The First Day of My First IVF Cycle Protocol Hormones, Dexamethasone, Gonal F, and Menopur: Effects, Side Effects, Tablets, and Needles, Oh My

After being cleared to start the new hormones in my first IVF cycle's protocol, I immediately took my dose of Dexamethasone (1 mg or two 0.5 mg tablets).

A little bottle, with little pills, that can wreak havoc on your body . . . 

Dexamethasone is a corticosteroid hormone (glucocorticoid) used for conditions like arthritis, but for IVF it is used to suppress the body's immune system response to make the body more cooperative in the IVF process. Side effects can include headache, dizziness, stomach upset, insomnia, menstrual changes, and increased appetite and weight gain. Naturally, there are worse things that can happen like infection, irregular heartbeat, mood and mental changes, allergic reactions, and seizures, etc., but these are not common.

A pentagon without the White House on speed dial.

My stomach was pretty empty when I took my first dose of Dexamethasone and I instantly regretted not having a meal on board, but it was mid afternoon. I initially started to feel nauseous, followed by agonizing stomach pains, indigestion, and then gas cramps and gas (I could not rule out some or all of this being menstrual symptoms though). After I had dinner, I felt a bit better, but still really iffy in the stomach. I had not expected Dexamethasone, two innocent little tablets, to pack a punch like this immediately. I had been more worried about the two different drugs that I would be injecting later in the evening.

We're going to make you feel weird.

The nurse who instructed us in how to use the injectable drugs recommended that I sit down to do the injections, because that way it would be easier to find a roll of fat around the stomach area to inject the medications into. I don't need that kind of assistance, but sitting down does seem practical when you're not experienced with using needles and you have shaky hands from years of taking lithium carbonate (and you're shaking with fear).

The first of the injectable drugs that I set about injecting was Menopur (dose 150 or two 75 vials), because it is not preloaded and requires being mixed (first take the lids off of all of the three vials, one water, two medication, wipe an alcohol swab over the tops of the vials, take the syringe out of the package, put a Q-cap on its end, take up the vial of sterile water into the syringe, then push it from the syringe into the second vial with medication in it, swirl to mix, then suck that up into the syringe, then empty all of that into the third vial with more medication, swirl to mix, then suck that up into the syringe, take off the Q-cap, put the needle end on the syringe, pull back the syringe plunger and tap then depress the syringe to get the air out). You then must pinch some fat on either side of your belly button, but not too close, clean the area with an alcohol swab, and jab in the needle and depress the syringe until all of the fluid is in. You then release the pinched fat, then take out the needle (if the fat was still pinched the medication would shoot back out apparently), and press the alcohol swab to the area for a bit to stop bleeding and prevent bruises.

Menopur comes with many various packages and of course don't forget your sharps box.

A handy mat with places for each item that you need to shoot up. When you pass "Go" you don't get $200. In fact you pay $10,500.00.

Since I've been terrified of needles my whole life, I didn't know if I'd be able to inject myself. But then I wondered if I'd feel more nervous if I let my husband do it and gave up that control. Plus, I worried that if he had to travel for work or work late, he might not be here and then I would miss my dose. I had to be able to do it myself. So I just did it. My husband was there to help take caps of needles and stuff (you practically have to be an octopus to deal with all of the steps and item required) and he took some photos. His presence was comforting too. The Menopur stung going in and continued to sting for quite a while after the injection.

In case you can't tell, I'm petrified.

Mixing up the Menopur between the three bottles and one syringe.

The air is out of the needle and I'm sick of pausing for my husband to take a creepy photo.

Oh my God this photo gives me the heebie jeebies.

Menopur is a medication that provides follicle stimulating hormone (FSH) and luteinizing hormone (LH) to help ovaries produce eggs (ie. mature them because women are actually born with all of the eggs they'll ever have, unlike men who produce sperm throughout their lifetimes). It's usually used in combination with a drug containing another hormone like human chorionic gonadotropin or hCG (I'm not on that type of protocol though). Side effects may include mild stomach pain and/or bloating, headache, redness or pain at the injection site, dizziness, and breast tenderness. There's the possibility of allergic reaction, flu type symptoms that need to be investigated right away, and very serious and rare side effects that sound like the person is basically at death's door (with a stroke or something) and needs treatment right away. The other possibility that doesn't happen to most people, but is serious when it does, is ovarian hyperstimulation syndrome (OHSS- the hissing acronym is enough to warn anyone that they don't want this disorder). OHSS causes fluid to built up suddenly in your stomach, chest, and heart area. Medical attention is needed right away to drain the fluid from the person. Signs include severe pain or swelling in the pelvic area, sudden or rapid weight gain, nausea or vomiting, and a change in the amount of urine.

The second drug, Gonal F is preloaded, but requires the user to dial up the syringe until the marker reaches the prescribed amount to be administered (300 in my case). The injection must go in the opposite side of the stomach, so as not to cause a reaction with the Menopur. The fat is pinched, area is cleaned with alcohol swab, the cap is removed, and the needle is jabbed into the area and then the plunger depressed. It must be held in for about ten seconds (unlike the Menopur), then the fat pinched is released, and the needle is withdrawn. The area is pressed with an alcohol swab to stop bleeding and prevent bruising. The sharp is removed and put into the sharps box and the pen is saved, because as I mentioned in an earlier post, they are overfilled, so the Victoria Fertility Centre will be extracting the last of the Gonal F from the pens and combining it for me to use in another dose (this will save about $200 they tell me).

Two different doses of Gonal F, brochures, and of course the sharps box.

The medication is preloaded into this epi-pen type gadget.

The Gonal F did not hurt as much going in as the Menopur, partly because the needle is finer, and partly because of the solution itself (it is Menopur that's supposed to sting more according to various sources). But I still felt a stinging sensation.

For God's sake please let me get this over with.

Jabbed into the opposite side of my stomach, so as not to cause a reaction with the Menopur.

The purpose of Gonal F is to stimulate the ovaries to produce eggs as it contains follicle-stimulating hormone (FSH). It can be used in conjunction with hCG to cause the growth and release of mature eggs (not in my protocol though). Potential side effects include headache, redness or pain at the injection site, mild stomach or abdominal pain, breast tenderness or pain, and bloating. Naturally, more horrifying side effects are possible like bleeding, swelling of the extremities, allergic reaction, fainting, stroke type symptoms, and the dreaded OHSS (above).

Other drugs will be added to my routine later this week when I visit the Victoria Fertility Centre (Thursday morning) for another pelvic ultrasound and blood tests (they'll be able to estimate if medication amounts need to be revised and when to add in the other drugs to ensure that the maximum number of eggs are retrieved at the best maturity possible and that they are not prematurely released before they can be retrieved.)

I've been started on a higher dose of Gonal F and Menopur than some people online, but Dr. Hudson has already told me that I don't seem to have a large egg reserve, so no doubt he's trying to increase the chances of a good egg retrieval and therefore the chances of IVF succeeding.

The day after, writing this post, and looking at the pictures, I still can't believe that I injected myself with two different hormones last night, after a lifetime fear of needles. It didn't hurt as bad as a lot of the pain that I've felt so far in my life and overall I'd say my mind is better at producing terrible scenarios than real life is, so it wasn't as bad as I thought that it would be (would I prefer to not go through IVF, yes, but I just don't have that option). The pictures give me the heebie jeebies and I'm not looking forward to tonight, but sometimes you just have to work really hard for something that you've wanted your whole life. As one of the boxes for the Menopur says . . .

Wonder what marketing genius came up with this packaging. Oh needles don't look nearly as scary when you put it that way!

Today, I'm still having intense abdominal cramping (like yesterday afternoon and evening) that I don't think is just from my period (the cramps keeps coming back and they woke me in the night). I suspect the hormones are contributing to the cramping (and that the Estrace made this a very heavy month as sources that I've read have reported). I feel tired, emotional, and irritable. I'm also feeling intermittently nauseous, I'm definitely  more bloated, and I have terrible headache. It's not as bad as it could be, but I can't imagine how I'll feel after another week to week and a half of these hormones. Stay tuned.

That damn stork better come soon, I'm sick of being smothered.