & others first and START putting ME first from TODAY on!

Hmmm....We will see how this pans out.

One MAJOR thing has transpired since the last time I wrote:

1- My hubby and I have decided IT'S TIME to take the LEAP- JUST DO IT- GO FOR IT- and MAKE A BABY! This may sound like an easy task coming from a young couple and a woman who already has two kids- but folks, let me tell you- IT IS NOT! Stay tuned for more in depth details on this complicated matter.

My blog is going to take on a new light dealing with one subject I never thought I would ever have to deal with in my entire life- INFERTILITY and IN VITRO FERTILIZATION. These are complicated complex matters and I feel called to write about our journey. I'm cooking up my first post on these two issues and you will be seeing it soon enough. So stay tuned and also say a little prayer for us as we embark on this journey of a lifetime and as I launch my new business!

Lots of new exciting things happening around here and of course it's Fall in Oklahoma- who doesn't love that? Football season is in full swing and I will be writing and posting pics of Cheer and Football! Go Bulldogs!