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!