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05/27/2006
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:
- 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?)
- 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.
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Ha. Good to know I'm not the only one that has used a dirty needle (while visitin my parents, no less. My mother was apopleptic).
Important note - you really don't want to do it more than twice or you may as well use a dull butter knife. Good luck with the pharmacist!
That is so freakin' funny! I am that NEWBIE!! Not so much now but when I started that was me! And I still use alcohol swabs!
*grin* Thanks for giving me a brief glimpse of the near future... Waiting for my meds to arrive for our first IVF...
And don't worry: as soon as you tell your pharmacist you're on Lupron, he'll hand you all the needles he's got, and if you still don't leave he's probably gonna hand over the registry as well, without even a blink!
My twins are 6 months old, and I have yet to clean out my closet. (or fridge, for that matter, I still have Gonal in there...it may still be good if you want it)I have bags, and bags, of syringes. I was about to throw them out someday, honest, and the still full sharp container too, I just have been to busy either gestating, lactating, diaper changing, stroller pushing, baby rocking, and please-go-to-sleep-now-by-god binky pushing to get to it. I don't think I will ever cycle again, but if your post teaches me anything it's "never say never". I guess I have an excuse now to just throw the whole mess into a hefty bag and stash it in the far reaches of my closet, in case, you know, I need to inject a turkey with butter. I highly reccomend mail order drug companies. They were often short on the drugs, but they sent me a motherload of needles and a sharps container with every order...even estrogen patches and progesterone suppositories (go figure)
I'm serious about the Gonal. I just checked the expiration date, and it's April of 06. I have 3 of the multidose pens, no syringes needed. I hope it's not illegal for me to post this, but I'm giving it away, not selling it. At the very least a pen may be useful to have around in case you run out in the middle of the night.
The frantic phone call is actually a good thing. It makes the doc on call feel as though at least they are on call for a reason...even if it is to keep a drugged up infertile chick calm.
Here's hoping the pharmacy caves and you don't have to make the call ;)
Wow. That makes me wonder if I really really *really* want to do this. I admire your commitment.
Well it might not be fun, but it makes a funny blog post! Love all the links.
Good luck! I'm praying for a wonderful sibling for Charlie.
Oh shit - I've definitely been caught red - handed. Alcohol pads are definitely overrated; you have to take the time to wait for them to dry. Hope you found some needles today.
I think some cheetos are in order. Get the "natural" version, that way it doesn't feel so naughty when you eat the entire bag.
Ay ay ay, call yourself a vet. Pshaw!
PS I could send thousands of needles but by the time the pigeons arrive, I am sure you will have intimidated the pharmacist ;)
My diabetic husband reuses his needles all the time. But they are the really fine "pen" ones.
Love the post... only you could do such justice to a round of IVF!
Take care and good luck!
Good luck with your cycle!
If I lived anywhere near you, I'd swing by and drop off my two bags of syringes sitting unused in my closet. Hope you got what you needed!
You and I are iCal soul sisters! Except I use green for ivf related stuff. Fertile-y color, and all. Yeah, that has worked well, hasn't it?
Hope you don't have to use the needle more than once more, because wow does that supple belly skin dull a needle quickly.
Hahaha... Yeah, I totally did that exact same thing, too--the full dose of Lupron with stims?
Now, if we were on boards, I might be tempted to say "(pg ment)But it was okay! I totally got pregnant anyway!! It only takes one!!! Baybee dust!!!!" but we all know how well THAT turned out, so I do believe I shall refrain. Also, multiple exclamation points give me hives.
Plus, you just never know what they cut that baby dust with these days. I heard that a shipment came through LAX that had been mixed with fish meal, which resulted in eightyfive posts on the boards about whether or not shellfish was okay during the two week wait, and we certainly don't need to see that again.
Just love it julie-you call "a spade a spade"!
You take the mundine and boring qualities of a cycle away!Thanks for explaining why I felt so miserable on Lucrin-makes sense now.
Yes I am guilty-Im a veteran but confess to using the alcohol squares religously!
Like "pamplemouse"my diabetic husband reuses his insulin pen needles and bsl finger pricker needles and hasnt seen an alco square in years!
I suppose in the scheme of things "Dont sweat on the small stuff" xxx
Julie, I have an entire small bathroom (my "shooting gallery") still stocked from IVFs #1-7 (2001 - 2004) and am most happy to mail you anything you need. Too bad we don't live closer -- I'd drop stuff off to you!! Even looking at the syringes, etc. brings back the best and worst of memories . . . can't wait until definitive studies during our lifetime show just how "healthy" it's been to conceive in this manner.
The best of luck with your cycle. Hope the roller coaster ride is relatively easy and that Charlie's baby sibling is soon on his/her safe way to you!!!!
Stacey
Well, I guess if you get desperate, you could head out to a bad neighbourhood and do a needle exchange with one of the AIDS prevention groups that takes dirty needles and provides new ones to junkies. Or, you could clean one of the dirty needles according to "bleech kit" instructions.
Doesn't Charlie have any syringes in his toy bin? They come with those little doctor kits by Melissa & Doug.
No, but I could take him to McDonald's so he could dive for treasure...
(Needles procured after a tiresome lecture from the pharmacist. Thanks, all.)
I've never posted on your blog before, but I've been reading it and loving it for a long time. Good luck with your cycle!
I think I used the wipes maybe one of the 15 or so times we have done this, I finally had to start telling the pharmacist to leave them off the order. I have the worlds largest supply of alcohol wipes, now if I could just figure out what to do with them, you can only stock so many first aid kits.
oh dear - I've SO been there.
Crossing all for you, that it's a SHORT journey down the loopy lupron road for you this time...
(I guess chewing on the wipes for a quick high is right out?)
I am so laughing - but I am that newbie, I use the alcohol squares every single time, and I have my little kit all ready to go again in a couple of weeks! Thanks for making some of this funny - God knows we could all use a laugh!
Paula
Deana - I use those wipes all the time. I use them if I have a blemish coming on, if I have a hormonally induced oily t-zone, if my trackpad is gunked (technical term) up with hand oils or lotions, if my work computer (effing pc) has a sticky mouse ball, to clean off my nails after lotion, but before buffing, to remove sunscreen after a day out in the sun, to clean off my tivo remote.
I could go on, but I use them all the time. (Sadly, I still have a lifetime supply - but I wonder what I used before I had these handy things.)
Good luck with your cycle Brittney... erg... Julie.
My protocol involves not cutting back on the lupron, so I figure you're ok. I've managed to beg, borrow and steal enough needles, though. My clinic has them in a drawer and you can just walk in and help yourself. YOu're a long way from London, though...
The little wipes are great for cleaning under the keys on your laptop as well.
I had to beg for a syringe and needle with my last cycle for my trigger. With my horrible reaction to repronex that made my stomach look like one giant red welt, how could they deny me a tiny old syringe to shoot me up with some HCG? Good luck. My fingers are crossed for you.
I still have alcohol wipes, 14 YEARS post ivf, so you can imagine how many I got with each of my cycles. I find them excellent for cleaning thermometers when you have more than one sick person at home at a time, and as someone else mentioned, cleaning my oily t-zone during hot weather.
Done the dirty needle thing too. I think everyone has at least once.
Good luck on this cycle.
Wow. I am so impressed that you are doing this again, you're REALLY doing it again. A while ago I read way back into your archives to get the whole story. I'm not sure how to express how I feel for you...but I'm on the edge of my seat. Here's wishing you a much easier experience than last time.
How fun to have you, er, back in the game.
Or, you could've taken a nice day trip to NYS, where, I believe, it is legal to buy needles in the drug store without a script...at least in the county I live in.
Oh my goodness - I am the newbie you described! Can I tell you how my husband and I argued on the night of my trigger shot? I wanted him to read the directions BEFORE, he wanted to do read them as he went along. I was so careful (read: anal) about every step of my first IVF cycle. I hear that alot of women are like this the first time, though. I had four embryos transferred this past Sat 5/27. I think I'm going to drive myself batty before my b/w test on 6/8!
I wish you much luck this cycle! I have added this blog to my daily reading =)
I'm with you about the Tylenol...had some midcycle bleeding, much heavier than ovulation spotting, for several months. Not wanting to screw the "real" period up, I stuck to extra-strength Tylenol. Extra-strength! I might as well have taken lemon drops. Totally, utterly worthless.
Wow Julie, reading that makes me very relieved that I was able to conceive just by being in the same room with my husband. My cousin however had to try for almost 3 years and she's due in 4 weeks. Keep your chin up, it will happen. I'll send happy, fertile thoughts your way.
Um...going off on a tangent here, but Julie, do you know what's up with Karen (Naked Ovary)? Her blog's gone and I'm worried, and I think I remember that you know her.
Yeah, I'm wondering about the Naked Ovary too, and don't know where else to ask!
re: The Naked Ovary- when you get the message about the page cannot be found, click on the link to her blog. There is a message from Karen explaining why she is closing shop for a bit. Hopefully it is temporary.
Julie, I hope things go well for you.
(((hugs))) Hopefully things are improving...
In the mid-west we have farm and home supply stores. Get meds and syringes for the dog all the time.
Julie;
I love your blog, and truly admire you for going thru this all over again.
I just wanted to drop a quick line about the Tylenol. I completely understand where you are coming from! I always thought Tylenol were the worst thing ever-totally useless- that is until dear hubby accidentally bought some recently for my horrible cramps. They have a new kind out-Rapid Release gel caps...these things are heaven sent!!! They are definately worth a try.
Jill,
Thanks. It took me a minute to figure your directions out -- I'm a Firefox user, what you suggested doesn't work there, works fine in Explorer. So anyone else concerned as I was can do the same.
But the punchline is someone [the blogger] knows IRL has been reading her blog and is upset about/with her and contacted her via the blog about this, and she (blogger) is trying to figure out what to do. Ack.
You are so lucky. I starded with you and I am on my IVF#7!!!!!!! And today just got that I am not pregnant. I know, I am an asshole. However there is nobody in this world that can undrestand me. Good for you. As I said, you are lucky.
Been there.. except it was Hubby who was thoughtfully giving me too much Lupron (for an unknown number of DAYS)!!! I looked at the syringe and screemed.. HOW LONG HAVE YOU BEEN DOING THIS?! As usual, the dogs ran under the table.. He looked at me blankly and said something utterly stupid.. I think it was "I'm sorry"... but i can't be sure because i was too busy searching for a large kitchen knife! For a brief second I conviced myself I couldn't get convicted!... Yea.. Your Honor, it was the medications that drove her to it! But... Upon seeing his trembling hands and the color run from his face...he lives another day.
Does anybody know what happened to the Naked Ovary? :-(
oops, sorry just saw above post. Come back, Ovary, come back!
Please ladies, and I repeat please! DON'T eat those tylenol or naproxen tablets! I am a scientist by training and I read about tylenol cos my wife is undergoing the treatment.
tylenol is a COX-2 inhibitor. It inhibits this enzyme which produces very important molecules necessary for implantation. Many doctors who are not trained or don't update themselves, including our doctor, don't know this. So unless you are crying in pain, don't even think about this. Low-dose asprin doesn't do this inhibition but high dose can do this.
http://www.ncbi.nlm.nih.gov/pubmed/17965253?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/19060098?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed