Meds Today, Shots Tomorrow?

My hormones arrived today at the office!  It wasn't as fun as receiving a shipment of shoes from Nordstrom's, but almost.  

It was 97 degrees in NYC today, and I was a bit concerned because the Ganirelix and Gonal-F need to be refrigerated (or at least at room temperature), but fortunately, the chilled pouch it came in was still cool, though the ice packs were very melty.  I brought frozen gel packs into work from home, and I kept the packs and the meds in the office fridge during the day, and then repackaged everything (surrounding the Ganirelix and Gonal-F with icepaks) so that they'd stay cool on the sweltering commute home.

Today is Cycle Day 1.  Tomorrow morning, Cycle Day 2, I head into the doctor's office to have my blood test to check hormone levels and ultrasound to check how my ovaries are looking, and that afternoon they will call me and let me know if I should begin my hormones that night, and what the appropriate dosage is.  I continue to go in about every other day so that they can monitor follicle progress and adjust meds until I'm ready to take my final shot, the Ovidrel, which triggers ovulation.  I should be on meds for eight to ten days, but it might be slightly longer.

All of my injections are subcutaneous (i.e., fleshy part of the skin) instead of intramuscular (inside the muscle), which is good because it should hurt less.  Subcutaneous shots are generally administered in the abdomen or thigh area-- I'm aiming for the abs because I'm plenty fleshy there!  No injections in the butt like in the movies-- those would be subcutaneous.  I think where you administer the shot and how deep depends on the type of medication.

Why am I taking hormones in the first place?  Usually your body produces one mature egg a month during ovulation.  For my purposes (and for IVF patients who go through this same hormone stimulation process), they want to produce many more eggs to scoop them out all up at once.  During my cycle, they want to suppress all of my natural fertility-related hormones during this time and use synthetic hormones instead in order to grow my eggs (which grow inside of egg "follicles"), as many as possible (within reason), at the same time, so that as many mature eggs can be retrieved when the time is right.  The more responsive you are to hormone stimulation, the better your chances are of a successful outcome, primarily because then the doctor has more in his control over your fertility environment.  

My doctor hopes for "ten to 12 eggs" from me.  I'm hoping for more, because ten eggs doesn't give me a lot of chances.  I read somewhere that 15 eggs seems to be the ideal number (though I'm not sure the basis of that study-- IVF -- correlates with what I'm trying to achieve here), and many more eggs than that can mean that the patient was overstimulated (learn about ovarian hyperstimulation) and doesn't necessarily result in good quality eggs.  According to the article, in this study, during 2006-2007, if they retrieved 15 eggs for an IVF cycle, a woman age 18-34 had a 40% chance of a live birth, which was considered.  That number is quite low, so I'm hoping that technology has improved a lot since 2007 (I think it has) and that fertility rates are better at private clinics than UK public ones...

So here's what I'm going to take:

• Gonal-F -FSH, taken in the morning throughout my entire cycle, used to stimulate follicular development
• Menopur - FSH and LH, taken at night throughout my entire cycle, used to stimulate follicular development
  
• Ganirelix - taken at night starting around Day 7, prevents the pituitary gland from secreting large levels of LH which would trigger ovulation
• Ovidrel - Just a single shot that I administer timed 36 hours before egg retrieval for final egg maturation and release

Here are the amounts I've been prescribed, but I may take more or less depending on how my follicles are progressing:

• GonalF:
• 2 x 300 IU pen (2 refills)
• 1 x 900 IU pen (1 refills)

•  Menopur:
• 25 x 75 IU vials (1 refill) 
• plus syringes and needles because I have to mix these myself

• Ganirelix:
• 4 x prefilled syringes, 250UG/0.5ml each (1 refill)

• Ovidrel:
• 1 x prefilled syringe, 250 mcg (no refills)

You can see videos here of how the medications are administered.  The Ganirelix and Ovidrel are prefilled syringes so that's straight forward.  The Gonal-F is a prefilled pen and you can adjust the dose by twisting the pen to the appropriate dose.  That seems easy enough.  But it's the Menopur that's the most complicated.  I have to put together syringes and needles, mix multiple vials of medication, change needles, and then inject myself.  I can't believe that they actually allow just anyone to administer this medication to themselves-- there are a lot of careless people out there, and I could see them making a mistake in the dosage.

My biggest fear was the dreaded air bubble-- I mean, haven't many characters in books and movies died tragically from the unseen but deadly air bubble in their shot?  I asked my nurse this, and apparently air bubbles are only deadly when introduced into bloodstreams, not flesh, so I am at low risk of inadvertently offing myself.  Small comfort when I think of all the shots I have to give myself.