IVF # 1 - How to Mix and Inject Luveris (and a monitoring appoitnment update)

*Update - the clinic just called with my E2 and we're up to 3879 (1057 in US units). Holy huge jump! I'm very pleased with this!

*Monitoring update at the end!

Today we are going to learn how to mix and inject Luveris, one of my daily injections. Luveris is synthetic lutinizing hormone, aka LH, and is used in conjunction with Gonal-F (which is a follicle stimulating hormone, or FSH) to stimulate oocyte growth. I'm now on day ten of injections, so I've kind of got this one down, but the first couple of times I was really nervous that I was going to miss a step and screw something up.

First thing first, you need to get all your supplies in front of you on the table. You need a box of Luveris, a syringe, needle, Q-cap, and two alcohol wipes.

Now go wash your dirty hands. I dry them off using paper towel just to avoid lint and possibly dirty dish towels. First step is to take out the two vials (one saline and one the powdered Luveris) and pop off the tops.

Using one of the alcohol wipes, wipe down the tops of both vials really well.

Set 'em down and open up the Q-cap and syringe. Make sure you don't touch either end of the Q-cap, especially the pointy end (that goes in to the vial).

The Q-cap screws in to the end of the syringe. Screw it in so it's tight (not too tight), and the pull back on the syringe plunger and fill it with 1 ml of air. You do this so you can displace the volume of fluid in the vial as you're drawing it out. Makes things easier, apparently.

Now that you have air in the vial, you can flip it over and push the Q-cap down in to the bottle of saline. It takes a teeny bit of force, but shouldn't be difficult to snap it in. Push the air in to the vial. Then, holding the plunger down (the air will try to push back out), turn the syringe/vial upside down and slowly draw in the saline.

Once you have it all in there, flip it back over and pull off the vial. Don't worry, it won't spill. Next, take your vial of powdered Luveris and pop it on with the syringe right side up. Slowly push the saline in to the vial. Now, swirl it around. Don't shake it, or you'll create bubbles, which are bad. It'll only take about 30 seconds for everything to dissolve.

Now that it's all mixed, flip it back upside down and slowly draw the mixture back in to the syringe. I usually draw back so I have a bit of air in the top, then push it back up so the liquid is right at the very top of the syringe. Next, screw off the Q-cap and open the needle package. The needle screws in similarly to the Q-cap.

Holding it needle point up, take a look for bubbles and flick the syringe to get them up to the top. It's ok if there are a few small bubbles, it's not like it's going in to a vein. Once you get the bubbles to the top, remove the cap and slowly, slowly push on the plunger until a few drops of liquid come out of the needle. Now you're set to inject!

Now is where the second alcohol wipe comes in. I inject in my stomach, but you can also inject on the outer thigh. I tend to move around a few inches each time too, just to avoid too much bruising. Take your wipe and wipe down about 2 or 3 square inches on your injection spot. Let it air dry for a few seconds and then take a good pinch of fat.

Keeping it in a pinch, insert the needle. It really doesn't hurt, just try not to hesitate too much. The anticipation is the worst part, trust me! Once it's in, slowly inject the liquid. It does seem to sting a bit if I go too fast, so I take about 10 - 15 seconds to inject it all. Once it's all in, hold the needle in for another few seconds to make sure it's all in there. Let go of the pinch, and pull the needle out.

Cap the needle, take it apart, and put it in your sharps container. Easy peasy, right?

Honestly, in the beginning of this all, I was thinking there was NO WAY I could give myself injections. But, I will do anything to have a baby, and it is not bad at all once you get comfortable with it. Good luck!

Monitoring update: my ultrasound this morning went well! I now have eight follicles on the left, with the leaders at 16mm, 13mm and 13mm, and five on the right, with the leaders at 13mm and 11mm. My lining is triple stripe at 8.3mm (this is good). They have me on the same dose of Gonal-F and Luveris for two more nights, and then my final monitoring appointment on Thursday morning. I should be triggering Thursday night if it all looks good, which puts the retrieval on Saturday.

Just wanted to post this cute note my husband left for me on our whiteboard the other day:

Yup, I'll get right on that!

IVF #1 - Day Six Ultrasound and Bloodwork and How to Inject at a Party

Bright and early yesterday morning (I never get to sleep in anymore) I headed to the fertility clinic for my day six ultrasound and blood work. Surprisingly, the clinic was pretty busy, so I had to wait about an hour and a half. One of the other clinic doctors did my ultrasound and he kindly showed me everything on the screen. He started on the left ovary and counted seven follicles. He measured five of them and they were all around 10mm or 11mm. The ideal size for trigger is about 18mm to 20mm, so we are just over half way there. The right ovary was not responding as well and only had four follicles, of which only two of them were around the 10mm mark. Not too bad, but I guess I was hoping for more.

I got the call with my E2 results a couple of hours later: 501. This is still pretty low, so they've significantly bumped up my Gonal-F to 375 UI. Hopefully this gets things going a bit faster! Either way, the nurse thinks we'll be triggering on Wednesday with egg retrieval on Friday. I can't believe how fast this is going!

So last night Derek and I travelled an hour and a half north of the city for his cousin Jon's 1920's dress up Murder Mystery birthday party (We had a ton of fun! Derek is still sleeping off the fun he had!). We arrive just a few minutes before six, which is when I do my injections, sos soon as I was in the door, I beeline it for the bathroom. Normally, it takes me about 10 or 15 minutes to do both injections, what with mixing the Luveris and making sure I'm doing everything properly. Considering there were a bunch of loud people outside the bathroom door, and a knock or two, I was trying to hurry up and get it done. I was nervous I was going to mess something up and tried not to drop plastic caps and needles off the small bathroom counter. I was unable to use ice on the injection sites, but surprisingly it didn't hurt at all - guess I don't really need it! I was so shaky and rushed that I had to take a few deep breaths before each inject to make sure I got it in straight. I think I was in and out in about seven minutes.

I've heard stories of women who've had to do injects in an airplane bathroom or in a vehicle - I don't envy them! Doing it in a strange bathroom was bad enough. Anyway, I got it done, and the side effects are certainly kicking in. I'm bloated and crampy, have a constant headache and am tired all the time. Hopefully my body is just preparing for the next ten months!

Next appointment is Tuesday for another ultrasound and blood work. Fingers crossed for good news!

Hobbling to my First IVF Appointment

First thing this morning Derek and I headed to the fertility clinic for my first round of blood work. They are looking at my estrogen levels, which are indicative of how my follicles are developing. Ideally, at this point, they like to see between 250 and 500.

While there, we spoke with the nurse and I had her explain to me what it was the doctor used during my ultrasound on Sunday to straighten out my cervix. Apparently they use what are basically forceps and pull on the cervix to straighten it out and get the catheter in. No wonder it hurt so much! I also learned, as the nurse was describing this process, that the non-pregnant uterus is about the size of putting your pointer finger against your thumb and making a tear drop shape. Way smaller then I thought. Must refresh self on anatomy, apparently! Derek is also having bad side effects from the antibiotics he has to take - lots of nausea. She said that if he's still having issues after tonight's dose to call and they may let him forgo the last day.

Following this appointment, we went to my physical therapy appointment for my knee to determine if I will need surgery or not. If I did need surgery, we would postpone the embryo transfer, freeze everything, and do the knee surgery first. Our primary concern was that my knee would not be able to support the pregnancy weight, and I wouldn't be able to get around during or after. Of course, I thought this was fine ("I'll figure it out!" says I, in tears), but Derek pointed out that this would put a lot of unfair pressure on him and the baby, which is not what we want. 

Anyway...I don't need surgery! Well, I might some day, but the therapist was confident that I will be able to rehabilitate and strengthen up enough to support pregnancy weight and even go back to cycling and running. He did say I will have to avoid the harder skiing, but could probably get away with skiing resort runs (not this year, of course). He did an assessment, said he felt some laxity in the forward/backward movement and thinks I may have partially torn my ACL and MCL. I am planning to pay for a private MRI in the next week or so and will see him weekly. We did a bit of acupuncture and ultrasound on my knee to help with swelling and he gave me two exercises to help increase the range of movement in my knee.

As I'm laying on the table with needles in my leg, the clinic calls. My estrogen today was 130, so not even close to where they want it. All this means at this point is that I increase my dose of Gonal-F to 225 UI, and continue with 75 UI of Luveris. Not a big deal, but this does mean our drug costs increase. We do get it back from insurance eventually, but it's still hard to pay thousands of dollars up front.

So, next step is to go in for an ultrasound and more blood work to check estrogen levels on Saturday morning. Fingers crossed everything looks good! If I progress as expected, it's only ten more days to egg retrieval!

IVF Number One - Day One

Bright and early this morning, I hobbled in to the fertility clinic (I hurt my knee pretty bad on Friday - more on that later) and had my baseline ultrasound and blood work. I remember when I used to be scared of needles and would almost cry any time I had to get blood taken. Ah, those were the days. Dr. S came in to do the ultrasound, check my lining, and check the depth of my uterus. She said my ovaries look nice and quiet (the right looks really good, apparently, whatever that means) and my lining is nice and thin. She had to insert a catheter to measure the depth of my uterus to determine how deep they insert the catheter during the embryo transfer in a couple of weeks. The last time I had catheters inserted was during our IUI's last winter and it hurt a lot back then. It still hurts now. She tried two sizes and still couldn't get through, so she ended up using this painful tool to straighten my cervix out and finally got in. I had some pretty good cramps for a few minutes, but nothing I've never felt before.

I came home and waited for the clinic to call with my blood results and the final go ahead. I got the call at 11:15 - my blood work showed my estrogen was 'below 72', which means I have no cysts or rouge follicles growing. So, I start injections tonight - 150 UI of Gonal-F and 75 UI of Luveris. I continue to take the Suprefact, which I've been on since February 2, but drop from five sprays a day to three.

Now, when you do IVF, there is a lot of information and...medical stuff to deal with. The afternoon I pulled the Luveris and one of my Gonal-F pens out and set everything up on our kitchen table.

It's a bit overwhelming

The Gonal-F is a pen, so all I need to do is insert the needle, twist the dial to '150', and inject in to my stomach or thighs.

Easy-peasy!

The Luveris is a bit more involved. It comes in two vials - one of saline, and one of the medication in powder form. Using a syringe (no needle on it yet) and something called a Q-cap, I pull the saline out of the first vial and inject it in to the powder. I swirl it around until it dissolves (no shaking - it creates bubbles) and pull it back in to the syringe. Add the needle and inject in to my stomach or thighs. I've read that this one might sting, so I'm planning on icing for a bit first.

Let's hope the instructions are clear enough.

I go in on Wednesday to get more blood tests to check on my progress. My estrogen should be rising indicating that my ovaries are being stimulated and creating those precious eggs. As long as my numbers are not too high, I don't go in again until Saturday, when I get more blood work and an ultrasound to count follicles. I'm just so glad we've passed this first hurdle and can get going!

Now, the knee injury. On Friday, Derek and I went skiing and I fell pretty hard on our first run. My ski got caught up and I twisted as I fell. When I fell, I felt and heard a loud pop in my left knee and had significant pain. After about 10 minutes, the pain started to subside and I tried to stand on it...no go - it felt like it completely dislocated and collapsed inwards. I was taken out by ski patrol and we went to the hospital. The preliminary diagnosis was a dislocated knee, but after some of my own research, I think it's more likely I tore my Medial Collateral Ligament (MCL). I am in a brace and on crutches, but the knee still feels pretty unstable. The bad news is that if it's a complete tear, I'll need surgery, and I'll need it before I attempt to support pregnancy weight on my knee. That means we might have to postpone.

I spoke to the nurse and she suggested we continue on with the injects until I can see the physical therapist on Tuesday. If it's something that is going to require surgery, we do have to option of freezing everything, or there is the possibility of doing the surgery with an epidural instead of general should I become pregnant (general anaesthetic isn't really recommended in pregnancy). If it does not require surgery, I'll be undergoing intense physical therapy to rehabilitate my knee as quickly as possible.

So, fingers crossed for lots of eggies and no surgery! Here we go!

Lucky Cycle Number 48!

When I went in to pick up my medications and review the instructions with the nurse the other week, she specifically told me I may or may not get my period while taking Suprefact. Regardless, my period was late, so I started to panic a bit. My first thought was that I must be pregnant, so tested. BFN, of course. And then I started worrying that this might delay things, and was ready to call the clinic this morning, when AF was six days late, to ask their opinion.

What happens when AF is six days late and your lining gets to build up an extra little bit before it lets go? You have a massive period, that's what. I was violently awoken at about three this morning in a sweaty mess with horrible cramps. I laid in bed, afraid to move, trying to breath through the pain. It's a tough spot to be in - thankful it's finally here, but pissed off that it sucks so much. I finally got out of bed and started searching for pain relief. I normally take Naproxen/Aleve, but it's off the table during IVF, so my only option was aspirin, which never works well for me. Because it never works well, I don't really keep it in the house. All I had was the low dose aspirin I take daily as part of my protocol. I check the bottle and see that one to four pills at a time are recommended. I take five, which is almost equal to one extra strength aspirin. I crawl back in to bed and waited for it to kick in, finally falling asleep around 4:30 or so for an hour.

So, yay, Valentines period! I'll take that as a good sign, er, somehow. We're at t-five days and counting until the baseline appointment this Sunday. The last four or five days have gone by surprisingly fast, and my week's plans are starting to fill up, so Sunday will be here in no time. I am a bit nervous about starting the injections, and hopeful I can do them in the evening rather then the 1:00 pm to 5:00 pm window they give on the information sheet. Bringing the needles and sharps container to work is not ideal.

Fingers crossed for a good baseline appointment and for finally getting going on this! We're now officially in lucky cycle number 48 - yup, about four years of TTC now. Crazy how time can fly but seem to drag on at the same time.

IVF #1 begins with Suprefact!

A couple of weeks ago I excitedly went and picked up the first two thirds of my IVF medication. I was excited until I saw the price, anyway. Oh, the costs of having a baby the science-y way.



Oh, the fun!


Along with low dose aspirin and prescription prenatals (with 5 mg of folic acid), I started my down regulation last Thursday (February 2) with Suprefact. Suprefact is synthetic LHRH analogue and the purpose of it is to put my ovaries to 'rest'. It stops me from ovulating on my own by supressing hormone production in my pituary gland. Suprefact is a nasal spray that I spray once in each nostril, every four hours, five times a day. As soon as I wake up in the morning, I grab it from my nightstand and squirt, squirt the stuff up my nose. Right before I go to sleep, I take my last dose. It's not horrible, but it does run down the back of my throat most of the time and it's not that tasty. Fortunately, the only side effects I've noticed so far are occassional hot flashes, and they aren't that unbearable.

I'm on Suprefact until my baseline bloodwork and ultrasound on February 19th. If my estogen levels and ovaries look good, I start injects of Gonal-F and Luveris to stimulate the production of follicles. More on that when the time comes.

While all this is going on, I'm also holding out hope that this last month of TTC worked. I know it likely didn't, but I am still analyzing every pinch and cramp. I'm 12 days past ovulation and should be getting my period on Wednesday or Thursday, but I'm holding out on testing (again!) until then. However, I do feel much more positive about the fact that if this cycle doesn't work out, we have a fantastic next step lined up! While I'm scared the IVF won't work, I'm hopeful that it might be our turn this time.

By the way, next cycle is cycle 48, so about four years of TTC now. Time flies, but not when you're TTC!