Trigger Shot, Acupuncture, and Waiting for the Egg Retrieval

Last night at exactly 10:45 PM, I injected myself with Pregnyl, which was prescribed as my "trigger shot." My egg retrieval is scheduled for 9:45 AM tomorrow at the Victoria Fertility Centre, exactly 35 hours after the trigger shot (Dr Hudson will be performing the procedure). Timing is crucial with this process. If the timing is off, the eggs won't be ready or they may burst forth from the ovaries and therefore cannot be retrieved via aspiration and used for IVF.

Pregnyl and other "trigger shots" like it, contain human chorionic gonadotropin (hCG). It is made from the urine of pregnant women (most of these "trigger shots" are.) It is used instead of luteinizing hormone for the final maturation of follicles and to induce ovulation. Ovulation will happen 38 to 40 hours after an injection of hCG when there are one or more mature ovarian follicles. In IVF, the shot is given and the egg retrieval (oocycte retrieval) is scheduled to happen 34-36 hours after the injection, just hours before the eggs would burst forth from the ovary (instead of ovulation, a giant needle aspirates the eggs from the ovary through the walls of the vagina).

Now with pastel colours that make you feel soothed even though you're giving yourself an injection!

Naturally, Pregnyl has some terrifying possible side effects listed like allergic reaction, blood clots, and the dreaded Ovarian Hyperstimulation Syndrome (OHSS- hisssssssssss I sound like a serpent, so you don't want to come down with me). The less extreme and more common side effects are mild swelling or water weight gain, feeling restless or irritable, depression, headache, breast tenderness or swelling, and/or irritation, pain, or swelling at the injection site. Some people get a large, raised red area around the injection site.

There are the many things that you need including the box of medication, a syringe, two different syringe tips- one for mixing and one for injecting, an alcohol swab, and of course your trusty old sharps box. Mine is almost full.

Pastels clash with syringes in my opinion.

Once the box is open, it holds an insert and two glass vials. One is liquid dilutant, the other is the medication in powder form.

Pregnyl requires some mixing like Menopur or Cetrotide (this is old hat for me now). A syringe is connected to a mixing syringe tip (really thick and scary looking). An email from the clinic told me how much of the mixing fluid to draw up into the syringe, 1.5 cc. After drawing the fluid up, I withdrew the syringe and then plunged the syringe tip into the top of the bottle with the powder in it (this is the hCG). All the fluid is injected into this bottle and gently rolled around to mix it. The difficult part came with withdrawing all of the mixed fluid out of the bottle. Unlike Cetrotide or Menopur where the needle can easily reach the bottom of the bottle and suck up the last bits of fluid, the bottle for Pregnyl is bigger, so it must be tipped upside down and angled to try to withdraw the last bit of fluid. Despite having started early to mix everything, so I'd be ready to inject at exactly the given time, I had a bit of difficulty getting the last bit of medication out and it took more than one try. It was pressure that I didn't need when I was already feeling stressed out. They should really improve their packaging (for more rants on packaging and overpackaging see my blog Overpackaging, et cetera).

A box of Pregnyl has two glass vials, one is liquid dilutant, the other is the medication in powder form.

The dilutant is sucked into the syringe.

The dilutant is emptied from the syringe into the vial of powder and then this is mixed and sucked back into the syringe to prepare for the injection.

So, as directed, at exactly 10:45 PM, I injected myself with Pregnyl. The injection did not hurt any worse than my other injections via syringe (Cetrotide, Menopur- naturally Gonal F used to hurt somewhat less, because it was in pen form with a very, very fine syringe tip). That was the only injection I had to give myself last night (before it was two per night and one in the morning, so this is an improvement).

Air out of the syringe, it's ready to be injected.

The Pregnyl is injected into the abdomen like the other hormones.

I went to bed after and had a ho hum sleep again. I woke up a few times again, had night sweats again, vivid and weird dreams, and woke up in the morning unable to sleep longer (I was going to try to catch up on some of sleep I've lost the last few days getting up early to go to the Victoria Fertility Centre, but no luck).

This morning, I took my Dexamethasone tablets and started Doxycycline with my breakfast as directed. I was definitely more swollen, especially in the abdominal area. But this means that things are working the way they are supposed to be. So that's good. Besides, a cashmere sweat suit is pretty forgiving to lounge in.

Doxycycline is an antibiotic that I have been put on to prevent infection during the egg retrieval and embryo transfer process. I will finish taking the course of Doxycycline on the night after the embryo transfer. It is supposed to be hard on the stomach (like Dexamethasone) and should be taken with food. Naturally, as with any drug, there is a list of horrifying things that could go wrong including allergic reactions, jaundice, blurred vision, and severe skin reactions, but those are not common. More common and less extreme side effects of Doxycycline are upset stomach (reduce this by taking with a meal), mild diarrhea, mild nausea, vaginal itching or discharge, and mild skin rash or itching.

Robin's egg blue pills are so pretty (until they cause side effects like diarrhea).

I cleaned the house a bit and wrote this morning, before getting ready to go to acupuncture at 12:15 PM. I was not feeling quite as terrible today as I thought that I would be after the Pregnyl (and the warning about side effects that Dr. Hudson had given me with it). In the shower, I discovered a giant bruise on my right lower abdomen, about three to four inches under the injection site of the Pregnyl. The bruise is about one inch by two inches and very blue. I wondered if this was something to be worried about and emailed the clinic. The site of the injection had no red marks or anything though as some people get, so it was curious. One of the nurses told me that this can happen with Pregnyl injections (bruising) and it's probably nothing to worry about, but they'll look at it tomorrow.

For an idea of the size of the bruise on my lower abdomen, I put a quarter next to it. It's pretty big.

Today, I drove myself to acupuncture and arrived about fifteen minutes early. I had a cup of the complementary Silk Road tea while I waited. The waiting room at Elements of Health Centre is a very calm environment and puts one instantly at ease. I went to the washroom just before (but this wasn't good enough- I've had to go pee a lot with the hormones and my session ran slightly over an hour and I was ready to die by the end of it, having to go to the pee really badly again) my session commenced.

No makeup and you can really see how exhausted I am from this whole process. It definitely takes a toll on the body and mind.

My acupuncturist, Stephanie, wondered if she could have given me the bruise on my lower abdomen, but I didn't have it yesterday, so I'm pretty sure that it was the Pregnyl injection last night (and it's on the same side as the Pregnyl injection). Stephanie is very calm, warm, and reassuring. She put needles into my forehead, stomach and abdomen, wrists, lower legs, and feet and left me to meditate in the warm and darkened room. I feel that the meditation and stress reduction/ relaxation component alone with acupuncture would be beneficial to anyone going through fertility treatments which inherently cause or contribute some kind of stress or several kinds of stress to people's lives. I felt rather drowsy and relaxed after my session (and after I had gone pee!).

The treatment bed is very comfortable with nice sheets. The room is warm and darkened and quiet when the needles are doing their work. It's a good opportunity to check in with yourself mentally, meditate, breathe, and prepare for the next big step in this very complicated process.

After the session, I asked Stephanie if the egg retrieval hurts a lot. She told me that she had had it done twice. She said that it was definitely uncomfortable, but strangely one time was much more tender than the other time even though it was the same doctor performing the procedure, Dr. Hudson. She said that some women are able to work the next day, but most need to rest. She also told me that they give you some "good stuff" and that while you're awake for the procedure, you're kind of in and out. I felt comforted being able to talk to someone who has actually been through this procedure before (more than once even). This unexplained infertility journey has been kind of lonely road.

When I find out when my embryo transfer will be, I can either go onto the website of Elements of Health Centre or call to book an appointment two to three days after the transfer. Thereafter, until the blood test to determine if the embryo has implanted or not, I will be visiting the clinic once a week for acupuncture to support my body in the IVF process.

I am noticing that the terrible headache that I've been suffering from for weeks is plaguing me again this afternoon (I didn't really have it this morning, which I attribute to not taking Cetrotide). I am bloated and somewhat crampy in the abdomen with some gastrointestinal distress, but not as much as before. As mentioned, I'm bloated, especially abdominally, but as I've stated before, the hormones have also led to swelling in my breasts. I'm somewhat irritable today, but not as bad as previous days, but I'm unclear as to if this is because I've rested at home most of the day or if it's the discontinuation of the three different hormonal injections that I was on. But all in all, so far Pregnyl doesn't seem as extreme as I thought that it would be. My lower back, around my ovaries continues to get more uncomfortable every day and night (the follicles and ovaries are swelling to far larger than their normal size). I do feel restless, but I can't attribute this to medication completely. I think that I'm just uncomfortable and I really want to get this over with.

Tonight, after midnight, I can't eat or drink anything due to being put under anaesthetic tomorrow morning for the egg retrieval (that should make for a fun morning- snaaaaarrrrrlllll!). I will take my thyroid medications and stomach pill tomorrow morning with sips of water, but the Dexamethasone and Doxycycline and vitamins will be skipped, since they are so hard on an empty stomach.

Tomorrow morning, my husband and I must be at the Victoria Fertility Centre at 8:45 AM for my 9:45 AM egg retrieval with Dr. Hudson (and my husband will provide a specimen just after that, so that they can do their magic at the clinic, hopefully creating embryos by mixing his semen with my eggs in vitro and by injecting a single sperm into an egg with the other half of my eggs- ICSI).

I am supposed to show up to the Victoria Fertility Centre not wearing any body lotion or any scented products at all (bad for eggs/embryos). I will be administered IV sedation (that's why I can't drive for 24 hours after the procedure and must have someone to watch me for 24 after, just in case). They recommend that you wear comfortable clothing and bring a pair of WARM socks with you (their emphasis, not mine). I can only imagine that the warm socks are to wear during the procedure, since surgery rooms are always freezing cold and I'll only be a hospital gown. Strangely, they also said that I could bring an iPod with me to listen to during the procedure (what is this, 2005?). 

Yesterday, I emailed the nurse coordinator to remind her that I have pseudocholinesterase deficiency, so I can’t be given Mivacurium or Succinylcholine for anaesthetic  (there are some other things that can't be used either). Usually these things are not used anymore, they're kind of old school muscle relaxants used in the anaesthetic process, but every once in a while they pop up (like the time they used one of them on me in 2003 during a surgery and then couldn't wake me up for about 12 hours after I was supposed to wake up- on a ventilator the patient is fine, but without it, they will likely die as the patient cannot process the offending drugs and it leads to prolonged and marked muscle weakness, inability to breathe). This condition is very, very, very rare and most people don't even know that they have it (unless they suddenly find themselves in surgery and the wrong stuff is used). In all of Canada, with the incidence rates listed, only about 700-11,000 people would have it (though most probably don't know they have it). Anyways, it always makes for an interesting conversation with the anaesthesiologist whenever I have a surgery (I'm like some sort of a mythical creature to them- something they studied at school, but have usually never encountered).

My husband has been very tender towards me through this taxing and distressing journey. The other night, he brought me home a beautiful black tea from Silk Road Tea with two adorable fox cups to drink it from. Tonight, he surprised me with a gorgeous bouquet of alstroemeria and sunflowers with some chocolate. I know that he's found it difficult focusing on work while he's at the office, as I have found it difficult to write and edit my work from home. We're both so preoccupied with this process so pivotal to our future. It is truly all consuming. While the Unexplained Infertility journey has been exceedingly difficult, we're lucky to have strong communication and a bond forged over almost ten years of being together. This trial has only brought us closer.

We both love foxes. They remind us of the Shinto shrines that we visited together all over Japan.

I love sunflowers and my husband brought me home this bouquet tonight.

It's impossible not to feel nervous about tomorrow (how much is this going to hurt, will they aspirate the eggs in time, will the eggs be at a good level of maturity, will there be any good quality eggs, will the semen sample be useable, will they be able to make any embryos, will any embryos survive, will any of the embryos be good enough quality to transfer back into me, will my blood work show that I am able to have a live transfer or will I have to have the embryo frozen and then transferred into me next cycle instead?). I'm trying to remain as calm as I can, breathe, meditate, distract, be gentle with myself, but in the back of my mind, the odds are still there. On average, the percentages quoted for success at any one IVF cycle are 33% to 50% for implantation (then for my age there is the 20-25% chance of miscarriage after that). I know that we've done everything that we could and that we're in good hands, but it's really hard to not be in control of your life. That is one of the most frustrating and upsetting parts of Unexplained Infertility.

The cat knows we're stressed out and not feeling well and has been spreading his purring therapy around. Last night he fell asleep on my husband's shoulder.