Feelin’ Trigger Happy

Everything in IVF is moving to the next step of the unknown: How are shots going to feel? What will side effects be like? How will monitoring go? It’s time for us to move to the “trigger shot” phase of things and normally this new step would leave me feeling anxious, since “triggering” means it’s time to put away the small SubQ needles and bust out the big guns: the (very) long Intramuscular needle. However, since we already administered an Intramuscular “mixing” needle to my stomach on my first night of injections, I feel pretty prepared to handle this next step.

As I reviewed here, during your Stimulation cycle, doctors are monitoring your body’s reaction to the fertility hormones for 4 major indicators: Progesterone levels, Estrogen levels, Endometrial lining, and Egg maturity. Once all four have struck the right balance, it is time to stop stimulation medications and administer the trigger shot to induce ovulation.

With my Estrogen levels skyrocketing to 1,128 pg/ml and my six growing follicles pushing 20mm, we are ready to pull that trigger!

What is a Trigger Shot? The trigger shot contains the synthetic hormone Human Chorionic Gonadotropin (hCG). In women who are pregnant, hCG occurs naturally as it is produced by the growing placenta. All home pregnancy tests (HPTs) are measuring for hCG, since trace amounts appear in the urine a few days after successful implantation of the embryo and continue to double every 2-3 days in early pregnancy. This rapid rise of hCG is also what results in early pregnancy symptoms, like nausea. 

In an IVF cycle, a high dosage of synthetic hCG (usually 10,000 IUs) is administered 36-hours before the egg retrieval process to stimulate ovulation. Although a women’s eggs will be manually retrieved during the medical procedure of Egg Retrieval, the hCG hormone helps to “trigger” the follicles to begin their release of the eggs, hence its name.

As I described in my last post, I had opted to stay inside all day yesterday to “mentally prepare” for this next step. Although that decision made me feel more organized, it also made me get into my head and I ended up really starting to dread this injection. When it comes down to it, I have never mixed a whopping dose of 10,000 IUs of hCG hormone and administered it into my butt via a 27-gauge needle before. How do you “prepare” yourself for that? The answer is you can’t.

Well my trigger shot went just fine; better than fine, it was really insignificant. I made sure to ice the area (the upper outer quadrant of my butt) for about 15 minutes, and when the clock struck precisely 11:45pm (my assigned time), my husband did the deed. Following instructions, he plunged in the needle at a 90-degree angle (quick, like “throwing a dart,” they say) and, for a brief moment, I did not feel it at all. Then of course the usual burning happened as the medication went in and my muscle felt tender and sore. Other than that, I felt nothing; and today it is as if it didn’t even happen.

What I did feel after the shot was a surge of energy and euphoria. I kept my husband up for an hour afterwards, excitedly explaining (in painful detail) my follicle progression thus far and all of the different outcomes that we might expect at the end of this cycle. After quietly listening to this really boring, one-sided conversation, he finally remarked: “Sweetheart, what in the world was in that shot! Speed?”

I think my “girl-on-speed” reaction was not related to what was in the shot, but rather that the shot was OVER and nothing bad had happened. No matter how brave of a face I put on before these shots, my heart always races, my anxiety levels surge, and when it’s all over, I’m filled with sweet relief that leaves me excited and (apparently) very chatty.

So now I have my first trigger shot under my belt! 🙂 Milestones! Milestones!

I wanted to note here that I did feel a bit uncomfortable for a few minutes before falling asleep last night. It was a pressure-like feeling on my lower abdomen that felt annoying more than painful – like an uncomfortable “itch-that-can’t-be-scratched” type of feeling. For the first time in this entire process I felt a little “claustrophobic” in my own body. Thank god these 6 growing follies are being retrieved from my body on Monday. We’re running out of room in here!

Lastly, one final note about trigger shots. Most early pregnancy symptoms – like nausea – are the result of the rapid rise of natural hCG in a pregnant woman’s body. This ranges between 50mIU/cc in the first few weeks of pregnancy and 1,000+mIU/cc by week six.* But I noticed that after administering 10,000 IUs of synthetic hCG into my body last night, I have felt none of these early pregnancy side effects thus far. No nausea, no bloating, no headaches. Does this mean that synthetic hCG affects a woman’s body differently than natural hCG? Does this mean that a dosage of 10,000 IUs (International Units) is different than the units used to measure hCG in the blood stream (mIU/cc), and therefore it’s not an exact 1:1 ratio? Or does this mean that I am not as sensitive to hCG as some? (The varying rates of hCG sensitivity explains why some women are “very sick” during the first few weeks of pregnancy and some “feel nothing at all”). I don’t know the answer to these questions, but I’m putting them out there because my curious mind wants to know. 

*There’s a wide range of pregnancy hCG levels. Click here for the full list.