Cleared For Round Two!

While sitting in traffic on Thursday afternoon, I noticed that I had finally started to spot! Yay, progress! I know my body pretty well and I could tell my period was definitely about to start so I called up the clinic. The nurse I spoke to said that many women spot for a week before they actually bleed and she couldn't make my appointment until my period started in earnest. The clinic closes early so when my period showed up right on time a few hours later, I had to wait until Friday morning to make my CD2 appointment. Since Friday counts as CD 1, that puts 11 days between trigger day and CD 1 which is pretty much my standard luteal phase. I almost couldn't believe it, even with all the hormone injections and the retrieval, my body is still running on it's regular schedule. Apparently there's no screwing with this body clock.

So, Saturday morning rolls around, bright and HOT, and E and I find ourselves back at the clinic for for another round of labs and ultrasound. The baseline ultrasound is probably my least favorite of all the ultrasounds. I'm bleeding, crampy, sore and the whole thing is messy and gross no matter what I do. Luckily, there's no follicle counting to prolong the ultrasound so it was as short as it was uncomfortable.

When the ultrasound was done, the tech was able to give us the best news possible. My ovaries look like they're completely back to normal, no more swelling,  and we are officially starting IVF round two! I was hoping Dr. D had aspirated that tiny cyst on my left ovary, he thought he might have gotten it too because one "follicle" over there had dark blood, but it was still there, stubbornly stuck in place. Little bastard.

A different nurse than usual called back to say that she's writing up my calendar now and I can start planning to order my meds. I didn't get an official calendar last time though I realize that most people do. I'm not sure how useful they are considering that everybody responds differently and every cycle is unique but I'll take it if she wants to write it up. Ultimately, it will come down to how my follicles grow and develop but I'm planning on ordering enough Menopur for 11 or so days and enough Cetrotide for 5 days since I was one short last time. I ended up having extra Omnitrope but it's because my nurse calculated the dose wrong. She told me to take 0.25cc of the 5mg/1.5ml but it should have been 0.37cc. I'll correct the dose in this cycle and maybe we'll get even more embryos :) Here's to hope!

Maybe Mature?

Tomorrow morning I'm going in for what is hopefully my last ultrasound and blood draw to check on the follies before I'm cleared to trigger. I was doing a little more research and it looks like Cetrotide can slow down follicle growth, which sort of makes sense since it's designed to prevent premature ovulation. It's probably why these follies didn't exhibit super growth from day 7 to 9, which is also a good thing since slow and steady wins the race in quality follicle development.

As of today I'm officially out of Cetrotide and the Omnitrope syringes as well, so I'm going to need to make a trip to the pharmacy to pick up one more Cetrotide injection and syringe for tomorrow night. If the follies need a couple more days of growth I will suck it up and deal but my poor belly is so, so ready for a break! Four injections is really a lot to do every day and my belly is starting to show the effects. 

I knew yesterdays injection was a bad one as I did it, and as expected it left a nasty bruise. I snapped a gross photo of it for your viewing pleasure in case you were wondering what injection site bruising looks like. In the upper left corner you can see two "good" injection sites where only the needle mark is visible. Then, obviously, there's the big nasty bruise from the shitty Cetrotide injection. Ugh.

Nasty Cetrotide bruise is nasty.

For tonight's Cetrotide injection, I ditched the included syringe and used one of my extras. It was still a pain to mix since it doesn't dissolve well,  but at least I was able to prime it correctly. I'm also not at all a fan of the below the belly button injection site, there has to be some sort of acupuncture point or meridian there since the needle zings and hurts every time it goes in. The lower right/left and upper right/left are much less painful to inject into so I'm definitely changing the site for tomorrow. My belly needs a break!

I've got everything crossed that the appointment tomorrow goes well. Come on follies, I need you to mature! And contain healthy, mature, fragile-x free eggs, that fertilize perfectly and grow into healthy embryos. Positive thoughts!

10 Fabulous Follies!

This mornings appointment yielded even more good news - I have ten wonderfully growing follicles! TEN!

ohmyfuckingholyhellmindofficiallyblown

I'm not sure if the ultrasound tech was counting the left over cyst as one of the follies though, I had a new tech today and asked her about it. She was a really nice, positive and gentle tech but she tried to give me a bit of a lecture on how all follicles are cysts -_- I asked again specifically about the SIMPLE cyst, the opaque little circle, not the dark, clear follicular cysts, and she said it might have shrunk down so much that it looks like a regular follicle. I left it there but I just can't believe that I have 10 legit follies after being told I should never expect more than 3. It seems too good to be true.

They seem to be growing more slow and steady this cycle than they did last time. Last cycle they jumped from 13 to 19mm from CD 7 to CD 9, with a decrease in medicine, and this time the largest follie was still only ~16. This means I'm on the hook for at least two more days of stim injections but I think slow and steady growth is a good thing.

As I understand it, a mature follie is 18-20mm and several of mine were still 10-12mm. I know we won't be triggering until as many of them as possible are in that range. When Dr. Danzer called today he said he thought I might be on track for a Saturday trigger and a Monday retrieval, so my next appointment is Friday morning.

I've also read that larger follies are better quality in "younger" women (under 35) but poorer quality in "older" women (over 35). The big question is - do my ovaries make "young" eggs or "old" eggs? Do they act like 27 year old eggs or does the premutation make them older/poorer quality? What is the ideal size for 27 year old, premutation eggs? If they're all committed to growth, they should grow 1-3mm per day so that lead follicle could potentially be 22mm after two more days of stims. I guess we'll just have to see!

Cetrotide, Menopur and Omnitrope

In the meantime, it looks like I'll be enjoying my 4 injections per day for a little bit longer, including the wretched Cetrotide. Every time I inject it I dislike it more and more - this last shot was ridiculous, it wouldn't prime and I wasted a ton of drops and still had a bubble that wouldn't get out. I'm actually thinking of using a different syringe all together for tomorrow and just chucking the glass one that you're supposed to use. Definitely not worth the hassle.

Itchy Sitchy

Today was day two of adding in Cetrotide to my IVF protocol and I have to say it's not my favorite medicine. I've been pretty lucky to only experience a few side effects from the various meds but the Cetrotide is one of the most annoying.

Thus far, I've had:

• Head aches -  I can't tell if these are from the Menopur/Omnitrope or from the insane heat we've been having. I've only had two that were really unpleasant and I'm trying to drink a ton of water in case it's the heat since I can't take Advil
• Cramps - These I think are mostly from my period take two, the withdrawal bleeding you get after you stop birth control, but I've had twinges after every injection as well. They're more in my uterus than my ovaries so who knows what is causing it. My bet is on the Menopur. 
• Numb toe - This one is definitely the Omnitrope. One small section of my right big toe went numb, it was the weirdest thing. I had no idea it was a common HGH side effect.
• Sore joints - Again the Omnitrope. Mostly my right knee and it's only been a couple times, another common side effect.
• ITCHING - ding ding ding, we've reached the Cetrotide! The Menopur burns while you inject it, but the Cetrotide itches for at least an hour after. The problem is the itch is under your skin so you couldn't scratch it even if you wanted to scratch a fresh injection site. Gah. 

Tomorrow is day 9 of stims and I'm hoping these follicles are going to be nice and mature at tomorrows appointment. We only needed 9 days of stims for our last IUI cycle and thus far these follies have been tracking my last cycle almost exactly. Plus, my belly is covered in track marks and despite it's ample and expanding girth, I'm running out of injection sites!

Our protocol now looks like:

CD 1: Nothing
CD 2 - 14: BCPs
CD 15 - 17: Nothing
CD 18 - 22:  600IU Menopur (2 injections), 0.25cc Omnitrope (1 injection) and 1mg Dexamethasone
CD 23 - 24:  600IU Menopur (2 injections), 0.25cc Omnitrope (1 injection), 0.25 Cetrotide (1 injection) and 1mg Dexamethasone

We also need to get the saliva kits shipped out for my mother and sister. They need to be over-nighted there which I'm sure will run us at least $50-$100, and means I need to get them collected and shipped on the same day. This has been a bit more difficult than you'd think since we need to coordinate three schedules and collect samples on the same morning. It's on my to do list for tomorrow so hopefully everything works out.

In the meantime, all my energy is directed at those 9 follicles maturing in my ovaries. Come on follies, grow, grow, grow! I need good, healthy, mature follicles at my appointment tomorrow.

It's Time for Cetrotide

E and I got so much accomplished this morning! We had a really tight schedule and just managed to fit everything in before he had to go off to work but we got to check a bunch of things off our list. As usual, my first task was this mornings injection - 4 Menopur to the right of my belly button and 1 swallowed dexa. Couple that with a shower, feeding the poor starving cats and dogs (2 had been fed only 2 hours previously while the others hadn't eaten since dinner, you know, a lifetime ago) and we just barely made it out the door in time to get to our vial pick up.

Just like last time, CA Cryobank was perfectly prepared. Our vials were waiting for us in their filled transport tank and I was in and out of there in under 5 minutes. We confirmed our donor number, the number of vials we were picking up (3), and signed the paperwork promising to return the tank, a errand I need to remember in the next couple days.

With our pick up complete, we headed straight to SCRC. They were really, really busy this morning but their lab tech D was ready and waiting for me. He took the tank to hold on to so I didn't have to lug it around to different rooms and I went in for my ultrasound first.

Today is day 7 and I had to look back through my notes to compare apples to apples but it looks like we're in almost the exact same place this cycle as we were last cycle. We saw NINE lovely follicles, eight maturing together between 10-13mm and one that was just a bit under 10. I am thrilled to tears with these numbers, even if it's likely the 9th one may not mature in time for collection. It's still way better than I was expecting and I am so hopeful that these eggs turn into healthy, viable embryos. Grow follies, grow!

After the ultrasound I went to get my blood drawn and chat with lab tech D. D is awesome, he had all my paperwork ready for me to read over and sign for SCRC and Reprogenetics, the vials for my estradiol and PGD probe sample ready to be filled and he managed to hit the vein in my arm in one go. I was just resolving myself to do all my blood draws from my wrist but now that I know D is such a rock star, I will be sure to ask for him again. He got a direct hit, perfectly into the vein and had those 3 vials filled within seconds. I am so, so appreciative of good techs.

D is going to be sending out one of our donor vials and two purple topped vials of my blood out to Reprogenetics today. I haven't received the saliva kits for my mom and sister yet, so getting those and sending them out is next on my list of to dos.

I also got my marching orders for my medication and it is time to add in my Cetrotide injection. This brings my daily total up to 4 injections, and since I've already done my morning shot, unfortunately means I'll be doing 3 in one sitting. This messes up the careful balancing act of rotating injection sites that keeps me from getting bruised and sore, I was hoping to balance it out to 2 in the morning and 2 in the evening but once you start at a certain time they prefer you keep it at that time. Ugh.

I've been doing:

• 1 Menopur in the morning to right of the belly button with my dexa pill
• 1 Menopur in the evening to the left of the belly button
• 1 Omnitrope in the evening high and to the right of the belly button, though I have done the left once or twice

I've found that even if I do one shot high and one shot low on the same side, I end up having to pinch over a fresh injection site to get the other site which isn't fun. Since it looks like this injection is supposed to go into the belly as well, I'm thinking of maybe trying it lower, below my belly button and somewhere in the middle.

An injection site diagram. I use both Menopur sites every day and change up the HGH sites. I'm thinking the Cetrotide should go down at the bottom.

It's hard to believe that I'm running out of injection sites, especially given how large the injections are making my belly -_- I'll have to give it a shot (ha!) tonight and see if I can pick a good spot that doesn't overlap with any other sites.

First IVFMeds.com Package!

My first package from IVFMeds.com arrived! And it was, surprisingly, right on time. I know I've already admitted that I was really nervous ordering from overseas - if you google IVFMeds.com there are a couple reports of people complaining about problems with shipping speeds, packages getting stuck in customs and trouble getting refunded. They all made me pretty uncomfortable but since my nurse had never had a problem with them, I ordered anyway. 

.....And then called their customer service line about 10 times. Asking about their process, asking about their shipping methods, confirming the order, confirming the prescription for the order, asking about when the package might be here, asking about when the second package should ship - you get the point. I called a lot.

Each time I rang, a customer service rep answered quickly and courteously. I had no problems getting through, they were helpful and friendly, and more importantly they gave me correct information. The British gentleman who answered my last call about the estimated delivery date and the second package shipping was spot on - he told me the package would arrive Saturday (today) and that I needed to have someone home to sign for it. If there wasn't anyone home, he promised me the package wouldn't have any identifying information on it and suggested I leave a note for the postman and ask a neighbor to sign for it. Since they had to split my order into two shipments, the second would be going out Monday and should arrive Thursday.

Excellent packaging

 

The postman pulled up right on time Saturday afternoon. I almost missed him because he heard my dogs bark and decided to just drop the note in my mail slot and run without ringing the doorbell. I'm so glad I had the heads up from customer service or I wouldn't have been lurking around waiting for him. This one didn't exactly have nerves of steel.

On to the package! The order came in two envelopes - an outer poly bag with no identifying marks and an inner padded envelop. Each box of medicine was wrapped in bubble wrap, and since this order contained 32/72 Menopur, my two individual vials of Menopur were bubble wrapped and then placed inside a separate small box. I opened each package to inspect the vials and every one of them arrived safe and sound.

As I expected, the European Menopur comes with glass ampoules of Sodium Chloride instead of glass vials. You're supposed to snap the tops off at the marked weak point and draw up the liquid with a needle and syringe. The US Menopur comes with glass vials and Q-Caps - these little plastic caps that snap onto the glass vial and allow you to mix the Menopur without a needle and syringe. It doesn't look like these ampoules would be terribly hard to use, but since I have tons and tons of Sodium Chloride vials left over from my IUIs, I don't think I'll need to use these. I will probably just use the American Sodium Chloride vials with a Q-Cap and a European Menopur vial. The European Menopur also comes 10 vials to a box, while the US version comes 5 vials to a box.

The European Cetrotide is something I haven't used before, but it looks fairly easy to use as well. The packages came with a syringe pre-filled with a liquid, a vial of Cetrotide powder and two needles - a large one for mixing and a small one for injecting. It looks like much the same process as the Menopur and I assume it's similar to the American version of Cetrotide. Inject the liquid, mix it around, draw it up, swap the needle and inject.

Thus far I'm really pleased with IVFMeds.com - their service has been great and as long as my second package comes on time and the medicine works as it should, I will have no problem recommending them to anyone else going through IVF.