Time is really flying these days. Our egg donor, Marie, arrived from the US eleven days ago now, and after an initial ultrasound to check her ovaries, she has already had injections for six days. She’s on the same medication I was on for my last (non-donor-egg) IVF cycle, but the hope is that she will have a much better response than I did. And seeing as I basically had no response at all due to my premature ovarian failure, this is pretty much guaranteed!
Many people are curious about the daily injections she’s taking on our behalf, so let me break it down for you here. As I mentioned in my last post, there are two basic components to IVF treatment:
- Inhibiting spontaneous ovulation. Women’s ovaries contain hundreds of thousands of ovarian follicles, each of which contain an (immature) egg. During a normal menstrual cycle, one of these follicles becomes dominant, matures, and naturally releases its egg about halfway through the cycle. In IVF, the eggs (note the plural, see #2) are retrieved from the ovaries surgically, so medication must be used to inhibit this spontaneous ovulation.
- Stimulating follicular growth. Normally, the non-dominant follicles die off before ovulation as hormone levels drop, resulting in just one dominant follicle with one mature egg. However, given all of the steps involved to go from egg to baby, I personally think it’s a freaking miracle our species has survived. The IVF process keeps the level of follicular stimulating hormone high, fooling the woman’s body into producing multiple follicles (and thus eggs) in one go, and thus helping the odds.
How does the medication accomplish this?
Of course, the exact medication (and dosages) depend on the country, clinic, and patient, but the medication that Marie is taking for the first part (inhibiting ovulation) is Decapeptyl 0.1mg. This medication turns off the body’s natural hormone regulation, thereby temporarily stopping ovulation. Even though the medication has to be mixed every day — including breaking a small glass vial with your hands — and even though it has to be administered as an injection, I actually prefer this medication to the nasal spray I took during my first two IVF cycles, which gave me a continuous sore throat.
For the second part (stimulating follicular growth), Marie is using 300 units of Menopur, which is actually the maximum dosage allowed in Belgium. This dosage was determined based on her age and AMH level (which, you may recall, is still over an order of magnitude better than mine). Menopur stimulates the growth of follicles in the ovaries using human menopausal gonadotropins that (fun fact) are extracted from the urine of postmenopausal women, who have naturally high levels. So I’ll just let that sink in for a minute.
How are the injections done?
Both of these injections are subcutaneous, which means they only need to go under the skin and not specifically in a muscle (like the recent injection I had to get). For my last three cycles, I always did my injections myself one-at-a-time in the side of the thigh. Marie isn’t a huge fan of needles, so she asked that my husband and I give her both shots simultaneously to get it over with quicker. This means there’s usually a contest to see whose shot hurt more, which I (administering the Menopur) won tonight.
How much does it hurt?
The needles used to administer both these medications are tiny, so unless you are very unlucky with the placement (like my husband was last night), they usually slip in without much pain at all. What can hurt is the injection of the liquid itself, particularly if it’s cold, or if there are air bubbles in the medication. For this reason, we make sure to get the menopur out of the fridge ahead of time, or hold it in our hands for a few minutes to warm it up to body temperature. We’re also pros at flicking syringes* to get the air bubbles to float to the top — something that I like to imagine makes us look like hardcore drug addicts to the police station directly across the canal.
In my past cycles, I usually found that the menopur burns a little even with these precautions, and I think Marie agrees. You can also bleed a little at the injection sites and develop some gnarly bruises after the fact. But as someone who has dealt with pretty bad chronic back pain, these issues are really only temporary — and thus minor — inconveniences. And as Marie has discovered, it’s nothing a little chocolate can’t help.
*Sidenote: “Flicking Syringes” is going to be the name of my punk band.