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.

And so begins egg donation IVF cycle #1

The last couple weeks have been a whirlwind of activity. First I was traveling abroad for work, then I was sick at home with a souvenir cold, then we had some last-minute German visitors who have been driving around Europe with their 6-month old in a VW bus (I feel cool just knowing them), and then my husband had the stomach flu. With everything going on, we had hardly any time to prepare for the arrival of our egg donor, Marie, and her two kids (ages 3 and 5), who flew in last Saturday from the US.

Two days after they arrived, we all piled into a borrowed car and drove 2+ hours to Belgium for our first appointment. There, Marie had what we in the infertility community refer to as “a date with Wanda” — i.e., a vaginal ultrasound with an ultrasound wand. The point of this first ultrasound is to check that her ovaries are quiet (no activity) before she starts the heavy-duty hormones. Her two girls were particularly curious about the procedure, with the 5-year old asking loudly at one point “IS THAT THING GOING IN YOUR BUTT?!”

Once Marie’s ovaries had been given the all-clear, we had an appointment with the egg donation nurse to go over the tentative egg donation IVF timeline. Then the kids had a quick break in a conveniently located hospital playground while I picked up our €1000+ of medication, delivered in a freezer bag for the long ride home. This was fortunate, as the normally ~2-2.5 hour drive ended up taking 3.5 hours with traffic. The kids were champs and were rewarded with a ride in the bakfiets (wheelbarrow bike) to get happy meals at McDonalds. They happily declared “This has been a GREAT day!”, which, after 6 hours in the car and 2 hours of doctor’s appointments, shows just how terrible kids’ memories are.

Our egg donor’s kids love riding in our bakfiets, which is essentially the Dutch version of a minivan.

Bring on the meds

Marie and I have both been on birth control for the last month to sync up our periods, but we took our last pills this past weekend. I started my period on Tuesday, which means I’ve now started taking the estrogen pills to build back up my uterine lining for the actual donation cycle. This is the same medication I did the test cycle for last month, so luckily we already know I respond to it well.

On Thursday, Marie started her first medication: daily decapeptyl injections to delay her ovulation until the right moment. Marie had me give her the injection, which she found painful and I — even after giving myself 3 IVF rounds worth of injections — found terrifying. It’s one thing to inflict pain on yourself, but it’s another thing entirely to inflict pain on someone else who is just trying to help.

What happens next?

Tonight, Marie will begin the second type of daily injections: “stims” (Menopur) to stimulate the growth of follicles in her ovaries. This means things are really starting to happen! It also means I have to give her two injections a night instead of one…oh joy. This will continue until her follicles have grown large enough in size to have the egg retrieval surgery, which should be around 12-14 days from now.

So what happens in the meantime? Well Marie will have another ultrasound and a blood test this coming Friday to check how her follicles are developing. Depending on how this looks, we will probably have to go back again a few days later. Once the follicles reach a certain size, we will drive back to Belgium for what should be the final ultrasound. Then she will take an injection to trigger ovulation, and exactly 36 hours later, we will cross our fingers that all this Dutch cheese we’ve been feeding her will result in the retrieval of multiple high-quality eggs.