FRUSTRATED.

***UPDATE: Just spoke with my nurse... She said that my RE is not concerned at all with my progress and is keeping my medication dosage the same! They said they are being cautious with me due to my young age and that I may just stim for a few days longer than normal. Needless to say... I feel much better! Next appointment is on Saturday at 9:30... I will be cheering on my follicles until then! :) ***

(Warning: Long post ahead full of whining and complaining… continue reading at your own risk.)

I am INCREDIBLY frustrated right now. Here’s what has been going down….

Tuesday – 3/29 – IVF Monitoring Appointment #2 – I went in hoping to see some follicle growth! For my first monitoring appointment, I had 22 follicles but none over 10 mm. So I was super disappointed after this second ultrasound when I found out that I still didn’t have any follies over 10! :( I did actually have 23 follicles instead of 22… I guess they miscounted at my first appointment. My estrogen came back at 200 and something… (I forget the exact number) so they decided to increase my medication dosage. No biggie…I was only on 108 ius of Follistim and 75 ius of Menopur to begin with. They increased them to 150 ius of Follistim and 112 ius of Menopur for Tuesday night and Wednesday night. The ultrasound tech told me that this was all normal and that she was sure that we would be measuring some bigger follicles on Thursday morning. Awesome.

Wednesday – 3/30 – Yesterday morning I was organizing some IVF related paperwork when I came across some information from my injection class. Everyone in the class was given a paper with their IVF protocols and medication. I noticed while I was there that it said I would be using a Lupron trigger. I remember thinking that was strange since the protocol my nurse had sent me a few days prior said I would be using an HCG trigger. I figured the class instructor had made a mistake and I made a mental note to ask my nurse about it but forgot to ask her the next time I spoke to her.

A few days after the class, all of my medication came – along with the HCG trigger. Perfect… I was certain that the class instructor had indeed made a mistake. I didn’t really think about it much more until I came across the paper work yesterday morning. I needed to call my nurse anyway to have her order more Menopur so I thought I would just mention it to be sure.

Here’s how the conversation went:

Me: Hi there… quick question: I was looking over my injection class paperwork and it says that I should be using a Lupron trigger rather than the HCG. I just wanted to verify that I AM supposed to be using the HCG trigger since that is what’s on the protocol that you originally emailed me and since you also ordered that medication for me.

Nurse: Um, … really? That’s strange. Well, let me check with the RE.

Me: Oh, okay.

(… a few minutes later…)

Nurse: Hi. Wow… you are right. She wants you triggering with Lupron. I’m so glad you caught that!

Me: Um… ok.

Nurse: So are you self pay or does your insurance cover your meds?

Me: Well, I do have insurance coverage for medication but I still have a co pay. And… I already PAID my co pay for the HCG that you ordered.

Nurse: Oh no big deal. We can get you a Lupron trigger when you come into the office tomorrow. It’s only like $20.

Me: Well, again, I already paid a co pay for the HCG that YOU ordered for me that I will no longer need. I’m not sure I understand why I need to pay for the Lupron since it really wasn’t my mistake. Is there any way I can bring in my HCG trigger and just trade it for the Lupron trigger?

Nurse: Um, well… yeah, that will work. I won’t be here when you come in tomorrow but you can just talk to any of the nurses and they will take care of it.

Me: Hmmm… ok…. So… can you order me some more Menopur? Or are you going to screw that up too? (Just kidding… I did not say that… I was nice… )

Okay…. So I got off the phone rather upset. First of all… I miss my old nurse. She was AWESOME but she is on maternity leave (of course, right? She left right before my IVF cycle… perfect) … so now I have this new nurse. And she is nice enough but I have always gotten the impression that she is unorganized. And she also seems to be the slightest bit impatient when she calls me and I have questions.

Secondly, I am not a nurse. That is not my job. This is my first IVF cycle and I really don’t think that I should be the one to make sure that my nurse has ordered the correct medication. Isn’t that what they are there for? To make sure everything goes as smoothly as possible? I understand that mistakes happen but I don’t know. I’m just annoyed by the whole thing.

Thursday – 3/31 – IVF Monitoring Appointment #3 – When I went in for my appointment this morning, I tried to go in with a good attitude. I asked to speak with a nurse right away and I didn’t have any problems exchanging my medication. The nurse that I spoke with was super nice, patient, and seemed really organized. I almost offered her money to become my new nurse but I decided against it. :)

Today when they took me back for my ultrasound, I was excited to see how things were progressing. It seemed like it was taking forever… I could see lots of follicles on the screen and the ultra sound tech was measuring, measuring, measuring for what seemed like a really long time. I kept thinking, “This is awesome! They are growing!”. Finally the ultrasound tech asked me, “Who is your doctor?” I told her and thought, “Wow! Things must really be moving along! Maybe she wants to check if my doctor wants to tell me to trigger tonight!” But before I got too excited she said, “Your largest follicle is 10.3 mm”. I think I almost fell off the table. What the heck! I said, “Are they all around the same size at least?” She said, “Yes, you have a lot of follicles at around 10 mm so that is good, but your doctor will probably have some ideas on how to get them growing. Your nurse will call you later.”

So I was really upset when I left. Tonight will be the 8^th night of medication. I thought normally people stim for an average of 10 days! I know that I started out on a lower than normal dosage of meds but I really thought I would have a better response than this. It’s really disappointing. I just wish that my body would cooperate for ONCE.

So right now I’m just waiting for my nurse to call me with my blood work results and the new game plan for medication/next monitoring appointment. I’m just hoping that there will BE a game plan…

IVF Monitoring Appointment #1

Yesterday was my first official monitoring appointment after beginning my meds. It went okay I guess. I really didn’t expect a lot after only three days of medication. I apparently have 22 total follicles – but they are all under 10 mm. My estrogen came back at 160. They tell me that all is well and that this is all normal at this stage. I’m hoping to see some bigger changes at my next appointment tomorrow morning. Keeping my fingers crossed but trying not to expect TOO much at the same time. So far, they haven’t changed my medication dosages. I’m still on 108 ius of Follistim and 75 ius of the Menopur.

One thing I was not expecting was for my injections to hurt so much! I really hope that no one thinks I’m just being a baby about it but the Menopur burns terribly! Before I began these meds, I had several people say to me that the meds don’t hurt at all and that they really aren’t a big deal. But I really don't like them. The Follistim really isn’t too bad. It stings just a little and it goes away pretty quickly. But the Menopur…. OH the burning! I hate it. I’m still not used to it. Thank goodness my hubs does all of my injections for me. It would probably take me forever to psych myself up enough to give them to myself. I just keep telling myself that it will (hopefully!) all be worth it in the end. At least I’m not having any major side effects or anything. I’ve had a few hot flashes but nothing major. No bloating either… although I’m sure that will change as time goes on.

Sorry for the boring post… just nothing too exciting going on just yet! :)

A Quick Update

First of all…. Birth control pills are FINISHED! I took my last pill on Sunday and it felt great. It seemed like I was on them forever!

I had my Pre-IVF blood work and ultrasound yesterday and it went great. Stims start this Thursday! I’m not feeling very nervous about the injections anymore. I’m just excited to get things moving! Everyone keeps saying that this part goes by quickly… I hope that’s true for me!

My next monitoring appointment is on Sunday (the 27^th) at 9:00 am at my clinic’s main office in Rockville, MD (I normally go to a satellite office that’s closer to me on weekdays). There’s a pretty big mall out there so I’m hoping to get some shopping in after my appointment! :)

17 Pills Down… 2 to Go!

Time moves so VERY slowly when you are on birth control pills. At least for me it does. But I’m excited to announce that after taking my pill this morning, I only have TWO MORE pills to go! Sunday will be the last day… finally! :) I have a 7:00 am appointment on Monday morning for my Pre-IVF blood work and ultrasound. Provided everything looks okay (keeping my fingers crossed!) they will hopefully tell me to begin stims on March 24^th! It’s getting closer!

Speaking of getting closer… I looked at my IVF protocol today. Provided that all goes well (and that I do indeed begin injections on the 24^th ), it shows that my tentative date for my egg retrieval is April 4^th! It’s exciting to think that it’s getting so close!  

So all in all… not too much going on here yet. I really wish I could blog more often but sometimes I find that it’s so hard to put my weird thoughts into words. My mind is constantly racing... I live and breathe this stuff. I will spend a whole day trying to decide if we should transfer one or two embryos and I will spend all of the next day wondering if we will even have ANY embryos to transfer! For right now, I’m just praying that my ovaries cooperate once we begin stims and that they produce lots of follicles that contain healthy and mature eggs!

 I’m just really trying to take things one day at a time… and trying not to go crazy in the process.

My Meds Have Arrived!

They are here! And it's very exciting... I've seen a lot of these posts with pictures of IVF medications so I thought I would be prepared... but it's still so overwhelming. All of the medications came in 7 different boxes and I was surprised how excited I was opening each box.

Here they are!


I have two Follistem Pens because my Nurse gave me an extra one just in case... :)

Just as I was getting acquainted with all of my brand new meds, UPS delivered one more box.... I opened it and groaned....

Yup... my Endometrin - Progesterone VAGINAL inserts. Now, don't get me wrong, I'm very thankful that my clinic doesn't use the PIO shots but I have a feeling that this is going to be...gross. I've done the Prometrium suppositories before and they were bad enough. The Endometrim comes with applicators.... and it says I have to use it THREE times a day. So... yeah, not looking forward to it at all.

I'm just so happy that everything is here and ready to go! 8 more days of birth control... I can't wait until I can toss those and get started with everything! Just trying to be patient.

After my meds arrived yesterday, Mark felt a little left out when I was taking pictures of all of my IVF gear. So, in an effort to include him... I took a picture of HIS IVF gear... 



He's ready to go too! :)



Update: Mock Embryo Transfer, IVF Injection Class, and Medication

Today marks day 7 of birth control… 12 more days to go! I wish I could skip over this part and just start the injections but I’m hoping the time will go by quickly.

Mark and I spent our entire morning today in my RE’s office. First, I had my mock embryo transfer…. And it went really well! For some reason, I was really nervous about it! I hardly had any problems at all with my HSG and this was MUCH easier. I had a TINY bit of cramping when the catheter was put in but it was very mild and went away quickly. When it was over, the RE said that everything looks great and we shouldn’t have any problems! :)

After the Mock, we had our IVF injection class. There were two other couples in the class with us and it actually was fun! We had plenty of time to “play” with all of the different injections and to ask lots of questions. It looks like I will be using the Follistim pen (so cute!) and Menopur. Both seem pretty easy and I’m not too worried about them. The Ganirelix injection looks like it will be the easiest – It’s a prefilled syringe just like the Ovidrel. Obviously, the one I’m most scared of is the trigger shot with the super huge needle … but I will survive. It’s only one shot. I’m thankful that I will be doing progesterone suppositories instead of the PIO shots that I hear so many horror stories about! Overall, it was a great class. It was really nice to talk with some other couples who are going through the same thing.

A few hours ago my pharmacy called with my medication price. First, they told me the price of everything without insurance…. Almost $5000.00! After I held my breath for a while, they finally told me that the total cost to ME was going to be $496.00. I was VERY happy to hear that! My big box of meds is scheduled to be delivered on Friday. I can’t wait! :)

My Weird IVF Protocol…

…. So CD 1 was yesterday… well, sort of. I started bleeding bright red yesterday morning but it was pretty light. My period usually always starts this way so I put in a tampon and called my nurse announcing the good news that today was CD 1! She said, “Great! You will start your birth control pills on CD 3. I will go ahead and order your meds and put together your protocol and email it to you. You will need to schedule your mock embryo transfer after you start your birth control pills.” Awesome! Of course I was super excited.

Until… she emailed me my protocol. I’m on the antagonist protocol… meaning, no Lupron. Now, I haven’t researched this protocol too much but I had just read in my IVF book the night before that the antagonist protocol works best for “older women”. To me, this in some way implied that they did not think that I would respond well to the longer Lupron protocol.

So I emailed my nurse back right away. I told her exactly what I had read and asked her if there was any reason I should be concerned.

Her reply:

Andrea,

That is not true. Our antagonist protocol is geared toward high responders, not low ones. You are going to be fine! Good questions though!

So needless to say, I felt a lot better. I also did some Googling and it seems as though a lot of RE’s are now prescribing the Antagonist protocol for all IVF patients with polycystic ovaries (like me!) due to the lower risk of OHSS. Now, the thought of OHSS scares the junk out of me and I’m so glad to know that my clinic thinks about things like that. I’m just nervous that I won’t have as good of a response as I would have had with the Lupron protocol. I’ve thought about it a lot though, and I’m going to try my best to trust my doctor and hope that my body does what it is supposed to do.

Here is the protocol that she emailed me:

Medications

*       Birth Control Pills - 21-day pack (1-2 packs)

*       Ganirelix or Cetrotide syringes - when directed.

*       Gonadotropin FSH (Follistim, Gonal F, or Bravelle) and 75 IU FSH&LH (Repronex or Menopur) or 75 IU LH (Luveris)

*       hCG (hCG, Pregnyl, Novarel), 10,000 units, 1 vial - "Trigger" intramuscular injection.

*       Zithromax 1 gram  - taken when directed evening before egg retrieval.

*       Estrace 2 mg (#60)  - taken when directed to start evening of egg retrieval.

*       Endometrin vaginal insert (#60), as directed to start the day after egg retrieval.

*       Prescription prenatal vitamin (Neevo) 1 tablet every day.

*       Baby aspirin (81 mg) – 1 tablet every day

Date   Protocol Day     Instructions

02/28/11:  Cycle Day 1 - CALL YOUR PRIMARY NURSE WITH THE FIRST DAY OF FULL FLOW.  No blood work or sonogram.

03/02-03/20:  Start Birth Control Pills - 1 tablet each day for 19 days.

03/21: Day after last birth control pill - “Pre-IVF Evaluation" blood work (E2, P4, Beta) and ultrasound.  You will be called in the afternoon with your results.

03/24:  If blood work & ultrasound are within normal limits, gonadotropins are usually started on the 4th day after your last birth control pill.  Your nurse will give you the date to start along with dosing instructions and date to return for follow-up monitoring.  * The stimulation with gonadotropins usually lasts 10 to 12 days, with frequent office visits. 

03/29: Once follicles are >14mm (or per physician's orders) you will be given instructions for continuing gonadotropins and beginning Ganirelix or Cetrotide.When instructed, you will take your first dose of Ganirelix or Cetrotide that evening, and starting the next day you will take the Cetrotide/Ganirelix in the morning.

04/04:  Egg retrieval (approximate date).

04/07-04/09: Embryo transfer (approximate date).

*Protocol will be individualized hereafter.

So that’s it! My approximate date for the egg retrieval is April 4^th! That seems so close yet so far away at the same time! It’s very exciting though.

But I have another dilemma. Sorry in advance if this next part is TMI. Remember how I said that my period started but the bleeding was pretty light? When I went to the bathroom later on yesterday to change my tampon, the bleeding was lighter than it was in the morning. Just a little heavier than spotting. This is really strange for me. Normally it gets heavier until it starts to ease up around CD 3 or 4. Instead, the flow continued to get lighter throughout the day yesterday until it was almost nothing by the time I went to bed. This morning, it’s back to really light bleeding. So I don’t know what to do. I have never before had to ask myself, “Is this really my period?” It’s always been so obvious! But now I’m nervous to start the birth control tomorrow. Ugh I don’t know. If it doesn’t get any heavier, I will probably call my nurse in the morning just to make sure. I just don’t want to be one of “those” patients who (at 25 years of age) calls to ask what my period should be like. We will see. Until then, I will just pray (for the first time in my life!) for heavier bleeding.

In other news, I read in my IVF book that I should up my protein during my cycle. So I went out this weekend and got some chocolate whey protein powder. I decided that I would go ahead and drink a protein shake every morning for breakfast. I made sure to prepare myself to hate it since I was pretty sure it would be disgusting. But it … was…. AWESOME. Seriously, I LOVE it. This may be my new favorite breakfast. I put the protein powder with skim milk, ice, and a banana in a blender and it tastes great! I really love it. This will be an easy way to get 25 grams of protein every morning.

Well… that’s about it! I still feel like a little bit of an IVF freak since I won’t be using Lupron like everyone else but hopefully all will go well!