The skinny on IVF medication

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:

  1. 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.
  2. 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.

Decapeptyl, a daily injection to inhibit ovulation.

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 levelsSo 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.

My husband and I administering Marie’s daily injections. This is how we make a baby… #romantic (Marie wants me to add #NoThighGap)

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.

All systems go…with one hiccup

In my last post, I talked about how our friend Marie had been approved as our egg donor, but contingent on three pending genetic tests. Those test results weren’t expected until today (25 June), which was basically the last possible moment in order to keep our timeline for donor egg in-vitro fertilization (IVF) on track. Well, our Belgian egg donation nurse, Bernadette, worked her magic again, and we got the test results back already on Friday 22 June (voila!). The same day, I had a blood test, followed by an ultrasound on Saturday to make sure I’m ready for the first injection. All of the tests came back clear, which means we are officially all-systems-go for a July 2018 egg donation.

I know that probably sounds like something in this process actually went smoothly. But you should also know by now that I enjoy (according to my husband) “doing everything the hard way”. This is why I got my PhD in a competitive field, and why I voluntarily moved to a foreign country…twice. This is also why I decided to accept a work invitation to speak at a conference in the US this week, right in the middle of this whole process.

It shouldn’t have mattered, or at least that’s what I thought. I knew I needed to have an injection during the week I was away, but I’ve already given myself at least 50 injections over the course of our three ‘normal’ (non-donor-egg) IVF cycles. I knew I could get a doctor’s note to fly with the medication and needles, and I figured I could just inject myself with a large dose of hormones in the morning and then go chair the plenary session like the modern working woman I am. Easy-peasy, right?

Wrong.

Literally the day after booking my flights (which I’d already waited til the last minute to do), I called Bernadette about picking up my injection, and she informed me that it was not necessary to pick it up, because this particular injection had to be done by my doctor…in Belgium. Apparently this injection was intra-muscular — not subcutaneous* — and it was very easy to do it wrong. She said it was ok if I wanted to do it myself, but that I had to agree to accept the consequences if I did it incorrectly. And the consequence was a canceled IVF cycle.

To go or not to go?

A mild panic ensued, where I briefly considered canceling my whole trip. That probably sounds like the obvious solution, but I’ve already canceled so many work trips for IVF, and I really didn’t want to cancel yet another. Then I considered trying to call a doctor’s office in the US city I was visiting, but I had had previous bad experiences with medical care crossing international borders. I highly doubted that if I called up a random US doctor, they would agree to inject me with some foreign (literally, including the box and directions) medicine.

Next I called up a Dutch doctor friend, who offered to help me practice stabbing the MASSIVE needle into my thigh before I left, but I was still worried I’d mess it up by not stabbing it in far enough, or too far (…is that a thing?) Then another friend had a suggestion: did I know anyone attending the conference who was a doctor? (Technically we’re all doctors, but not the useful kind…)

Luckily, I remembered that one of my fellow conference attendees is originally from the city I’ll be visiting. I emailed to explain my predicament and ask if she knew any doctors. Lo-and-behold, her childhood best friend is a doctor, and she still lives in the area. After some more emailing back and forth, this friend-of-a-friend agreed to help me!

So this is how it has come about that tomorrow, after I’m done chairing my session, I will take a taxi to the home of a woman I’ve never met before and have her stab me with a very large needle.

*FYI, ‘Intra-muscular’ means the medication needs to be injected into a muscle rather than just under the skin. There was actually a whole separate confusion over whether this was still the case if I got the prescription filled in the Netherlands (where I live) rather than Belgium, as the medication is apparently slightly different (because again…hardest way possible!). The box actually said it could be done both ways, but confusingly, there was no subcutaneous needle included in the package. After multiple phone calls to various medical professionals by my (invaluable) Dutch doctor friend — including to the actual manufacturer — we eventually decided it was a safer bet just to do it intramuscularly. (On a related note, I recommend everyone befriend a medical doctor.)