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.

Another Win for IVFMeds.com

I woke up before my alarm this morning, worrying even in my sleep about my meds being delivered. I checked the tracking first thing but it hadn't been updated at all since the package landed in New York. Uh oh.

I got everything ready to start prepping my morning shot and got USPS customer service on the phone. The rep was very nice but had absolutely no new information - all she could see was the same tracking page I was already looking at. I told her the package contained time sensitive medication that I needed for the weekend and after a 2 second pause she told me the package wasn't going to make it and I should look into getting my meds locally. Double uh oh.

So here I am, trying to mix my Menopur via needle and figure out what to do. I called Kaiser first since they had a valid prescription on file for me - no answer. I forgot that they changed their pharmacy hours and they're no longer open over the weekend. My next call was to Rox San pharmacy, the pharmacy my clinic deals with most often, where I left the most scattered voicemail ever:

"Hi, my number is...I mean my name is S, I'm a patient over at SCRC and I ordered my medication online but it looks like my package has been delayed. I don't have enough meds to get through the weekend...I'm supposed to take 8, I mean a day...so I need to pick up a couple boxes of Menopur. I should probably get my Novarel too....My name, I mean my number, is blah blah, sorry I'm super scattered today kthanksbye"

It's not easy to use a cell phone and keep your field sterile and I kept accidentally sticking the mixing needle through the side of the rubber stopper. Oy. The next call was to SCRC where I left a message for the weekend nurse since no one was picking up. This one wasn't as scattered but you could probably tell I was freaking out a bit because both the pharmacist and the weekend nurse called back a few minutes later. The pharmacist was calm and kind and told me she could get in touch with the nurse for me and have my meds ready asap. It was about 9:30am now and they closed at 11:30am so we would need to move fairly quickly. A minute after that, the nurse called back and said she was sending over a script for 15 vials of Menopur and the Novarel. I was finally able to take my injection and ten minutes later the pharmacy called to say my order was ready.

Now here is where things got muddy again. I was all ready to go and pick up my Menopur when I get a tracking update that my package has landed in Los Angeles at the big sorting facility. Thus began the debate - do we go and buy the Rox San meds? Do we wait and hope the package makes it to our local post office and out for delivery before they close? The package was running several hours behind the first one which had made it to our local post office by 9ish. It was now almost 11am and it still wasn't there. Do we risk botching the entire cycle and have to cancel? No.

We decided it wasn't worth the risk. Rox San wasn't open on Sunday and this was my only chance to get my medication locally so we went ahead and bought more meds. Three boxes of Menopur,  one box of Novarel and needles/syringes ran us $1250 that I hadn't planned on spending this month. Ouch. But now we were prepared, I had enough meds to get through the weekend and if the package didn't come till Monday I would still be okay.

The pharmacist who packed my order at Rox San gave me this lovely hand carved jade pendent for luck. I'm sure they give them to all their infertility patients but it still made me feel all warm and fuzzy. I can't help but appreciate the little things like this and the way they can brighten up even a crazy stressful day. 

1pm rolls around and our local postman pulls up with no package. He double checked everything and said that he usually receives express packages in the morning. They never make deliveries in the afternoon. He definitely hadn't received anything for me, so I shouldn't expect the package till Monday. Again I felt okay about our decision, we had made the right move, the package didn't come so we'd covered our bases. I bet you can see where this is going.

2:30pm rolls around and there's a knock on my door. Oh hey, look at that.  It's another, different postman. He has my package. Safe and sound and delivered as expected, given that it was shipped out two days later than expected.  Oh man. So now I have the whole IVFMeds.com order, each package was shipped on Wednesday and delivered on Saturday and I just spent $1250 on local meds. Whoops.

I probably would have felt worse if the stakes weren't about 20k high. Cancelling this cycle would mean we were out what we'd already spent plus all the medication, so I'm glad we covered our behinds. I'm also looking into the offer the IVFMeds customer service rep made to reimburse me the difference in medication costs since they knew my package was shipping two days late. I'm not sure if they'll still honor it given the circumstances, but I'll give it a go. I had to bump my protocol two days anyway to accommodate the shipping time which I know not everyone can do and I had 15 vials of local Menopur to offset it. We'll see what they say on Monday.

Day 5 of injections is now complete and it looks like everything ended up working out. I will definitely be ordering from IVFMeds.com again, but with a little more wiggle room for shipping. Four days really does cut things a bit close. Their customer service has been amazing thus far but I'd like to have my meds in hand a couple weeks before my second cycle so I don't have to repeat this crazy stressful process.

Follies Ahoy!

Day 4 of stims and my ultrasound showed at least EIGHT follies! This is the best start to a cycle we've had yet!  And although I'm not getting my hopes up, the tech actually wrote 4-5 for each ovary, but I could only see 4 on each when I looked at the screen with her. Maaaaybe 5 on the right side, but she went pretty quickly. They don't measure each follie individually until they're bigger, mine were all under 10mm. They did all look about the same size though which is wonderful, I didn't see any lagging behind or pulling ahead. I forgot to ask my nurse what my estrogen level was since I missed her call and she left a voice mail, but I will definitely remember to ask next time. Until then, my marching orders are to continue with our existing protocol.

I didn't realize E had snapped this photo :) There are my 8 lovely follies, and my lining is 7.7!

I had the same phlebotomist this time as my last appointment, but I decided not to mess around and went straight for the hand. I told him about the bruising from last time and he agreed he'd rather go for the vein he knows he can get in one go, rather than poking and jabbing and bruising me again. It stung again but didn't leave a bruise and it didn't hurt nearly as much as being repeatedly poked.

Our next appointment for ultrasound and labs is Monday morning when I also do my blood draw for PGD and bring in my donor vial to be sent to Reprogenetics. Our clinic's lab guy said he'd rather all our genetic material go out at once so he asked me to let the clinic send the vial instead of having the cryobank send it directly.

Tomorrow I'm expecting my second package from IVFMeds.com and I NEED that package to come on time. Thus far it's mimicked the same delivery movements as the first package and it should be right on schedule for tomorrow morning. I've posted signs on the door for our postman to Not Leave without delivering the package, and there should be someone home all day. If the package doesn't come, I will be completely screwed and will have to rush to a pharmacy and get vials for the weekend. I don't think the Kaiser pharmacy is even open over the weekend so that package has to come on time.

Thinking positive, I'm so excited for those 8 follies. Sticking myself at least 3 times a day will be all worth it if this works!

Vials Ordered!

Today we were able to check off another thing on our IVF checklist - we officially ordered our donor vials! The doctor in charge of PGD at SCRC has started coordinating with Reprogenetics to get our genetics package ready to go. I was going to ask for a blood draw for PGD tomorrow when the phlebotomist is already doing a draw for estradiol but the PGD doc said no. He'd rather send all our genetic material at once, and since he doesn't want to ship our package on Friday, he asked me to come in and get it done on Monday. 

He's also ready for our donor DNA so we went ahead and placed an order for 5 vials. We're going to pick up 3 of them on Monday morning and hand deliver them to SCRC ourselves when I get the draw done. That way he can send our vial and my blood sample in the same package - I might even try to get my mother and sister's saliva samples in the same box but I don't know if the kits will come in time. The other 2 vials will be stored at CA Cryo in case we need them.

I realized I never got a good shot of the EU Menopur mixing needle so I snapped another shot this morning. This was the first batch I'd mixed entirely via needle and it did take longer than it does via Q-Cap. It also seems to get more bubbly which means I spent more time tapping out bubbles and waiting for each vial to settle. 

EU Menopur and mixing needle

The EU Menopur vials are the slightly larger vials with the blue caps. From left to right, you have the 3ml syringe, the mixing needle and the little injecting needle. The mixing needle is really flexible which means you can get into those corners to get every drop, but you do have to do a lot of wiggling and sucking to get everything.  More than once I ended up with bubbles on the bottom and had to empty the liquid back in, swirl and tap out the bubbles, and then draw everything back up. It takes awhile to mix a lot of vials. 

As for the HGH, I had good luck with the Omnitrope last night and managed to not bruise myself! I did my injection a little closer to my belly button and aside from the heat and soreness that night, there's no other sign of injection besides the tiny pinprick. I'm about an hour away from prepping this evenings injections and will hopefully continue the good luck!

Day Two of Stims!

Today was day two of my stim injections and I think I'm finally getting back in the swing of things. The first day was a little tough, I felt unexpectedly nervous and my heart was pounding in anticipation of the Menopur burn. It was pretty much exactly as I remembered it though, and by this morning it felt routine again.

Now that I've tried a few of the new medications for this cycle, I'm starting to get a feel for how everything works in practice. Thus far:

• Omnitrope (HGH) - this is one bubbly sucker. The solution is really fragile, you're not supposed to shake it and it bubbles at the slightest provocation. This can be a pain in the ass but since I got the cartridge vials and not the 5.8 vial I'd have to mix like the Menopur, I'm not complaining. I have to draw it back and inject it with the same needle which does dull it slightly, and I do have a small bruise at my first injection site. I also have some heat and soreness at my injection site this evening but I can't tell if its from the Menopur or the Omnitrope since I injected them on the same side. I do morning injections (4 Menopur) on the right, and evening ones on the left (4 Menopur and 0.25 HGH). I might switch things up tomorrow and inject the Omnitrope on the right to give my left side a break.

The cartridge vial is so skinny, but you can still draw pretty well from the rubber stopper at the top.

• European Menopur - I decided not to use the glass ampoules that came with the EU Menopur since I have a ton, like 5 boxes, of the sodium chloride vials left. I tried to give the Q-caps a shot and they do fit on the EU vials, but the rubber stopper in them isn't ideally shaped to extract all the liquid. I have to use the big mixing needles to get every last drop and it takes a bit longer to do. I also had a nervous scare when I combined cold sodium chloride with room temp EU Menopur powder and it turned instantly cloudy. Cloudy Menopur is supposed to be bad Menopur but since it cleared up after about 30-45 seconds, I deemed it okay.

You can see the hole in the rubber stopper is only in the center of the stopper, which means liquid can pool around the sides. The US vials have a long slit to better capture liquid from all sides.

I can already tell my belly is going to be bruised and poked and sore once this cycle is over. Three - four injections is a lot for a day and I'm going to run out of places to stick the needles since they all have to be injected in the same area. I can't rotate between belly, thighs, butt, etc, they all go into the same section of my lower belly. Owie. 

IVFMeds.com had good news, my second package finally shipped! It ended up going out two days later than it was supposed to which necessitated 2 more phone calls to customer service asking why I hadn't received tracking info yet. I would have liked it to go out sooner but if it travels like the first one did, I should have it in time. The customer service rep also said that if my medication didn't come in time, they'd reimburse me the difference between their cost and the cost of the vials I'd have to buy locally. It was a really nice offer but I'm hoping I won't have to take them up on it.

I also got a good convo in with Reprogenetics and they've put my blood and saliva kits into the mail. I have to send in a vial of my blood, a saliva sample from my mother and my sister, and a single premium IUI vial of our donor. They were originally requesting two vials (~$2,000) but their lab agreed we could go with one since these are really high yield vials instead of the low yield kind they'd usually be sent for PGD. That saves me an extra $1000 which is excellent, every little bit helps!

IVF Protocol a bit Clearer

Today I picked up my Omnitrope, needles, syringes and Dexamethasone. Kaiser is usually great about prescriptions but this time they were way off - they gave me Omnitrope cartridges in a weird dosage without the pen to inject them, they forgot my injecting needles and only included the mixing ones, and they only had half the needles and syringes I needed. I ended up spending 30 minutes at the counter while they tried to sort everything out and I still ended up without the pen for the Omnitrope. When I called my nurse to talk over it and find out more about my protocol, she had never worked with Omnitrope in this form before and had to sort out how it's going to work. It looks like I'll have to draw it up and inject it with the same needle, which is going to blunt the needle and make it hurt more -_- I'm not excited about that part.

Although I was hoping for only a couple days with tons of injections, it looks like I won't be that lucky:

CD 1: Nothing
CD 2 - 14: BCPs
CD 15 - 17: Nothing
CD 18 - 25:  2 injections of Menopur (4 and 4), 1 injection of Omnitrope and 1mg Dexamethasone

At some point I'll add in an injection of Cetrotide for 4 days, bringing my injection total to 4 injections per day. My little belly is going to be so, so sore! I have to go in tomorrow morning to get the small needles and syringes I'll need for the Omnitrope so I think I'll ask the nurse if I can inject the Omnitrope into a different place. If I'm already doing two injections into my belly each day, I'd really like to not have to add two more to the same place.

I was going to insert a photo of my new supplies in here, but I'm too lazy to take one right now. Just picture lots of needles and syringes, including big mixing needles, and I'll post one tomorrow when I'm less lazy.