IVF Shots & Side Effects

This is so weird. 

I think these words nightly, as I stand in my pajamas, icing my belly while my husband preps a syringe of sodium chloride in the middle of our living room.

Injecting myself with synthetic hormones in my own home is one of the weirdest things I’ve ever done. But the human ability to quickly adapt to the oddest of circumstances is astonishing.

After our horrific experience on our first night of shots, we have quickly settled into the new normal. These days it goes like this: Get home from work, throw on sweats, light a candle, and retrieve my medications from the refrigerator. Shortly after, my husband arrives home from work and we get down to business:

One 225 IUs Menopur injection. One 225 IUs Gonal F injection. One 250 IUs Cetrotide injection. Three sterile wipes; three gauze strips; three little welts forming on my belly…and we’re done.

After a few nights of this exact routine, we feel like old pros. Here are some tips we’ve picked up along the way:

IVF Stimulation Tips:

• Chilly Meds = Stingy Meds – Remove medications from the refrigerator at least 15-minutes prior to injection. Giving them time to warm to room temperature makes them less viscous and thus easier to inject. It also helps them lose some of that stingy bite.
• Ice, Ice, Baby – In the game of injections, ice is your best friend. The more time you have to ice your stomach, the less you feel the pinch at injection site. I ice for ten minutes prior to injection. I wrap an ice-pack in a dish towel, since pressing a cold ice-pack to your bare stomach can be just as painful as a shot sometimes!.
• Seek New Real Estate – Rotating injection sites sounds like a “no brainer,” but by the end of your cycle, you quickly start to run out of real estate. My husband has stuck me in really tender spots, not realizing that they had just been punctured the night before. 🙁 Take the time to seek out new spots on your stomach, but remember to stick to the fattiest parts.
• Lather, Rinse, Repeat – A creature of habit, I feel so much more in control when sticking to the same injection routine each night: Same time; same place; same little candle lit; same icing ritual; same husband. 🙂 There is so much about this process that we cannot control; it feels empowering to exert order and influence over that which we can.

Overall, IVF Stimulation goes by fast. In the beginning, you can’t fathom the thought of giving yourself nighty shots and your mind obsesses over every little side effect your body may have. By the end, you hurry home to take those shots because you’re now obsessed with those very side effects, anxious to have your hormones rise and your follicles grow. It is indeed a weird little world – here is an unedited window into ours for the past nine days:

Stims Diary:

Day 1
Refer to this post.

Day 2
I woke up today still smarting emotionally from the drama of yesterday, but feeling okay otherwise. During yesterday’s craziness, we also discovered that we were mailed the wrong SubQ needles! The ones we received are too thin and too small to administer the correct dosage. So although yesterday was a major fail, at least it uncovered this other mistake, which needed to be corrected ASAP.

We have spent all of today on a major scavenger hunt across Manhattan on a search for 27 1/2  gauge needles. After many, many hours, we finally found a pharmacy that carried these needles on the Upper West Side. One subway ride, one cab, and two hours later, that adventure was over. But now it was time to stop at our regular pharmacy to get my husband’s antibiotic – Doxycycline – which I had forgotten to pick up. My clinic had ordered it last week and had left me a voicemail about it, but it completely slipped my mind until this morning.

Too. Many. Drugs. To. Keep. Straight.

This evening, we administered 225 IUs of Menopur and 225 IUs of Gonal-F. The Redi-ject pen makes Gonal F easy and painless. The Menopur, on the other hand, is messy with a bit of a bite. After mixing it with the diluent and the powder, it often takes my husband a few minutes to remove all the air bubbles in the syringe. When we inject it, I noticed that it has a nasty, lingering sting. It’s not too significant, but it’s my least favorite medication of the bunch. 

Side effects thus far are minimal. At the injection site of the Menopur, I have some red, raised skin. I also have a HUGE bruise on my right side where the mixing needle went into my stomach the night before. 🙁 On account of this bruise, we administered both Gonal F and Menopur on the same left side tonight. Other than this, nothing to note, but I’m heading to bed early because I do feel drained from this little cold I have.

Day 3
I woke up early this morning for my first weekend monitoring session. I took a cab into the city to our clinic and it was nice to coast through the sleepy, quiet streets of early morning Manhattan. I got to my clinic by 7:45am, signed in with my electronic card, and was seen pretty immediately. Just blood work today (no ultrasound) and they’ll call me later with my levels.

I completely forgot that it’s Halloween weekend. On my way home from the clinic this morning, I noticed a lot of people doing “walk of shames” still donning their Halloween costumes. One twenty-something young woman was literally limping down the sidewalk wearing a purple unicorn costume and sparkly high-heels. How funny to breeze by her on my way home from IVF monitoring – two completely different points of a woman’s life crossing. haha. 😛

I got home by 9:00am and had blueberry pancake breakfast (made by hubby) and a green smoothie (made by me). I’m now leaving to go grocery shopping, as I want to cook chicken noodle soup from scratch. It’s going to be a long week and I’d like something healthy to grab on the go, particularly if I’m not feeling that great…which by the way: I’m feeling great so far! Other than my cold, I have no side effects yet.

As I’m starting to feel pretty in control of my protocol, it just dawned on me that the nurse might call today with new instructions for tonight’s protocol. Yikes! But it’s fine, I feel prepared to handle it since nothing (nothing!) can be as bad as that mixing needle to the gut we did a few days ago.

One last thing to note: as I was waiting for blood work this morning I couldn’t help but think that, so far, this whole thing has not been too bad. I’ve officially turned over my body to this process and I have to trust in it. I’m noting this because I have read so many horror stories online about this time. I’ve let it cloud my own experience and make me feel unnecessarily anxious. 

Lesson Learned: Be cautious of the Internet “peanut gallery.” This is your own experience and it will manifest in its own unique way. Maintain positivity until proven otherwise.

Day 4
The first big checkpoint during IVF Stimulation is the midpoint ultrasound to examine how your body is progressing to the medications thus far. I had mine this morning and was told all looked “excellent.”

We are currently tracking 6 follicles (three on the right ovary; three on the left). Remember that each follicle contains an egg; so 6 follicles potentially means 6 mature eggs at retrieval time. At baseline blood work, my Antral Follicle count was 10 – which is standard, if just slightly reduced. (PS: What in the world are Antral Follicles? Read about them here).

From those 10 at baseline, 6 have become stimulated by the IVF hormone medication and have started to grow and mature. Currently, they are between 10-13mm. Once they grow larger than 18mm, we will be ready for retrieval!

Since the IVF cycle has such a high attrition rate, many eggs are needed to end up with one “good” one. Additionally, since we are doing the PGD and PGS testing, we can expect our attrition rate to be somewhat higher, as these tests filter out what cosmetically looks like a “normal” egg, but genetically is not.

I’m well aware that our 6 little follies are on the lower end of the spectrum when compared to those who produce as many as 20 during the IVF Stimulation cycle. However, I’m also aware of the risks of Ovarian HyperStimulation Syndrome, which happens when too many follicles grow. So being a “low and slow” responder isn’t too bad, as long as our quality of eggs remains good.

Everything about this process is a delicate balance (grow! but not too much! produce many eggs! but only the good ones!). I guess I won’t  know what’s truly “good” or “bad” about our results at each stage until we’re on the other side of it all.

Last night we added in Cetrotide to our nightly drug routine. Cetrotide is taken to stave off the body’s natural process to ovulate. It works by blocking the release of  your luteinizing hormone, stopping the eggs from being released too early and giving them the time to grow properly. So many systems at work, people!

So far, no major side effects, although I’m noticing an immediate headache after injections each night. This is due to the body’s rapid rise in Estrogen – which at baseline mine hovered at approximately 35 and at current time of writing is creeping over 300!

Day 5:
I kind of can’t believe how quickly this is going – we are already halfway through this cycle!

I had today off from going to the clinic for any monitoring and it was great to sleep in and not get poked and prodded. I’m really hoping that tomorrow’s ultrasound shows some good growth and high levels of Estrogen. I’m starting to get nervous that maybe we’ll have nothing to show after all of this work! I used to be so nervous to take these drugs and scared of all the side effects they might have. Now I just want all the drugs in meh belly! 🙂 

Tonight was the usual routine, with the usual suspects, and nothing more to report other than I’m starting to feel bloated.

Day 6
Tonight our IVF shots are brought to you by the 2016 World Series. My husband is from the Chicago area and is a huge Cubs fan. It’s Game 7 tonight, and for obvious reasons, he insisted we do our IVF protocol wearing our lucky Cubs hats! 

My protocol tonight was the same – Menopur, Gonal-F and Cetrotide – and everything was pretty standard. We jumped into a cab after shots (around 8:00pm) and headed into Manhattan to watch the final game with the boys. We aren’t imbibing during this time, but Dr. M. gave my husband the green light to enjoy a beer during the game.

It was a fun night, but I was on my feet the entire time and was very tired. It’s a long time to be standing at a bar whilst slowly sipping water amongst a crowd of drunken Cubs fans. In the end, the game got rain delayed and we hopped into a cab because it was 12:00am….but halfway to Brooklyn they called the game back on and my husband (literally) jumped out of the cab to go find his friends so that they could all watch the final two innings together. (Despite his insistence, I chose to stay the course in the cab headed home. I was exhausted!). It was a crazy, exciting night and an awesome W for the Cubs! It nearly made me forget all about our strange little IVF life we’re living right now.

Day 7
Today I got to see Dr. M. for my morning ultrasound. We are still only tracking between 5-6 follicles, but another one is catching up to make (maybe) 7. It was good to talk to Dr. M. in person for the first time since starting Stims. She said everything looked good and I can expect another 3-4 days of meds…which means Egg Retrieval will be either on Monday or Tuesday of next week already! I asked her about my “low follicle count” and she did not seem concerned in the slightest. She said that statistically, it’s on the lower end of the larger spectrum, but that I was processing nicely and that quality of eggs trumps all.

Tonight I had tickets to Brooklyn Bowl to see a concert. I purchased them a few months before starting IVF and never imagined that we’d be in the thick of this weird world come concert night. After pushing it the night before (I was up until about 1:00am on account of the game), I didn’t feel like having another night out, feeling slightly uncomfortable and worried about the time, quality of food and being on my feet.

So we ditched the concert and stayed in. We cooked some dinner and I opened up the new gift that I bought myself. Last weekend, after a few hours of research, I decided to pull the trigger on a luxury purchase that I’ve been eyeballing for awhile. Maybe it’s because I’ve been feeling sorry for myself for having to undergo these dreaded shots every night or maybe it’s because I feel like I’m working hard (extra hard!) to bring a healthy human into this world and I feel like I deserve a little something for my efforts that will make me happy…Whatever the case, it HAS made me happy. Really happy. And it’s spiced up this somber time with a little indulgence. 

Lesson Learned: Do something extra special for yourself during Stims week. You deserve it!

Day 8
I had early morning ultrasound and blood work at the clinic today. It was fine, but I couldn’t get it together in terms of energy. I feel very sluggish and foggy – kind of like I’m moving underwater. Dr. M. calls it the “Estrogen haze,” and since my estrogen levels have now climbed to 800+, it’s safe to say I’m in it! Still only tracking 5-6 follies. I decided to work from home today and tried to rest, but ended up pushing myself to work through this funk that I’m in. The nurse called and gave me instructions for tonight’s protocol which is the exact same, however, we *think* that tonight will be the LAST night of shots for this cycle!

Tonight we ordered in food for dinner and just relaxed as I’m feeling so lethargic. My headaches post shots are getting way more intense and I prefer to head to bed as soon as shots are over.

Day 9
Guess what today is…TRIGGER SHOT DAY! Holy moly did that go fast! I’m officially on “Day 9” of my first IVF cycle and there will be no regular meds tonight. Instead we’ll do a shot of the Cetrotide and then the (dun. dun. dun.) TRIGGER shot at precisely 11:45pm. The nurse said that timing is critically important with this shot and it has to be timed exactly 35 hours before my egg retrieval. 

How am I feeling? Emotionally, I’m a pretty even mix between excited, anxious, and focused. We had a friend’s party to attend today in Connecticut. It is a sunny and unusually warm day for November and our other friends offered to drive us. I was torn between going and enjoying the day, or spending my afternoon glued to the computer and researching everything IVF. Guess which one I chose? 🙂

I am so happy I stayed home. Physically I’m feeling bloated and “large” in general. I also have a slight headache and still feel foggy. But most of all, I want to focus on this endeavor right now as we’re nearing the end. The nurse is supposed to call me later today with instructions for our Trigger shot tonight and there’s no reason to push myself to attend a party and then juggle a phone call from her while I’m there. (I’m picturing myself writing down instructions for tonight’s big shot in the midst of wine glasses clinking and appetizers being passed).

I do think I’m babying myself just a little bit because, overall, I do feel well enough to leave this apartment; but I don’t care. Staying organized gives me peace of mind…and you’re supposed to do what keeps you sane during this time.  

My husband went to the party and he is on his way home now.  Once he gets here, we will take the shot of Cetrotide and try to relax, and then give the trigger shot exactly when assigned tonight at 11:45pm. We also turn the clocks back tonight, which factored into the time that was assigned to me for my Trigger. Thank god the nurse reminded me because I would have definitely not remembered, and the entire timing would have been ruined. 

Tomorrow morning at 6:30am we will go to our IVF clinic for a “pre-operation” appointment. During this time, a nurse will review the specifics of our assigned Egg Retrieval, which will take place the following day. I will also get baseline blood work done and pick-up all instructional information needed for the big retrieval day. I can’t believe it is (almost) here!