Summer of Shots....not the fun kind.

I woke up early this morning (5:15 on a summer morning..yuck!) to drive into Foxborough for the first step in our IVF cycle:  hormone check.  I had to have blood drawn to check my progesterone level.  It is important that I have already ovulated before started my first medication: lupron.  The blood draw took about 1 minute with about 2 hours of drive time.  Not too bad right? Not all of my appointments will be just blood work; some will require ultrasound as well, but those don't start until later in the process.

Earlier this afternoon, I received a call from my nurse.  My numbers looked good, and I have go ahead to begin Lupron tomorrow morning.  Lupron is a subcutaneous injection, which means the medication is injected in my lower stomach area using a smaller needle.   These injections I normally do myself.  At first I was petrified and had Sean do them, but that actually was more difficult.  Like many things in my life, I needed to be 100% in control.  I will take these injections every morning until at least July 20th (maybe later depending on my cycle) and then I need to go in for what is called "baseline monitor".  This time will include both blood work and ultrasound.

I am doing what is called a long Lupron protocol.  This is the same protocol that I used when I got pregnant with Olivia; if it's not broken don't fix it.  This is one of many protocols for IVF success; everyone reacts differently so each has flex room.  With the Lupron protocol, I will do at least 12 days of Lupron injections on it's own then I will go in for my baseline.  If things look good, I will begin stimulation medication.  For me this will be Gonal-F, also a subcutaneous injection but this one will be done at night.  I will be continuing my Lupron during this time as well.  Yup that means two injections a day!  Good thing my bathing suit doesn't expose my stomach; the instructors at swim lessons would be calling CPS on me.  I will do this anywhere from 5 to about 10 days depending on how I react.  During this time I will be going in every few days (daily towards the end) for blood draws (yes more needles) and ultrasounds.  Once things are where the doctors want them to be, I will take what is called a trigger shot.  This is an intramuscular shot (aka butt shot) that tells my ovaries to release all the eggs that have been growing.  36 hours later (yes that specifically timed), I will be having my egg retrieval.  I will be put until general anesthesia and the doctors will go through my uterus to remove all the fluids in the follicles, which hopefully contains eggs.  The same day all the mature eggs will be injected with the strongest of Sean's sperm in a process called intra-cytoplasmic sperm injection.  The embryos will then grow in the lab.  I will also begin progesterone injections nightly.  These are intramuscular like the trigger shot.  These are literally a pain in the ass.  I need help to do them, so Sean has to make sure he is available every night.  If the oil is too cool, it is hard to inject and can sometimes leave hard lumps under the skin.  On day 3, the embryologists will choose the best embryo and hatch it, and then it will be transferred into my uterus.  The rest will continue to grow in the lab until day 5.  Any embryos that a still striving will be frozen.  The process for freezing has changed greatly since we last did IVF in 2012, and the success rates have jumped from about 50% to closer to 90%.  We are hoping to not need the frozen embryos, but it is good to know that we have that option if needed.

This protocol is slightly different than the one the doctor originally recommended for us.  She wanted us to do a 5 day transfer.  There are many benefits to this.  Because they grow longer in the lab, the embryologists have a greater chance of picking the one that will be the most successful.  It is totally possible that the "best" embryo on day 3 fails to thrive by day 5.  On day 5 the embryos have developed to a blastocyst, so there is no need for assisted hatching and the less handling of the embryos the better.  All this sounds fantastic right?  Why did we choose to do a day 3 AMA? We have attempted a day 5 previously at our last clinic.  Our results were not good.  None of the embryos developed in blastocysts; they had stopped at a stage called a morula.  At the transfer our doctor told about the low chance of something even taking.  We left that day heartbroken but had an idea that assisted hatching could be our solution.  Just thinking about the possibility of having another transfer cancelled left me in tears.  I expressed my concerns with my doctor.  She listened to me, and even though she spent about 10 minutes explaining how labs and techniques have changed in the past 3 years, she expressed her desire to not have any additional stress put on me.  She came up with this "compromise".    We will do the 3 day transfer of a single embryo (no twins for us THANK YOU!) and the embryologists will closely watch the remaining embryos in the lab.  The embryos will be frozen on day 5 (those who make it).   We understand that the embryologist may not pick the right embryo, but if the cycle doesn't work, at least they have a clear idea of what blatocysts are the strongest.   Also, if none of them survive or develop into blastocysts, this will give all of us a deeper understanding about what may be causing our infertility, which is always a good thing.

I got a special package today in the mail....all my meds.  Want to see?  Here it is!

Just a few meds to take up my countertops.  Thankfully the new house has plenty of counters!

So ladies (and gentlemen if any of you have made it this far), that will be my summer fun!  I will be trying to inject (pun intended) my summer with some great activities with Olivia and the rest of my family.  We are unable to actually away because of this, so we will be doing a number of day trips: beach, zoo, Edaville.  Suggestions?