Injection Training

Well, in short, it was definitely overwhelming.

Warning: if all you wanted was the short story, see above. The rest is going to get lengthy because I'm literally writing everything that's fresh in my brain before I forget everything!!!! 

I left work around 3pm yesterday to head home and pick up Kyle before we went to Shady Grove. My stomach hurt ALL day yesterday, I think because I was so nervous. We arrived 10 minutes before our class started at 5pm and were the first there. I knew they only accepted 3-4 couples per class, so I expected it to be small. We had only 3 couples in our class (including us).

Once everyone arrived, they took us into a meeting type room (and it was freezing in there - why do doctor's office's always have to be so cold?? And it was 72 degrees outside!! In February!!!!). They had little place cards set out with our names on them telling us where to sit and all the supplies lined up and organized. It was kinda cute, in a sick, needles laying out, kinda way.

Our nurse leading the class was super nice and I was impressed with how organized it all was. She had a list in front of her that detailed which couple had which doctor and which medications each of us would be taking. Everyone's IVF protocol is a little different depending on the doctor and your personal infertility diagnosis and the nurse did a great job separating out what each of us had to do. 

First we started with Menopur. It was the "hardest" of all the medication prep, so they teach you that one first so the rest seem easy. Menopur does not come with a preloaded dose in a syringe because it requires mixing saline and the medicine powder. My protocol requires a double dose (150 IU) of Menopur, so we use the saline (1 cc) to mix into two vials (75 IU each) of the powder. We learned how to use a mixing needle to mix the correct amount of saline with the correct amount of powder, and then how to switch out the mixing needle for the injection needle, and finally, how to properly inject it. [I was relieved when I found out we were using a little rubber cushion for our injections rather than our actual bodies during the class... whew]. Menopur will be one of my daily injections during the stimulation phase when we are getting my ovaries to grow multiple eggs (in a natural cycle, you only produce one egg).

Next was Follistim. This one was cool - it comes with a "pen" that you use for the injections so you don't need to use a new syringe every time. Simply load the pen with the medicine vial, dial the right amount of medication (300 IU) on the end of the pen, insert a needle at the top, and then push the end of the pen in to inject. This one will go right along with the Menopur, used every day during the stim phase to stimulate my follicles (about 10-12ish days).

During the stimulation phase when we are injecting Menopur and Follistim, I have to go in for monitoring (bloodwork and ultrasound) about every other day, or even daily, to monitor how my ovaries are responding to the medication. They want to watch your follicles grow and make sure they know exactly when they are at the perfect size. Shady Grove will call me every evening after I have a monitoring appointment to let me know my results from the monitoring and if they want me to change any dosages. Once my follicles are getting big and looking like they are about ready, they will put me on a new medication to prevent me from ovulating. We don't want my body to ovulate on it's own because we want the eggs still there for the egg retrieval surgery!

So, then we learned how to inject Cetrotide, which is the medication that prevents ovulation. This one also wasn't too bad because each box I received comes packaged as one dose. The syringe is pre-loaded with the saline, but it does require mixing powder again like the Menopur. I'll only be taking this injection once my follicles are almost ready and I'll probably only take it for a few days. So during this short phase of a few days, I'll be injecting Menopur, Follistim, and Cetrotide - max 3 injections.

The final injection is the "trigger shot." This injection is to prepare your body to release the eggs. Once I get to the end of the stim phase and my doctor decides I'm ready for egg retrieval, Shady Grove will call me that night saying "tonight you'll do your trigger shot." At that point, I stop doing the stim meds and I wait for a second phone call. A scheduler at Shady Grove will call me again that night and tell me the exact time to take my trigger shot. The timing is so important because my egg retrieval surgery has to be exactly 36 hours after my trigger. So, they could call and say, "do your trigger tonight at 3am" and then my egg retrieval will be 36 hours later at 3pm. CRAZY!

Dr. Sagoskin had me order two types of trigger medications, Lupon and HCG. I'll only use one of them, but he makes that determination depending on what my follicles look like at the end of my stim phase. I'm not exactly sure how all that gets decided, but all I need to know is that, they will tell me when it's time for me to take it and what to take. The Lupron and HCG are taken differently. Lupron is injected subcutaneously (in the fat in your stomach) like all the rest of the injections, but HCG is a giant shot that you take intramuscularly (in the butt muscle! ouch!!!!). I already forget my dosages for each of these, ugh (I think it was 0.8ml of Lupron and 10,000 IU of HCG), but I have it written down at home. Also Lupron is the medication I'm still waiting to order because it expires quickly!

That was it for the injections, but we also went over the few other medications I'll be taking. I have 2 pills I'll take the night before my egg retrieval - easy. Then I also have meds I take after egg retrieval is complete. One is a pill that I take every day up until 10 weeks pregnant. The other is a vaginal suppository (oh yeah, fun stuff) of progesterone that I take 3 times a day (yes, you read that right, 3 TIMES a day) up until 6 weeks pregnant - HOLY MOLY. Both of those are to help my uterine lining be perfect for embryo transfer and implantation! It also helps reduce the chance of miscarriage.

Whew, that was everything. Did I feel better afterwards? In terms of knowing the schedule and also the inventory of everything, yes. But it was SO overwhelming. Honestly, typing it all out though makes me feel better, at least I remembered it. We also have videos we can watch too so if we forget something, that should help.

When we got home, I wanted to go through all my meds again to make sure I had everything now that I knew better what I was supposed to have. While we were practicing the Menopur, I realized we needed 2 needles (large mixing needle and small injection needle) and a syringe - one for each day of the medication. I didn't remember seeing any of that in my package and wanted to check at home. And I was right, literally no syringes or mixing needles for the Menopur. I don't know who messed that up - my nurse that sent the order or the pharmacy that filled the order. I'm gonna guess CVS Caremark since they've been a pain to work with already. So, this morning I had to call my lovely CVS friends who don't speak english to tell them that I have nothing to inject my Menopur with. Ugh. I was also missing alcohol wipes and a sharps container to dispose all my needles in. It was painless for the most part this morning talking to them, so I'll spare you the details, but luckily I should have all the missing things delivered by tomorrow. Yay more needles in the mail!

So, now we are just waiting on cycle day 1 to show up so I can call and get my official dated protocol from Shady Grove. Should be here tomorrow-ish. Never wanted my period to show up so badly in my life - let's get this show on the road!!!!!

Hopefully I'll be writing soon with my official dates!!! It's really starting!!!