Monday, March 11, 2013

Shooting Up

I could be way off here, but I find this one of the most unusual and perhaps even fascinating aspects of the IVF cycle.  The injections...

Currently, my doctor has me following the Microdose Flare Protocol.  There are a number of different drug regimens out there, each differing slightly to accommodate the woman's unique infertility profile.  The Microdose Flare Protocol is a pretty aggressive course.  It is often cited as the "poor responder" treatment; you give it to women once they've already proven to have a hard time making eggs during an IVF cycle.  Why give it to me on our first try?  Take a look at this excellent chart below:

This shows AMH (Anti-Mullerian Hormone) levels for women over time.  Testing AMH levels can gauge the extent to which someone's biological clock is ticking away faster than the woman next to her.    The hormone being tested here is excreted by the small follicles in the ovaries (the little pockets where the eggs grow), and it gives the doctor an idea of just how many eggs are in reserve.  If you follow the solid curve on this graph, you'll see the average AMH levels for any particular age.  For someone my age, it should be about 20.  Mine is 7.2, which is right around the 25th percentile.  Another way to look at this chart is that I have the egg reserve of the average 39 year old.  This means I'm 30% less likely to produce enough eggs in this cycle to be successful.  Hence, BE AGGRESSIVE!  B-E AGGRESSIVE!

Right now, I'm taking three injections a day.  I use insulin needles and inject them subcutaneously (just below the skin).  It really doesn't hurt at all.  I find it way more painful to play with Harper for five minutes.

Lupron (2x/day) - This stimulates my pituitary gland to produce more of its own luteinizing hormone (LH) and follicle stimulating hormone (FSH).

Gonal F (1/day) - Synthetic version of FSH.  This one has to be mixed daily.  I pretend I'm a chemist.  I might get some of those sexy goggles and a white coat just for this ritual.

Low Dose HCG (1/day) - Synthetic version of LH.  This one is premixed, but they want me to combine it with the Gonal F in a single syringe.  It's nice because there's only one tiny prick for two drugs, but it sucks because getting both of these combined takes roughly twelve steps (no hyperbole here), and by my way of thinking, that's twelve unique opportunities to screw up.  (I wanted to film this unbelievably complex series of actions, but Jake assures me this would be weird.)

All this is to push my eggs to go bananas right now.  I went in for my first monitoring appointment today, and it seems like everything is going relatively smoothly.  They were able to see 9 follicles on the ultrasound, though they were very small, and my estradiol level was 85.  Trying to figure out whether that's good or not is really confusing.  I'll get back to you guys on that one.  Keep your fingers crossed, y'all!

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