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Oops, I did it again

I will say in my defense that it's been more than two years since I did this last.  It's my only excuse for making stupid mistakes.  I've done this four times, for crying out loud; I'm practically a professional.

Last night I started injecting gonadotropins for our upcoming IVF cycle.  For those of you unfamiliar with the drug regimen for IVF, I'll explain the long Lupron protocol, the only one I've ever used:

Inject tiny daily doses of Lupron, a drug that ruthlessly stomps your ovaries into silence.  (If you're lucky, it also kicks the shit out of your cranium, resulting in a blinding headache, absentmindedness, and a tendency to set fire to abandoned tenement buildings for the insurance money.)  These injections continue for at least seven days before the real fun begins.

Shed your uterine lining in what may or may not seem to be a normal period.  In my case, it is decidedly not normal; for me, a normal period means six ibuprofen every six hours.  (I like to string them on elastic thread like a candy necklace and wear them to bed for midnight snacking.)  But when you're preparing for IVF, Tylenol is the only medication you can take; I find them so ineffectual that I hardly even bother.

Have your baseline bloodwork and ultrasound.  Your E2 (estradiol) is checked to determine whether your hormone levels are adequately suppressed, and your ovaries are examined to make sure no unauthorized activity is taking place.  At my clinic, they expect E2 to be below 100, and for no worrisome ovarian cysts or follicle development to be occurring.  (My E2 was a well-behaved 14 on Wednesday.  "Well, whaddya know," said Julia, "my E2 was 14 before IVF, too!  Congratulations!  You're practically pregnant already!"  I don't know what else she said, because I had to dash out to Babies R Us to begin restocking the nursery.)

Start gonadotropin injections, colloquially known as stims.  You'll be injecting either pure FSH (follicle stimulating hormone) or a combination of FSH and LH (luteinizing hormone), with the dose dictated by either your weight, age, hormone levels, past performance, astrological forecasting, or a careful topographical analysis of the lumps on your head.

When you begin stims, you are to continue your Lupron injections.  However, you're supposed to reduce the dose by half, going from a tiny daily dose to a teeny-weeny daily dose.  Theoretically this will allow follicles to develop while also preventing early ovulation.

Last night I forgot I was supposed to cut the dose in half.  As I shoved the plunger I remembered.  Now, there are two differences between a newbie and a veteran:

  1. A newbie wouldn't have forgotten in the first place.  She would have her instructions in front of her, reading them carefully, moving her lips reverently, as she went through the nightly ritual.  She might even have noted her instructions on her calendar, synching it to her Palm Pilot for daily reminders. (Believe me, I say this with love.  I even used to use those alcohol swabs.  Cute, huh?)

  2. If a newbie had made this mistake, she might have experienced a flare of palm-sweating panic, making a frantic 9-o'clock-on-the-Friday-of-a-holiday-weekend call to the doctor on duty, asking what she should do, demanding reassurance that her cycle wasn't irrevocably doomed to failure.  A veteran, on the other hand, would have shrugged, pulled up her pants, and figured that if the cycle were bound to fail, it would probably be for reasons more spectacular than a single botched dose.  (And then have had an interminable night of terrible dreams of death and loss, but that would be completely unrelated.)

I made another mistake a newbie never would have made.  It is common practice to open one's first shipment of medication with a certain degree of eagerness and wonder, counting the amps, polishing the sharps container with a soft cloth until it gleams, arranging the syringes into a spare but lovely attitude worthy of an ikebana master.  But this time my medication arrived while I was out of town, so Paul helpfully stashed it in the cool of the basement, and I didn't even look at it before it was time to do my injections last night.  Not the best time to discover that I had everything I needed but syringes.

We searched the house from top to bottom, but we searched in vain; apparently no syringes were sent with my order.  But all was not lost.  In the linen closet I found a bag of supplies I hadn't thrown out.  In it there was still a single unopened syringe, complete with mixing needle.

But that doesn't help for tonight, or for the next few nights of the holiday weekend.  I'm going downtown this morning, fertility drugs in hand to show that I have a legitimate use for 21-gauge needles, and will throw myself on the mercy of the pharmacist.  If that doesn't work, I'm resigned to having to make that frantic phone call to the doctor on duty, after all. Either that or re-use the syringe.  Wouldn't be the first time I'd used a dirty needle.  Which makes me think maybe I'm not such a professional after all.