Our IVF class started right at noon with Nurse V. We went into her office and she started to go over the cycle calendar. I would start 10 units of Lupron the evening of 2/11. Dave immediately looked at his watch, looked at me, and it hit me that I would be starting Lupron that night. My last birth control pill will be Saturday. Thursday 2/20 will be baseline testing to make sure everything is suppressed and ready to go. If things look good I will start stimulation Saturday 2/22. I will drop down to 5 units of Lupron a day and add in 75iu Follistim and 75iu Menopur. My first monitoring appointment will be Monday 2/24 and will likely go in every morning. My dose of Follistim could change depending how I respond, we're starting at a very low dose. Egg retrieval will likely be the first week of March. They do the procedure in office and I will be under anesthesia for the collection while Dave is giving his sample. We are doing the CCS (also known as CGH) testing so any embryos that make it to blasts on Day 5 or 6 will be biopsied and frozen. The biopsied cells are sent to a special lab and will undergo full chromosome testing. We'll get the results in a few days and if my body is ready we'll start prepping for FET right away.
Nurse V went through each medication showing how to assemble the needles, load cartridges, where to inject in the belly, etc. Everything is pretty straightforward. The Follistim comes with a cool pen that the medication cartridges are loaded into, you set the dosage on a click wheel, and inject. The Menopur comes as a powder so it needs to be mixed with saline before injecting. The Lupron is very simple, just fill the syringe and inject. Funny enough the thing I am dreading is the Crinone. Crinone is a messy progesterone gel that is inserted into the vagina through an applicator after ER (egg retrieval). Guess I shouldn't be too worked up about it though, for the FET I will be using PIO (progesterone in oil) which is administered via a big needle in the butt cheeks.
We both had to get some blood drawn as our infectious disease panels were over 6 months old. After finishing that up we met with the IVF coordinator K to sign lots of forms. He went through the ER procedure, embryologist's process, CCS procedure, and subsequent FET. He felt our chances were very high and expects lots of good quality embryos. While looking through my chart he noticed that Dr. S had circled that I should start metformin, but further down the page had crossed it off. Apparently I have PCOS.
After signing and initialing more forms than we could count it was back to the waiting room. My trial transfer was to be done by another of the REs, Dr. C. Dave ran out to get us lunch since it was going to be at least a 30 minute wait for the procedure. I was called back and had to change into a paper robe so Dr. C could check my vitals and abdomen. We talked a bit about my concerns for ER, mostly due to my wandering right ovary. He was confident that the ovary would be heavy from all the follicles and sink down. I would be knocked out anyway so they could try and push it down like I have to do during some ultrasounds. I asked him about the PCOS and he looked at my previous ultrasounds and commented that my ovaries are textbook PCOS. Looking back on it, I do have a lot of the symptoms of PCOS so it really isn't that shocking. I just don't know why Dr. S has never brought it up before. The nurse was going to talk to him today to see if I should start the metformin. Dr. C said it would help prevent hyperstimulation which we already know I am at high risk for.
After taking my blood pressure, listening to heart and lungs, and checking my abdomen it was time for the "fun" part. I'm pretty sure the speculum he used was meant for use on elephants and was spring loaded. There was so much pressure and pain. If I had not used the restroom beforehand I probably would have peed on him. The catheter went in very easily and he didn't suspect there would be any trouble with the embryo transfer. The timing was perfect as Dave was just getting back from picking up lunch from a nearby Indian restaurant.
That night it was time for the first injection of Lupron. I was so nervous, afraid of messing it up like I had done with the Ovidrel. It took a few seconds to psyche myself up to push the needle in, but it surprisingly did not hurt at all. There was some discomfort after injecting the Lupron and I had to keep the needle in for five seconds. There was no bleeding, but it felt a bit sore for a few minutes afterwards. My confidence levels have definitely gone up and should have no problem with the remaining Lupron.