Day 8 of Cycle, Another Pelvic Ultrasound and Blood Test, Multiple Follicles Developing, Better than Expected Results So Far, and I Start Cetrotide

My personal IVF nurse has been supervising me constantly (even in the bathroom).

This morning, day eight of my cycle, I was to appear at the Victoria Fertility Centre, between 7:30-8:30 AM for another pelvic ultrasound and blood test. My husband came with me again. As he was on his way into the office, we chose to show up just before the earliest time to get on the sign-in list first, so that we would get the first examination spot and be out of there sooner.

Another car #selfie

In the parking lot of the clinic again.

We were the first on the sign-in list and only had to wait a few minutes before being taken into an examination room. A nurse took my blood before I partially undressed for yet another pelvic ultrasound.

Blood test done. This is old hat.

On the good old exam table again, waiting for my pelvic ultrasound.

I met Dr. Graham today, the other doctor who works at the Victoria Fertility Centre. He gave me the pelvic ultrasound with yet another new nurse looking on. He let me take photos as he showed me my uterus, the right ovary, and then the left ovary. He stopped periodically to mark and measure the developing follicles in the ovaries. He counted nine that are currently developing.
We asked if this was a good result or not. He said that it's not clear whether or not all of these follicles will develop to the point of being usable, but for my initial prognosis with low egg reserve, this was a better than expected result having nine developing all at once.

Ultrasound of my uterus.

My right ovary (near the top left you'll see dark masses, these are follicles developing)

Measuring follicles in my right ovary.

More follicles in the right ovary.

This is the left ovary (top right you'll see dark masses which are follicles developing in that ovary).

More follicles in the left ovary.

Follicles in the left ovary.

Dr. Graham told me that he would have to wait for the results of the blood test to know if I would start Cetrotide today or not (timing is everything in IVF). In the mean time, I will continue with Gonal F and Menopur and Dexamethasone. If I do start Cetrotide today, I will be on three injections per day (Cetrotide will be in the morning, the other two are in the evening).

I will be returning Sunday at 9:45 AM for another check up at the Victoria Fertility Centre. They will be giving me another pelvic ultrasound and blood test to determine what will happen with my drug protocol and when the egg retrieval might occur.

I went over to the drug dispensary in the clinic to pick up more drugs. I was out of Menopur and Gonal F. As instructed I had brought back my Gonal F epi-pens to have them draw the overfill out so that I could use this in another dose and save money. From the three pens they drew 225 mL (my normal dose is 300 mL), almost a full dose. They made up the rest with a 75 mL Gonal F pen that they sold me (the overfill retrieval saved me about $90.00). Unfortunately, this will lead to an extra needle tonight, but since this stuff is like "liquid gold" in the nurse's words, I'll take it. I also had to pick up more Menopur. I had one Cetrotide that they sold me last time that I have not used yet and I had to get two more of those, enough to last me until Sunday morning. The total drug bill today was about $1,500.00. So that brings the total spent on drugs for this first cycle of IVF to $4,295.00 so far (and the Estrace I used this cycle I bought last time I thought I was going to do a cycle, so it's not even included in this total). This is above the estimate of $4,000.00 that we were provided for all of the drugs required for one cycle of IVF, but I am on a high dose of everything because of my low egg reserve, so this is not surprising. Oh, and we're not done yet, so there will be more outlay on Sunday and then potentially again in a few more days.

Fortunately, we have a drug plan that covers these drugs (unless the claim that we just sent in gets rejected- unfortunately as a former insurance litigator this would not surprise me, but I can hope that our company won't dick us around). I can't imagine what people do who don't have a drug plan. The drugs cost almost as much as the procedure itself, so it would almost double the cost of IVF. I read yesterday that 70% of people who have IVF in U.S. go into debt to have it done. It's easy to see how this statistic is possible.

This is only enough to get me through to Sunday morning when I'll have to buy more drugs (except for the Dexamethasone which will last me longer). The nurse asked if I needed another sharps box yet. Thankfully I do not.

The nurse told me that the clinic would call me this afternoon after the blood work results are back to tell me if I should start Cetrotide today or wait, so I set about my day. I ran an errand on the way back into town after dropping off my husband and then cleaned a bit at home and did my morning writing.

I'm noticing increasing discomfort in my back where my ovaries are and I'm dizzy more often now, especially when bending over or standing up too quickly (I have low blood pressure to begin with, but this is a lot more). The other side effects continue (the bloating in my abdomen in particular is more pronounced). But I'm still alive. I can do this.

Yes, you can do this. Come back to bed and join me for a cat nap. 

The clinic called in the early afternoon. The nurse reported that my blood work was normal and that I was to start Cetrotide today as soon as possible (normally I would inject it in the morning) and that I would continue all the other drugs as before (so with the extra syringe from the bonus Gonal F, I'll be giving myself four injections today). This brings my total number of current medications for IVF to four, Dexamethasone, Gonal F, Menopur, and Cetrotide.

Cetrotide is a gonadotropin-releasing hormone (GnRH) antagonist. In other words it blocks the hormone that makes the ovaries release eggs (to prevent premature ovulation during ovarian stimulation). Common side effects include headache, nausea, and pain, bruising, redness, itching, and/or swelling at the injection site.

The nurse gave me alternate alcohol swabs to use rather than the ones in the package because apparently the ones in the package sting a lot.

I immediately broke out a package of Cetrotide and followed the nurse's instructions from earlier today at the clinic. She had shown me how you take the syringe out, attach the thicker needle tip, inject the fluid in the syringe into the one vial of medication, then draw it back into the syringe after swirling it to mix. Then the thick needle tip is abandoned and a finer one is attached. As with the other injections, it is done into the abdomen into a pinch of fat that has been cleaned with an alcohol swab. Because this injection has so much fluid, it should be held in for a few seconds before the fat is unpinched, the syringe is removed, and an alcohol swab is pressed to the entry site to stop any bleeding. 

So many pieces in one Cetrotide package.

Cetrotide was easy going in, but then it stung quite a bit. I felt instantly dizzy and nauseous and had to lie down for a while. Of course, my personal nurse joined me and purred soothingly over the injection site. It seems that the next half a week to a week (until the egg retrieval) might be more difficult (not that the egg retrieval is supposed to feel good either). But I'll hope for the best.

Purring can cause healing. My personal nurse knows that and he put his magic to work on my swollen abdomen right after injection of Cetrotide this afternoon.