November 11, 2015

Shots! Shots! Shots-shots-shots-SHOTS! (Errrr'body!)

And not the fun kind! The kind you jab into your belly fat!

My new vanity set up: a pretty Kate Spade box filled with syringes, needles, and alcohol wipes; hormones ready to be mixed and injected; and a sharps container for allllll the needles.

First, a quick overview of how IVF works, which I may or may not get right:

We ladies all have a bunch of follicles hanging out in our ovaries at any given time. Each month, a hormone called FSH (follicle-stimulating hormone) is sent down from the pituitary gland to stimulate [snort] a follicle and cause it to produce an egg. As the follicle grows, the FSH also encourages estrogen production in the follicle. Then once the estrogen level reaches a certain point, that signals to your pituitary gland to knock it off with the FSH and start producing LH (luteinizing hormone), which in turn causes ovulation. (That peak in LH is what you're testing for when you pee on ovulation sticks. If you happen to be someone who pees on ovulation sticks, I mean.) Once the egg is released, the empty follicle starts producing progesterone, which you need in order to maintain a pregnancy; if the egg doesn't fertilize, progesterone production calls it quits and everyone shuffles back to their places to start the process over again the next month.

With IVF, they use the same FSH and LH hormones, but control when & how much you're getting. Instead of your pituitary gland focusing on just one follicle, ALL follicles get a participation trophy and get stimulated equally with the FSH. The hope is to make every single follicle you've got hanging out in there produce an egg at the same time, then once you have two ovaries crammed full of ripe follicles, they trigger final egg maturation and ovulation (with an appropriately named "trigger shot") but swoop in and harvest the eggs from the follicles before they release into the wild (or, uh, I guess your fallopian tubes) on their own.

Then the mad scientist piece happens: in the lab, they individually fertilize each viable egg that they retrieved, then pop them in an oven to bake for a few days. (They do not actually bake them in ovens.) This is the danger zone for the newly fertilized little eggs though: there tends to be a lot of attrition over the next few days as nature takes its course. So it's not uncommon to have, say, 18 follicles, but only 16 eggs, and only 12 of those might be high quality. Then they can fertilize all 12, but maybe only 10 "take." Then of those 10, only 5 make it to the blastocyst stage, which is like a pre-embryo, and what gets put back in your cozy uterus (in my head, they're on a piece of parchment paper, and someone sort of rolls up the paper and tips it into my waiting uterus. I am told this is also not how it happens.) Then you pump yourself full of progesterone to convince your body to hold on for one more day to the wee blastocyst(s) and hatch 'em into babies.

SO! I'm still in that first stage, where I'm coercing all available follicles to get off their lazy asses and grow into nice, big, egg-harboring follicles. And to do that, I need to inject Gonal-F and Menopur into myself.

These are two of the EASIEST injections one can have: the Gonal-F is in that pen up at the top, and I just have to put a fresh needle on it each night and dial up the correct dosage by twisting the cap.

I mean, and then there is the part where I have to jam a needle into my own stomach, but the process leading up to it is simple, at least.

The Menopur is a little more complicated. I start with the big syringe, remove the needle it comes with, and put that plastic cap thingy in the center of the picture on it. The cap has a needle in it too, which I use to jam into one of the wee vials which contains sterile saline and draw the saline up into the needle. Then I jam the needle through the top of the other wee vial, which has the Menopur (which comes in the form of white powder). I shoot the saline into the Menopur vial, let the powder dissolve, then draw the mixture back up into the syringe, pop off the mixing cap, replace it with a (thankfully) thin small needle, make sure there are no large air bubbles, THEN jam the needle into my stomach. This is still on the easy side of the spectrum when it comes to mixing and preparing injections.

They have you go to an injection class before doing this because it's kind of overwhelming. And the injection class was great! I felt very informed and competent afterwards.

(I was also the only woman at the class who came sans husband. Apparently most people prefer to have their menfolk do this for them. One woman brought her husband AND her sister with her. I was all, psh! Whatever! I am totally fine with needles and giving blood and getting shots; I can do this! Plus I didn't want to make it Chris's responsibility, especially since he sometimes has to work late and there will be plenty of opportunities for him to have to miss work during this process; giving me daily meds didn't seem like a good enough reason yet.)

But man. Feeling competent, and physically jamming a needle into the tender flesh of your stomach? They are not the same. After learning what to do and how to do it, I was all, I'm cool! This is no big. I don't see what the hullabaloo is.

Fast forward to me standing in my bathroom, after having successfully mixed my first injection, with the primed needle ready and pointed at my stomach for like 45 straight seconds: ....ah. OK. I now see what the hullabaloo is.

I mentally shook myself, told myself to stop being a baby, and counted backwards in my head helpfully for myself. OK self, just stick it in on 1. Ready? 3.... 2.... 1!

[Self remains standing there, doggedly not stabbing self with needle]

Getting over the mental hurdle really is the worst part, though. The needles are wee. I can barely feel them going in. And fortuitously, I had been saving up a niiiice layer of fat around my abdomen for just such an occasion. Non Sequitor Chica warned me that the Menopur burns a little, which is true, but it really is just a little, and it goes away almost immediately. I'm now a 3-day veteran of the process, and even with all of the hand-washing, alcohol-swabbing, mixing, and stabbing involved, I'm down to about 3 minutes soup to nuts.

I'm also lucky in that so far I'm very low on the side effects meter. A lot of women are VERY uncomfortable during this process. My main complaint so far is a low grade but persistent headache, plus a dramatic, newly-developed flatulence prowess. I hear that I will soon be able to feel my ovaries, once they get jammed full of big-ass follicles, which I find equal parts intriguing and alarming. My sister - who was blessed with not only a robust set of her own extremely volatile emotions, but apparently also inherited all the ones I am lacking - is eagerly hoping that I become an emotional wreck as a result of the hormones.

Me: Wait, what?!
Her, literally cackling with glee: It will be HILARIOUS!!!

At least one of us is looking forward to that stage.


  1. I'm going to really enjoy these posts. Not because of the fact you're going through this, but because I will probably have to do the same in the near future and I want the REAL TALK about this shit!

  2. I usually feel when I ovulate and it is not comfortable (but totally bearable). I'll be interested to know what it feels like when ALL the follicles pop up and do their thing! Also the docs should have mentioned that prior to sticking yourself with a needle you should do a shot of alcohol. It's totally correct and relevant medical science stuff.

  3. I used to give David and I B12 injections and the mental games you go through before stabbing yourself or your loved one with a sharp instrument are insane! I used to take a big breath, count to three and then go! UGH. Anyhow, good luck!

  4. This is why I'm so happy you're blogging again - posting about real shit with an excellent sense of humor. I appreciate your willingness to put yourself out there like that as a means to help others going through similar experiences.

  5. Super fascinating! Sorry you have to go through the hard parts, but well done on the informational post! I know you'll help a lot of Googlers. Bless 'em. (and you)

  6. I love how detailed you're being about this. I can already tell that these posts will be an incredible resource! And hopefully helpful for you too.

  7. Glad you aren't having too many symptoms so far....if the shots are working and you start to grow a lot of follicles you will just feel a "heavy" feeling. It's weird but not painful. And no alcohol (which I'm sure your RE has already told you) while on stims!