Cycle Day 2: My First Shot

I arrived at the doctor's office this morning to a room overflowing with women waiting to have their blood tested (testing hours are 7am to 8:30am).  It just hit me how many women need reproductive help these days (including myself), and what a business reproductive medicine is.  It was hard for me to think about the situations some of these women were in, potentially at the end of their options...  I hoped for most, that they were just starting an uncomplicated journey towards a happy reproductive outcome.  I spotted a woman I'd met before, the wife of an acquaintance of mine, but thankfully she did not recognize me.  That would have been an awkward conversation.

While I waited for a half hour, I settled up my bill.  You know, the took a casual swipe of my new credit card with the 0% APR to charge $9000, and I handed over a check for $750 made out to the anesthesiologist.  I was relieved that the credit card went through on its maiden swipe with no hitch-- thank you, Chase Slate Visa, for the no interest loan and for arriving just in time (yesterday) so that I could use you to pay for my oocyte cryopreservation cycle.

Then I got called for my blood test which was quick and painless.  After waiting some more for an exam room, I was seen by a doctor (not my usual doctor) for a quick pelvic ultrasound to see how my ovaries are doing.  She said that she saw about "six follicles on each side", that I'd likely start my meds tonight, and that I should expect a call from a nurse later today after my blood results come in.

At first I was a bit upset to hear that I only have about 12 follicles because, to recap, each follicle holds only one egg, so I thought that this would be the maximum number of chances I'd have at egg retrieval.  Also, sometimes a follicle holds no egg, or the egg it holds will be immature at the time of retrieval and therefore unusable.  It is highly unlikely that 12 follicles will result in 12 mature, retrievable eggs, which is why we want to see a higher follicle count.

But reading up on various IVF forums, it seems like part of the reason I'm taking the follicle stimulating hormones is to encourage follicles to grow, including small ones that may not have been visible on the ultrasound.  It seems like many women produce more visible follicles as the cycle progresses, so I just have to hope that the hormones do their magic, and that the next time I go in, there will be more follicles.

So I got the call around 2:30pm, and I am to start on 150 IU of Gonal-F and 150 IU of Menopur tonight.  Starting tomorrow, I just take the Gonal-F in the morning and Menopur at night, and then I go in three days later (Monday morning) for another round of blood tests and ultrasound.

I attended what will be my last yoga class for a little while this evening, because I can't do "bouncy" things while I'm on stims (for risk of "torsion", when the enlarged ovaries get all twisted up).  I thought it was an appropriate sendoff to my cycle.  Goodbye, headstands, I will miss you...

I'm relieved that I'm starting my cycle over a weekend so that I can process what is happening to my body in relative peace quiet.  I can let my body adapt to the medication, and I will have the time and head space to be good to myself, do restorative yoga poses (at home), etc.  

I braced myself for the administering of the medication.

I decided to start with the Gonal-F first because seemed more manageable, because it comes in re-usable "pen" form.  Each time I use it, I add a new (small) needle, adjust the dose, inject, and discard the needle.  To change the dose, I just twist the arrow to the amount I need.

I wanted to stab myself quickly as the nurse instructed me to and the woman in the injection training video did so efficiently, but after staring back and forth at the needle and my intended injection site for about 50 seconds, I realized that the two were not going to come together unless I did something, so I resorted to slowly pressing the needle into my skin.  It didn't even hurt, just a tiny pinch.  Pretty simple!  This is the one I'll do in the morning, so it's good to know that it's no fuss and pretty painless.

And now, time for Menopur.  I watched the video at the Freedom Pharmacy Teaching site about three times and re-read my notes from my injections class with the nurse to make sure I understood what I needed to do, and I was still nervous.  The tricky thing about Menopur is that it comes in powder form, so you have to mix the powder with a liquid solution called "diluent" before you can inject yourself with it.  My dose is "two vials" (each vial is 75 ml so it was a 150 ml dose), so I had to go through the mixing procedure twice.  I kept seeing air bubbles in the syringe that I couldn't get out, so I was a bit concerned.

Finally, I injected myself.  This time, the needle hurt going in, and the entire time I was pressing down on the plunger, I felt that unpleasant sting that certain shots have where you really feel the medicine going into your body.  I wonder if it's because the Menopur was cold-- I'm going to try to bring it to room temperature the next time I use it.  (I don't need to store Menopur in the fridge like I have to with the Gonal-F and Ganirelix, but it was 101 degrees in NYC today, and the nurse told me that it never hurts to keep everything in the fridge.)  The Menopur was a really unsettling experience.  I highly encourage the makers of Menopur, Ferring Pharmaceuticals, to work on a "pen" solution like the Gonal-F people have.

I reiterate that I can't believe that they let just anyone administer this kind of medication to themselves because it's a little complicated.  The most anxiety-producing aspect is how sterile everything has to be, and I'm scared that I'm not disinfecting correctly and introducing germs.

The injection sites were sensitive immediately after the shots, but no blood.  About an hour later, all redness went away, and my skin felt normal again.

After the mildly traumatic Menopur incident, I administered myself a scoop of pistachio almond ice cream from Blue Marble which I had ready to go in the freezer (bought as a post-injection reward earlier today).  I might need ice cream after every Menopur shot.  Thank goodness I don't have to do Menopur for another 24 hours.