Protocol Class
First off I just have to say that we got our start date! Apparently we can start with whatever cycle we want, even my current one! But I decided for various reasons (three reasons: one, I’m not emotionally prepared yet, two I’m not physically recovered yet, and three starting now would mean an early January baby, not my ideal), so we’re starting next cycle. She said it doesn’t matter if we use birth control pills or not, this month or the suppression cycle… because I ovulate so regularily they can start lupron in my luteal phase if I so desire. I might just do the pills anyways, but it depends how I feel next month.
Okay, so my day was super long today, I had so much to do, I’m just totally wiped out. The whole reason I was rushing around was because I had a million things to do and we had our protocol class at 2pm… I had to pick Den up at work at 1:30, which meant leaving my work at noon so I could get home, shower, do the things I needed to do here, and take off.
We got to the class just on time, mere seconds before the nurse walked in. We were one of four couples. The class was mostly about what exactly our cycles will look like, what medications we’ll be taking when and why, and also how to take the medications… how to mix them in the vials and inject them.
A lot of what I wrote down is specific to me. Here’s what it’s looking like for me. (I apologise in advance to any of my readers who aren’t familiar with IVF protocols. This is likely going to sound very confusing.)
Next cycle when I get my period I will call and let them know. I will either start the birth control pill then, or go with a natural cycle. They’ll start the insurance process and call in my prescriptions. She said that the overseas pharmacies, while cheaper, will not accept any insurance so we’d have to pay entirely out of pocket. So we’ll have to go with either Freedom Pharmacy or IVP Care. I’ll be using either Gonal-F or Follistim, she said for me it doesn’t matter which I use (some of the other ladies need to use one particular one), so she’ll just ask which one’s cheaper at the time they call it in and do that. They both come in “pens”, even.
If I do the natural cycle I’ll go in for a blood test on day 21 to see if I’ve ovulated yet. If so and everything looks good to go then I start lupron. (I think that’s what she said, but I’m not sure now.) If I do the birth control (which is likely, I think) I will start lupron on day 18 of the pills (last pill at day 21).
I continue taking the lupron until I get my period one way or the other.
On day three of that next cycle I’ll have a baseline ultrasound to make sure everything is quiet and ready. If it is that night I’ll start stims – the follistim or the gonal-f, with menopur… and of course the lupron, all mixed together. She said we could do them seperately if we want, but that most women prefer one shot to three. I fall into that group. ;) Once I start stims I am not to take any advil/ibprofen – tylenol only for any headaches, etc.
On about the third day of stims I go in for a bloodtest to make sure my estradiol is behaving accordingly. If it isn’t they’ll adjust my dose. After that I go in for frequent (every other day, I think) ultrasound and bloodtests to check the development of my follicles. She said most women stim for 7-10 days.
At some point in there both Den and I will take antibiotics (doxycycline) to clear out any infections, etc. You have to take it with food or you will get a very upset stomach… and apparently it makes you more succeptible to sunburn, which in my case is pretty hard to believe. Sunscreen is important.
Also in there somewhere (I forgot when I start it) I will start taking baby asprin (81mg) daily. She admitted there’s no real conclusive proof that it helps, but it does no harm by taking it and it could increase chances of a success, so they do it.
They’re looking for the follicles to get to be 17-19mm. When that’s the case they’ll tell me to stop the follistim/gonal-f, menopur and lupron and to take my hcg trigger. They will give me a precise time that I need to take it, and she said it needs to be done within 10 minutes of that time given. The day after the trigger I do nothing at all, and then the morning after that I go in for retrieval. The retrieval will be exactly 36 hours after my trigger shot… so if I trigger at 8:30pm tuesday my retrieval will be at 8:30am thursday.
When I go in for retrieval I’ll get there an hour ahead of time. It is a surgery proceedure, with anesthesia… which means – oh yes – an IV. Fucking hell. If it takes four times again I’m going to cry. (Did I mention the back of my right hand is STILL covered in a bruise?) I don’t remember if they put me right out or if they just make me completely loopy and don’t remember anything. Either way. I will meet with the embriologist and andrologist(?) before the proceedure, so I’m told. Den will go give his sample at that time, and then wait for me to be done. She said it will take about half an hour. Afterwards he’ll drive me home and I’ll probably sleep the rest of the day due to the anesthesia. Oh yes, I remember that well.
The next morning they will call with our fertilization report. Very important. Very exciting. Then we sit and wait in anticipation. Oh, and take the prometrium (vaginal suppliment… apparently NOT very fun – however it sure beats an intramuscular butt shot, IMO) 3 times a day and estrogen patches, two patches changed every other day.
3 days past transfer they will either want to do a transfer, or let them go to blast stage. So we won’t really know which day we’ll be going in for the transfer.
The transfer is the exciting day, she said – the day you’ve been aiming for. It can be uncomfortable, though… worse than an IUI, but the same sort of thing, just more uncomfortable. She said you need a 3/4 full bladder, and my ovaries will still be tender from the torture of the many follicles they just removed. They go in with a catheter, guided by abdominal ultrasound. After they’ve put the little embryos where they need to be I’ll stay laying down for 20 – 30 minutes. Then they tell you to go home and take it easy… desk jobs are okay, but anything more than that (like my job) they want you to take the day off. So I will. I can go back to work the next day though.
Then we wait. Oh the waiting is hard, she said. I can only imagine.
I forget how many DPR they want you in for the blood test. She said it’s so early that a lot of times it’s too early for anything to show up on a urine pregnancy test… they advice you don’t waste your money. (I probably will.) You go in the morning for the blood test, and they call you that afternoon with the big results.
If it’s positive, we celebrate! ;) I’ll go back a few days later for a repeat blood test to confirm doubling beta numbers. I’ll continue the estrogen patches until 6 weeks pregnant and the prometrium suppliments until 8 weeks. They give an ultrasound at 6 weeks (generally that’s to confirm good placement of the sac and to count how many there are!). At 8 weeks they release you to your ob/midwife.
If it’s negative, I stop the estrogen and prometrium and wait for my period. Which, she said, will be a really heavy one, unfortunately. She told us it’s totally up to us when to try again… some couples start another cycle right away, some take a month or two off, some take 6 months off. “We’re not going anywhere,” was her comment. At that point Den and I will have to figure out what the hell to do next – if a FET is an option, then to decide whether or not to use our last IVF cycle coverage on it and when to do it. I doubt I’ll be ready to start another cycle right away – but she did say that it’s something you won’t know until you’re in that position. She also told us that once a week the entire time – nurses, doctors, embryologist, etc – get together and review failed cycles. They look at what went wrong, what could be changed to improve chances next time, if it was just plain bad luck that caused the cycle to not end in a pregnancy. Then they mail you a letter with their recommendations.
So there it is, the summation of the upcoming cycle(s). It’s a different set of nurses from the “other stuff”, and at very least the one who gave us our class today was super nice. And knowledgeable… not just about what she’s talking about – as I’d expect her to understand that ;) – but she knew each of our protocols and what we were doing. After class when she talked to each one of us personally, when I said I’d just started my period a few days ago she said she thought I’d have started already. That impressed me. She also told us that the three nurses are constantly in contact and updating each other on each patient’s status so they all know where each patient stands and are able to help them with any questions or problems they have.
And now I am so friggin’ exhausted I think I’m going to fall asleep.